In February 1999 Mrs Laura Touche, the wife of an American lawyer in London, died of a brain haemorrhage after giving birth to twins by caesarean section at the private Portland Hospital in London, the favoured choice for maternity care of the Royal Family and many celebrities. It emerged that unlike NHS hospitals, the Portland had no protocol requiring patients’ vital signs to be checked at frequent specified intervals following a delivery. Although complaining of a headache Mrs Touche was not checked for two and a half hours, by which time it was too late.
In the UK maternal deaths directly due to pregnancy are extremely rare – around five in 100,000 live births. A coroner’s jury found that neglect had contributed to Laura Touche’s death. Her husband Peter Touche said the facts disclosed at the inquesthad convinced him that his wife’s death was ‘completely avoidable’. He added: ‘This all took place in a private hospital at the end of the 20th century. I understand that the Government is now contracting out NHS operations to the private sector. The NHS is opening up and publishing statistics. So should the private sector. The irony is that often, as in Laura's case, a patient is transferred to an NHS bed and so the death is registered at the NHS hospital.’
And it is not just deaths that are a cause of concern. Serious incidents short of death can be devastating too. For example over the past year no fewer than three patients at one private hospital in Southend had the wrong joints replaced – ‘never events’, in NHS parlance.
The key lesson from all such cases was actually drawn in 2002 by George Osborne, then a backbench MP. Referring to the Touche tragedy he moved a private members’ Bill ‘to require private hospitals to publish independently audited information on clinical performance and on complaints from patients on the same basis as that required of NHS hospitals.’ He pointed out that:
Unless the hospital volunteers the information, it is impossible to know how many deaths occur within 30 days of surgery or how many emergency readmissions take place, yet information of that kind is now freely available in the NHS. Although private hospitals now need to have a proper complaints procedure, there seems to be no requirement for them to publish complaints in the same detail. Other prospective patients therefore cannot judge the hospital's record for themselves.
But as a new report by the Centre for Health and the Public Interest points out, this information is still not available. Sir Robert Francis reporting on Mid Staffs, Sir Bruce Keogh reporting on 14 NHS trusts, the American Don Berwick reporting on the safety of NHS patients in general, and more recently Jeremy Hunt, all stress the importance of openness. But what George Osborne called ‘an endemic culture of secrecy in many private hospitals’ persists. There were 1.6 million admissions to private hospitals for surgery last year, including some 420,000 funded by the NHS; yet none of the patients involved had any means of knowing whether the hospital they were going to had a better or worse than average patient safety record, or how it compared with their local NHS hospital.
Suppose you need a hip replacement. The NHS Choices website shows all the hospitals in your area, including private hospitals, which as an NHS patient you now have the right to choose. Since Jeremy Hunt’s recent patient safety drive, for every NHS hospital you can now see, besides a users’ rating, the number of hip replacement operations it does, the average length of stay in hospital, whether the mortality rate and the rate of unplanned readmissions are above or below average, plus the hospital’s rating for infection control, whether its staffing level is safe, how far its own staff recommend it, whether patients are assessed for blood clots, and whether it reports safety incidents honestly. But for private hospitals only a users’ rating, the number of operations they do, and (for some) the average length of stay, are given. The rest remains secret.
This makes informed choice impossible, even for private patients. There is a separate Private Hospital Information Network website. But it compares private hospitals only with each other, and for most indicators does not provide the data on which the comparisons are based.
And having informed choice is only one reason for transparency. Even more crucial is that only full information allows risks to patients to be identified, trends to be analysed and lessons to be learned so that mistakes are not repeated. Yet the Care Quality Commission acknowledges that it has comparatively little information on private hospitals.
Given that the taxpayer is now the second largest source of funding for the private hospital sector and that this has, according to the Competition and Markets Authority, sheltered private hospitals from the economic downturn, there is no good reason why they should not be subject to the same reporting requirements on patient safety as NHS hospitals.