Health Service Focus

22.10.19

Policing the private hospital sector

Source: NHE: Sep/Oct 19

David Rowland, director of the Centre for Health and the Public Interest (CHPI), argues that in order to protect patients, the Ian Paterson Inquiry must address the inherent risks in the private hospital sector’s business model.

If you were told before you boarded a plane that the airline did not accept any liability for the actions of the pilot would you still get on board? 

Probably not. 

Yet the denial of liability for the competence of consultants working in private hospitals is a key part of the UK private hospital business model, although patients are not told this before they consent to treatment. 

The 750 women who were deliberately harmed by the breast surgeon Ian Paterson found this out when they sought redress and compensation against the hospitals where Paterson treated them. 

In fact the company which owned the hospitals where Paterson worked told one of the patients he had harmed that they had been under no legal obligation to provide her with a competent breast surgeon. 

The reason for this is that consultants who work in private hospitals are mostly NHS consultants freelancing in private hospitals in their spare time.  They are not employed directly by the private hospital where they bring their patients for treatment. 

Even though the private hospital company ultimately settled the compensation claim for £27m, the question of a private hospital's liability for the actions of the consultants who treat patients in their facilities is one of the many issues which the formal Inquiry into Ian Paterson must address. 

The Inquiry must also look at the private hospital business model which relies heavily on the NHS to deal with the consequences of mistakes or errors which happen in private hospitals. 

In the event that something goes wrong in a private hospital, patients are transferred to the NHS to be looked after, but the private hospital isn't charged for this service by the NHS. 

Our research shows that on average 7,000 private patients are transferred to public hospitals each year which, in effect, saves the private hospital sector around £80m in costs. Put simply, if the private hospital sector does not bear the full cost of its errors or liability for the incompetence of its consultants, what incentives does it have to avoid them in the first place? 

The lack of corrective incentives in the private hospital business model is made worse by the existence of strong financial incentives which means that there could sometimes be good financial reasons for a private hospital to turn a blind eye to the failings or poor practice of an individual consultant. 

This is because it is the consultant who brings the business to the hospital in the form of their patients. A consultant practising privately in London is worth on average £380k a year to a private hospital, with some consultants bringing in patient income worth millions.

It is hardly surprising then that the CQC found the consultant is often treated as the main "customer" of a private hospital company, and it is perhaps inevitable that private hospitals will be wary of monitoring or regulating their consultant workforce for fear of pushing them into the arms of their competitors. 

A consultant who is not given the freedom by a private hospital to practise in the way that they choose can easily take their business and their patients elsewhere. 

The inquiry into the actions of Ian Paterson is expected to report before the end of the year, after hearing testimony from over a hundred of Paterson's patients. 

We have argued in our submission to the Inquiry that it must address the private hospital sector’s refusal to accept full liability for the work of the freelancing consultants that takes place in their facilities and also the strength of the financial incentives within the private hospital business model which weigh heavily against the best interests of patients. 

If it doesn’t, the Inquiry will not produce a set of recommendations which will protect patients or prevent another consultant like Ian Paterson from harming hundreds of people.

For More Information

Tw: @CHPIthinktank

W: www.chpi.org.uk

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