Is the NHS funding crisis opening the door to poorly regulated private hospitals?

Jeremy Hunt is crying crocodile tears on patient safety - squeezing patients out of the NHS and towards private hospitals that are a 'black hole' of information.

Paul Hobday
16 November 2015

Jeremy Hunt never misses an opportunity to mention patient safety in the NHS, but rarely, if ever, has he turned his attention to private hospitals. Surely all patients should know what risks they are taking?

Private hospitals admit patients each year for at least 1.61 million surgical procedures. A quarter are funded by the taxpayer (ie the NHS), and 28% of private hospital income now comes from treating NHS patients paid for by the taxpayer.

CQC inspections have resulted in 13 NHS hospitals being placed in special measures. Why aren’t private hospitals subject to the same scrutiny?

Private hospitals do have CQC inspections, but vital information is lacking – as we’ll see shortly.  

I was a GP in Kent for 30 years and had patients die in local private hospitals. These tragedies never leave the memory banks, especially the fit man who died after a simple nose operation as the hospital had no resuscitation team, or the lady who bled to death after a routine hysterectomy.

So in Hunt’s new world of “transparency” I thought I’d gather some data from the 13 facilities in my county.

I thought it reasonable for “consumers” to know what sort, and how many operations were performed and paid for by the taxpayer. To know the level of staffing, including out-of-hours. To know the rate of complications, and how many patients needed transfer to NHS hospitals. Altogether I asked 11 questions, still nowhere near the detail required of NHS facilities.

The results are less than impressive. 9 hospitals eventually responded and 4 have ignored repeated reminders.

None of the hospitals answered any of the questions I posed directly.

Two hospitals stated “we have no obligation to provide information”. One refused to answer on the grounds of “commercial confidentiality”. Five suggested contacting the CQC or commissioners. One told me they would look into the request but warned a fee may be payable. Nothing has been heard since.

Would you tolerate responses like these from NHS hospitals, Mr Hunt?

The Centre for Health and Public Interest (CHPI) did manage to find out, through a Freedom of Information request, that between October 2010 and April 2014 802 unexpected deaths and 921 serious injuries were reported by private hospitals. But it’s hard to know how concerned we should be. CHPI states that “the Information that is available is significantly less comprehensive than that which is available for NHS hospitals”.

They also discovered that about 6000 patients each year are transferred from private to NHS hospitals to treat complications. And this is amongst a caseload cherry-picked by private providers to be low-risk.

Dr Foster suggests, there is a ‘black hole of information in the private sector’, with information either not collected, or not shared outside the hospital.

The Competition and Markets Authority found recently that data available on the performance of private hospitals for patients was “poor”.

And the CQC agrees too – testifying recently that “The CQC has stated that it “currently has access to relatively little information that relates to private healthcare”.

What data there is, is mostly collated and published by the private healthcare industry itself (the Private Hospitals information Network), rather than by an independent body.

It’s worth remembering the words of the Francis report: “It is particularly important that information should be available from unimpeachably independent and reliable sources”.

Private hospitals do have to report rather more data on the NHS patients they treat than on their privately funded patients, but Dr Foster says “the data on those small cohorts alone is not enough to offer a true picture of quality. To achieve this, we need to be able to see all the patients treated to enable a fully comprehensive comparison.”

So NHS-funded patients in private hospitals aren’t able to get a true picture of the relative risks involved.

And these risks may be considerable.

The CMA’s report shows that many private hospitals do not have intensive care beds. The Royal Colleges have pointed out that post-operative care is normally the immediate responsibility of relatively junior resident medical officers. Often there is no dedicated resuscitation team - as my patient found out to his cost.

CHPI highlight how the limited information that IS available suggests a worryingly high proportion of private hospitals have poor record keeping and questionable clinical governance.

Nor are private hospitals subject to the Freedom of Information Act - and unlike NHS trusts, they do not have to publish their Board papers.

Jeremy Hunt talks of patient safety but his serious underfunding of healthcare and drive to privatised provision is putting patients at risk.

There is even now a “Hunt effect”, according to the British Medical Journal. Believing Hunt’s distortions about weekend safety and the lack of doctors, seriously ill patients have been scared into waiting til Monday before presenting at hospital. Many have suffered unnecessarily, and there have even been two deaths, according to the BMJ.

Hunt has been reported for allegedly breaching the ministerial code of conduct by misleading MPs about week-end safety..  He is accused of misrepresenting official statistics to help justify a dangerous contract he wants to force on hard-working junior doctors. By doing this he has forfeited any right to be taken seriously on patient safety.

Jeremy Hunt mentions ‘Mid Staffs’ just about every time he’s asked an NHS question in parliament. But he’s been quietly abandoning many of the key recommendations in the Francis report into that tragedy – and he has never admitted that a significant part of the reason for it, as the report said, was the corporate and competitive mentality (and consequent lack of openness) forced on both management and clinical staff.

There are clear double standards operating here to help the Government in its pursuit of shifting more work to the private sector. Any NHS hospital is now put under the microscope by the CQC to find as much fault as possible.

Often the problems are simply the result of underfunding—a conclusion all the staff at the hospital could have told the CQC before it turned up and cost everyone hundreds of thousands of pounds.

Meanwhile, as overstretched and underfunded NHS hospitals are increasingly forced to cancel operations, a lot of taxpayers’ money is now being diverted from the NHS to these private hospitals.

It is vitally important that this sector is subject to the same scrutiny as NHS providers of care. Such a genuine level playing field is essential for ensuring the highest standards of care and patient safety.

Spare us the crocodile tears about patient safety, Mr Hunt. Patients have a right to know what risks they are taking whether NHS patients diverted into private facilities or simply paying themselves. If the full data were know I think the public would be shocked.

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