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Royal College of Surgeons: Open letter on patient protection in the NHS and Private Healthcare Sector

The Royal College of Surgeons calls for urgent action to be taken to pursue ‘a culture of openness and transparency’ with an equal focus on patient safety in both the private and public sectors in the wake of the Ian Paterson scandal.

In an open letter (17 May 2017) The Royal College of Surgeons (RCS) proposed a review of the safety standards in the private healthcare sector following the ‘abhorrent actions’ of Ian Paterson, the Birmingham-based breast cancer surgeon found guilty of 17 counts of wounding with intent and three of unlawful wounding against 10 patients after a seven-week trial at Nottingham Crown Court.

In the letter the RCS reassures that the ‘processes to improve standards of care have improved dramatically in the NHS and in the private sector’ since Paterson’s suspension in 2012. It has warned, however, that there is ‘no room for complacency’ and that it is imperative to ‘find out why he was able to cause so much harm for so long and what can be done to minimise the risks of similar incidents in the future.’

Action to be taken to improve patient safety

The RCS welcomes the Secretary of State’s suggestion that an early inquiry be conducted by the next Government to understand how Ian Paterson was able to work as a surgeon for more than a decade despite concerns being raised about his practices. This inquiry, it suggests, could build on the findings of Sir Ian Kennedy’s report and the independent reviews undertaken at the private Spire Parkway and Little Aston Hospitals, both where Paterson practiced. The RCS Council also confirms that it intends to review the Paterson case, and in particular ‘how and why those working closely with Ian Paterson did not spot his behaviour or were unwilling to challenge it.’

Whilst the RCS do not suggest that there is evidence of less safe care in the private sector, it does cite that there is less reporting on safety incidents and, quoting the Centre for Health and the Public Interest’s 2014 report, there is ‘dearth of independently verifiable performance data’. This lack of transparency inevitably raises questions about ‘practice, consent and patient safety’ as regulators are unable to assess the risk of harm posed to patients in private hospitals.

In light of this, the RCS calls for continued action by politicians and NHS senior leaders to improve patient safety with a focus on the private sector. It calls for more transparency and similar reporting to that carried out by the NHS around unexpected deaths, never events, and serious injuries. It also suggests that the private sector take part in Clinical Audits with registration with the Care Quality Commission (CQC). The letter also outlines the RCS’s particular concern that cosmetic surgery remains under-regulated and under-legislated; as the law currently stands any doctor, even a non-surgeon, can carry out cosmetic procedures. It asks that the General Medical Council be given powers to annotate the medical register with details of which surgeons are qualified to undertake cosmetic procedures, a move which would benefit providers and patients alike.

Patient protection – what progress?

Progress has been made with the May 2017 publication of the first three, of eleven comparative performance measures by the Private Healthcare Information Network (PHIN). These performance measures mark the first comprehensive attempt ‘to measure the activity and performance of private healthcare across the UK to NHS standards’.

This newly published information has made it possible for patients to check the number of admissions, the average length of stay and patient satisfaction of 149 common procedures at over 200 private hospitals. Further measures will be released over the year including rates of adverse incidents and infection rates, followed by additional comparative measures in 2018 and 2019.

This move towards greater transparency in private healthcare can only be a good thing. It is reassuring to know that they are striving to bring standards of transparency and data quality in line with that which already exists in the NHS.