On Wednesday 2nd November CHPI is hosting an event at the Royal Society of Medicine in London, at which we will explore and discuss the ongoing scandal of patient safety in private hospitals, and why so many women, in particular, have been affected by negligent medical practice and regulation. In this blog, David Rowland outlines the policy and practise landscape which has led us to today. All are welcome to join us at the event, which takes place between 5-8pm, please register using this link.
Repeated calls for change
In 1999 a parliamentary inquiry into the regulation of private healthcare was warned by Winston Peters, the President of the Consultant and Specialists Association, that “a scandal of the proportions of the Bristol baby hearts saga is waiting in the wings to happen in the private hospital sector.”
This warning came some weeks after the activities of the gynaecologist Rodney Ledward had been exposed by BBC Panorama. Ledward, a so-called “rogue surgeon” pressured patients to go private, told some that they had cancer when they didn’t, and subjected untold numbers of women to ‘repeated and unnecessary surgical procedures’, in both the NHS and private hospitals.[1]
Unbeknown to Mr Peters, at the time of issuing his warning the largest medical scandal to hit the UK was indeed waiting in the wings – in the late 1990s another surgeon, Ian Paterson, was carrying out unnecessary mastectomies and other forms of unnecessary surgery in private hospitals in Birmingham as well as high risk “cleavage saving mastectomies” on breast cancer patients in NHS hospitals.
Both the Health Committee and the Ritchie Inquiry into the activities of Rodney Ledward made strong recommendations about improving the oversight and auditing of consultants working in the private hospital sector, to enable the provision of unnecessary treatment to be picked up more quickly by the hospital’s management.
This included putting the Medical Advisory Committee (the main clinical governance mechanism in private hospitals) on a statutory footing, requiring the Chief Executive of each private hospital company to be fully responsible for the quality of care provided in the company’s hospitals, and requiring consultants to comply with clinical audits and incident reporting.[2]
However, none of these measures were effectively implemented and in 2018 the Care Quality Commission continued to raise concerns about private hospitals having ‘informal’ governance arrangements in place and the fact that many did not carry out clinical audits or even collect outcome data from consultants.
When Paterson’s activities were uncovered in 2011, almost a decade after the Ritchie Inquiry, this was due to the efforts of ‘whistle-blowers’ and insurers, and not because of effective clinical governance.
It is unclear how many women were harmed because of the actions of Paterson and the clinical governance and regulatory failings which allowed him to keep practising in the private sector, but it is likely to run into thousands. As of June 2020 the coroner is said to be examining 7 cases of unnatural deaths relating to former Paterson patients.
In 2019, the Inquiry into Ian Paterson made a series of similar recommendations to those put forward by the Ritchie Inquiry into Rodney Ledward in 2000.
As of October 2022, some two and half years later, only 12 of the 15 Paterson Inquiry recommendations have been accepted by the government, which also ruled out requiring private hospitals to comply with the same safety standards as to the treatment of patients in the NHS.
And in relation to the recommendations which the government accepted, it is not clear what if any changes have been implemented.
Repeated cases of negligence
The 1999 health committee inquiry heard from Caroline Buckley, the daughter of Carole Burwash, who died in a private hospital from post-operative complications.
The consultant surgeon who had carried out a hysterectomy left Mrs Burwash solely in the hands of Resident Medical Officer, the only doctor on the premises, who had never met the consultant surgeon, was not qualified in advanced life support, and incorrectly administered the drugs which ultimately killed her.
Nearly 20 years later in 2018, in the case of Peter O Donnell, who died in an NHS hospital after being treated in a private hospital, the coroner found that the Resident Medical Officer who had been charged with looking after Peter was the only doctor in charge of post-operative care, was working a shift of 24 hours a day for 7 days a week, and was not subject to monitoring by the hospital.
In addition to Peter O’Donnell’s sad and avoidable death, reliance on Resident Medical Officers for post operative care in private hospitals has been cited as a contributing cause in 4 other coroner’s inquiries or court rulings into patient deaths.[3]
A letter from the coroner to the then Secretary of State Jeremy Hunt about Peter O’Donnell’s death led him to write to the private hospital sector telling them to get their house in order on patient safety or face possible legislation to improve standards.
But as with other attempts to bring about change nothing happened.
The need for stronger effective regulation
In the intervening period since the 1999 Parliamentary Inquiry into the regulation of private hospitals, and the warning of a mass patient safety scandal, thousands of mainly female patients have been subject to harms which have affected their bodies, their mental health and the lives of their friends and families.
Most of these harms have occurred not because of rogue surgeons or poorly performing doctors, but because of well known systemic patient safety risks inherent in the private hospital model in England which the government, regulatory bodies and the medical profession have failed to address.
We need to ask what interests stand in the way of reform, and how bad does it have to get before effective regulation of the private healthcare sector is introduced?
Similarly, whilst the systemic patient safety risks which have been documented by the numerous inquiries highlighted above apply to people of all sexes and genders, it is hard to ignore the fact that female patients have been disproportionately affected by many of the high-profile scandals of the last 20 years.
In addition to the Ledward, Paterson and PIP breast implant scandals, the recent Cumberlege review of Medical Devices showed how hundreds of women have been harmed by unnecessary pelvic mesh surgery, the use of hormone pregnancy tests and as a result of being prescribed sodium valproate whilst pregnant.
Similarly, the numerous NHS maternity care scandals all point to a healthcare system where women’s voices are not being listened to, to the detriment of their health and their babies.
Understanding why so little has changed in the regulation of private healthcare over the past 20 years and why so many women have experienced avoidable harms is a complex and challenging undertaking.
But it is increasingly urgent. As more and more patients are forced to go private because of growing NHS waiting lists, and more and more NHS patients are being treated in private hospitals, it is imperative that further unnecessary harms are avoided and that known patient safety risks are addressed.
We will discuss these issues at our forthcoming event, hosted by CHPI at Royal Society of Medicine on Wednesday 2nd November 2022, 5-8pm. The recent ITV documentary into the Ian Paterson scandal will be screened followed by a panel discussion and contributions from the audience.
If you would like to join us, please register using this link.
[1] The Report of the Inquiry Into Quality and Practice Within the National Health Service Arising from the Actions of Rodney Ledward 2000 (The Ritchie Inquiry)
[2] See page 315 of the Ritchie Inquiry.
[3] See the High Court ruling into the death of Mr Hughes,; the coroner’s inquiry into the death of Mr Crittall; the coroner’s inquiry into the death of Mr Healey and the coroner’s inquiry into the death of Mr Hannides
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