Research highlights need for stronger patient safety protections in NHS and private hospitals
Research led by AMBS and published by a team from the Universities of Manchester, Birmingham and York, finds that patients in NHS and private hospitals need better protection against problems with the quality and safety of their care, and more joined-up care.
Almost a decade ago Ian Paterson, a breast surgeon in Birmingham, was sent to prison for 20 years for doing unapproved and entirely unnecessary operations, many of which were botched, on hundreds of patients across both the NHS and private hospitals in the West Midlands.
An inquiry in 2020 made a series of recommendations for reforms to the systems for assuring the quality and safety of care and protecting patients and the public, which were largely accepted by the government. But the research finds that, six years later, most of those recommendations have not been implemented.
Kieran Walshe, Professor of Health Policy and Management at AMBS, who led the research, said: “Most care in both NHS and private hospitals is safe, and we did not find differences between them in the quality of care. But when things go wrong, information about problems is often not shared between the NHS and private hospitals where doctors work.
“As a result, poor practice and serious harm to patients can happen for years before action is taken. The Paterson Inquiry recommended new systems for sharing data about the whole of every doctor’s practice wherever they worked and highlighting concerns much earlier, but those reforms have not happened.”
Key research findings
- Systems for assuring the quality and safety of care in NHS and private hospitals exist within organisations but they do not work well between organisations. They rely too much on consultants themselves choosing to share or provide information about their performance or any concerns with the hospitals where they work.
- Data sharing between NHS and private hospitals has been hampered by misplaced concerns about GDPR and confidentiality. Hospitals should have a clear legal duty to share any concerns they have about a doctor with any other hospital where that doctor works.
- Since 2012, all doctors have had regular, annual appraisals and five-yearly checks that they are still fit to practice, but those appraisals and checks are mostly done in the NHS hospital where they work and don’t always cover the work they do in private hospitals, nor are they always shared with those private hospitals.
- The Paterson Inquiry recommended that there should be one database of all hospital care, covering both NHS and private hospitals and available for doctors, hospitals and patients to check the quality and safety of care. Six years later, that has yet to happen. Although the data is being collected, it is not shared effectively.
- The quality of care in NHS and private hospitals is pretty similar on the whole, and any differences are largely explained by the fact that private hospitals do less complex treatments and don’t undertake emergency work.
- The report found no evidence that when doctors work in both NHS and private hospitals, it has any adverse effect on either the quantity or quality of their work for the NHS.
- When patients are treated in both an NHS and a private hospital, their medical records are often not transferred or shared. All hospitals should contribute to a shared care record and have access to the same medical records.
- NHS Integrated Care Boards commission NHS funded care from private hospitals, but they lack capacity and capability to monitor and manage those contracts. This is important as a growing amount of NHS funded care, mainly elective surgery, is provided by private hospitals.
The study was funded by the National Institute for Health and Care Research (NIHR).