Reading List - Reports on patient safety in private hospitals

Although transparency is continuing to increase in the NHS, there is still relatively little information available about the quality and outcomes of care in private hospitals.

In August 2014, the CHPI published a report on the known and unknown risks to patients undergoing operations in private hospitals. The report revealed that there have been over 800 unexpected deaths in these settings in England over the last four years, and that there is insufficient information to determine whether these mortality rates are a cause for concern.

The report brings together what was known about safety in private hospitals, and identifies areas where further information is needed in order to assess risks. Accessible and consistent information is also essential for patients and regulators to able to assess performance and make informed choices. It draws on a number of sources, including the following reports:

Competition and Markets Authority (2013) Private healthcare market investigation: final report

This investigation looked at a wide range of factors to assess whether there are any factors which prevent, restrict or distort competition between privately funded healthcare services in the UK.

The Authority found that there is insufficient publicly available information on private healthcare provision, impeding the ability of patients to make informed choices about where to be treated and so failing to promote competition. The report further notes that the growth in income from the NHS has, to some extent, protected private hospitals from the weak state of the privately paid for healthcare market.

Department of Health (2013) Keogh Review of the regulation of cosmetic interventions: final report

The report found that some of the surgeons undertaking cosmetic surgery may be performing operations too infrequently to maintain competence – an issue that is more widely applicable to private hospitals which tend to be low-volume settings. It also expresses concern about low levels of participation in confidential inquiries amongst private providers – crucial to ensuring patient safety.

The recommendations in the report include the suggestion that the remit of the Parliamentary and Health Service Ombudsman should be extended to cover the whole private healthcare sector,a recommendation supported by our report.

National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reports 

These audit studies seek to maintain and improve standards of medical and surgical care and the results are made publicly available.

Our report particularly drew upon a 2012 review of bariatric surgery and a 2010 review of cosmetic surgery. These studies found that less than a sixth of private hospitals performing cosmetic surgery in 2013 had intensive care beds, presenting a risk to patients if complications arose.

Of 132 private hospitals that responded to a 2012 enquiry into the resuscitation of patients following in-hospital cardio-respiratory arrest, 14 had no dedicated resuscitation team.

Several NCEPOD reports also draw attention to the failure of some private hospitals to collaborate in the enquiries.

House of Commons Health Committee (1999) The regulation of private and other independent healthcare

In their examination of the operation of theprivate healthcare providers, the Committee emphasised the importance of ensuring that patients treated in private hospitals are not exposed to greater risks than patients in NHS hospitals.

The Committee recommended that the governance arrangements in private hospitals should be made statutory and that if a patient who has received treatment in a private hospital subsequently needs treatment in an NHS hospital due to a failure by the private hospital, the NHS should have the power to recoup costs. Both recommendations are supported by our report.

Philip Blackburn (2012) Private acute medical care, Laing and Buisson

This report shows that the NHS provided over a quarter of the income from acute healthcare provided by private hospitals in 2012, although this varies considerably between providers. The number of NHS-funded admissions for elective surgery to private hospitals has increased from 19,620 in 2004-05 to 394,260 in 2012-13.

There are also a number of relevant books reflecting worldwide interest in the subject.