Comment

04.06.19

Independent sector and NHS must meet the same standards of care

Source: NHE May/June 2019

Professor Derek Alderson, president of the Royal College of Surgeons (RCS), outlines how and why the independent sector must meet the same standards of care as the National Health Service.

Like so many of my colleagues, I was deeply shocked by the behaviour of breast surgeon Ian Paterson. He was a rogue surgeon who misled and abused the trust of patients. While the vast majority of doctors perform their work to a high standard with the utmost care for their patients in both the NHS and independent sector, the case of Ian Paterson highlights the need for an urgent review of how we assure safety standards in the independent sector. 

This is why the RCS has called for independent hospitals to collect and publish equivalent data to that which the NHS routinely provides. While progress has undoubtedly been made, there is still work to be done to create the regulatory alignment that is needed to bring independent sector hospitals’ reporting requirements in line with the NHS.

Although the independent sector is required to report data around unexpected deaths, never events and serious injuries directly to the Care Quality Commission (CQC), the data is not routinely published by the CQC. This must change so that patients can be assured that the independent sector is meeting the same standards as the NHS.

There is also an issue in that the independent sector does not have a data set equivalent to Hospital Episode Statistics that detail how many and what procedures have happened in the NHS. Discussions are taking place between the Private Healthcare Information Network (PHIN) and NHS Digital to allow independent sector data to be included in these statistics.

Clinical audits are a valuable tool to ensure healthcare is being provided in line with standards and to improve the quality of care. However, the independent sector has not been able to contribute to the majority of national clinical audits, including cancer audits, despite the fact that many independent providers regularly offer cancer treatments. The RCS has been working with the Healthcare Quality Improvement Partnership (HQIP) and the Independent Healthcare Providers Network (IHPN) to review which existing national audits the independent sector can contribute to, as well as the barriers that need to be overcome.

The National Joint Registry (NJR) is one example of an audit that the independent sector can already contribute to. The NJR is funded by subscriptions paid by NHS hospitals, private hospitals and clinics implanting prostheses, as well as by implant manufacturers. HQIP and IHPN plan to explore how the NJR works in the independent sector and pilot independent sector involvement in the cataract, breast cancer and possibly prostate cancer audits. 

We also need more robust clinical governance procedures in the independent sector to monitor consultants’ practising privileges and scope of practice, and to better share information about consultants’ performance between the NHS and independent sectors, particularly for the purposes of appraisal and revalidation.

A single dataset or repository about a consultant’s practising privileges, indemnity cover, scope of practice, the identity of their responsible officer and their appraisal status should be accessible to all independent and NHS hospitals where they work to enable prompt action in response to concerns about a doctor’s performance. 

From the work we have done over the last year, it is clear that the will to change how the independent sector collects and reports data is there. We must now push forward to ensure the required changes happen. 

We owe it to the victims of Ian Paterson, and patients that follow, to make sure the same high standards of care and governance apply regardless of where a patient is treated.

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