The Care Quality Commission have just released their latest inspection report on the state of care in independent acute hospitals.
The fact that the Care Quality Commission is tasked with overseeing the care provided by independent hospitals is welcome in itself, as patients have the right to expect the same clinical/nursing standards as they would expect from NHS care.
The largely positive findings in respect of responsiveness (prompt access to treatment and managed flow of patients), staff interactions with patients (good continuity of care with staff who had the time to provide patients with individualised, one-to-one attention), effective treatment from highly skilled staff in carrying out routine elective procedures (supported by pre-selected admissions) are perhaps unsurprising given the nature of independent health care provision. Leadership and engagement with staff and patients were also largely viewed as positive.
Where the Quality Commission was less positive was in the areas of governance, where there was found to be wide variation in the quality and effectiveness of governance arrangements and a number of examples of poor practice. Likewise, clinical audit was found to need substantial improvement by a number of independent acute providers in terms of auditing, reporting and benchmarking outcomes.
Finally, and perhaps most importantly, they found deficiencies in safety culture: “in some cases, there was a lack of a culture of learning from incidents and a weakness around incident reporting, where systems may have been in place but were not as robust as they needed to be. There were risks in operating theatre safety due to informal practices and consultant behaviour. For example, we saw a few instances where the World Health Organization surgical checklist was not being followed rigorously and this was not always sufficiently challenged by staff within the operating theatre.”
These findings have to be of concern in the light of the actions of convicted breast surgeon Ian Paterson, whose poor practice was allowed to continue for far too long before the alarm was raised. An independent, non-statutory, inquiry into the harm inflicted on his patients by Ian Paterson, chaired by the Right Reverend Graham James, Bishop of Norwich, was formally launched on 6 February 2018. When the inquiry was announced it was promised that it would be ‘informed’ by the views and priorities of patients of Ian Paterson and their families and its remit would likely consider:
- the responsibility for the quality of care in the independent sector
- appraisal and validation of staff in the independent sector
- the safety of multidisciplinary working
- information sharing between the independent sector and the NHS
- the role of insurers of independent sector healthcare providers
- arrangements for indemnity cover for clinicians in the independent sector.
This latter point is something that is seen increasingly frequently as an issue when patients seek redress following harm: who is indemnifying the actions of private health care practitioners and who will ultimately be responsible for paying out damages if awarded?