Correspondence

Patient safety and acute care in the independent sector

Published 8 May 2018

I am sure you will have read the recent CQC report on the state of care in independent acute hospitals. Urgent action is needed in response.

The NHS has been on a long and hard journey to transform the safety and quality of care in the wake of Mid Staffs, and has now been ranked the safest health system in the world. The CQC report suggests that there is a real risk this progress is not being matched by equally high standards in parts of the independent sector. Given that the sector employs many NHS consultants who have benefited from NHS training, relies on the NHS as a safety net for emergency care, and holds a number of NHS contracts, a situation where it is potentially letting down patients on safety and quality is unacceptable. As such, I am seeking your co-operation on a number of vital safety and quality issues:

1. Where an NHS trust is rated ‘inadequate’, we take rapid enforcement action, including special measures, leadership changes and extra oversight. We have a duty of care to all patients - whether NHS, self-pay or insured - so we will also look at what similarly robust action could be taken to ensure rapid improvement from private providers offering inadequate care.

2. We need much greater transparency from your sector. From the publication of surgical outcomes by clinician to the publication of avoidable deaths by hospital trust, the NHS is leading the world on transparency, and I am disappointed by the variation in voluntary progress to address the disparity of information on standards in private settings. I am aware of the positive impact that the Private Healthcare Information Network is starting to have, but I believe the Independent Sector needs to move much faster to achieve alignment with NHS standards. I would like specific assurances that every provider is submitting comprehensive data sets to PHIN, and we will explore whether the reporting requirements need to be strengthened to make them comparable with the NHS.

3. As you will be aware, in cases of proven negligence, the NHS is able to claim back costs from the negligent party. However, I am not convinced that in those cases where the NHS is obliged to deal with the consequences of negligent care from the Independent Sector that NHS hospitals are getting fair remuneration. I have asked my officials to develop proposals to ensure that where NHS organisations bear the costs of negligence, they are better able to secure payment that reflects actual costs from your sector.

4. Critical care and transfers to the NHS. The CQC’s finding that many private providers lack appropriate escalation processes or transfer agreements is unacceptable. This has been brought into sharp focus again with the case of Peter O’Donnell - on which I received a disturbing report from the Manchester West Coroner. All healthcare providers dealing with more routine procedures need to have clear processes for managing deterioration and for escalation.

5. The case of Ian Paterson has highlighted the issue of consultants with practising privileges effectively acting without proper monitoring of their work or standards as they are technically not employees. More broadly, CQC identified a lack of formalised governance procedures, meaning that hospitals were not effectively monitoring the work of consultants, and when something goes wrong the private hospital provider is able to point to the fact they were not an employee and thereby avoid liability.

6. Apprenticeships. We would like to see your sector making a meaningful contribution to the government’s apprenticeship program where organisations meet the turnover and other thresholds, and would be grateful for an update on your work in this area.

Like many of my predecessors on both sides of the political divide, I believe that the independent sector can play a useful role in adding capacity, promoting innovation and offering patients choice. However, if the sector is to partner with the NHS and benefit from our world-leading medical training, we need urgent assurances that you will get your house in order on safety, as well as a commitment to take rapid action to match the NHS’s world-recognised progress on transparency. I would therefore ask you to provide a response to this letter - with clear actions set out - within 2 weeks.