'I hate the bastards'

Health select committee chair David Hinchliffe has never been one to mince his words, especially when it comes to the private sector. 'I hate the bastards - and you can quote me on that,' he told HSJ. 'They know that anyway.'

Not a good start for the team of independent healthcare representatives called to give evidence to the committee's inquiry into the regulation, monitoring and inspection of the independent sector.

Even BUPA managers admitted to being 'a little concerned' at the prospect of a confrontation - not least because their hospitals had the misfortune to be at the centre of a scandal over consultant gynaecologist Rodney Ledward.

The surgeon was struck off after being accused of injuring 400 women in BUPA and NHS hospitals. Mr Hinchliffe's inquiry was triggered by reports of people who had received poor care in the private sector. The inquiry covers mainstream hospitals registered by the NHS and fringe cosmetic surgery clinics, where no regulation exists.

It has been somewhat overtaken by events.

Health secretary Frank Dobson reportedly had plans for the private sector to be regulated by an independent inspectorate. But the Department of Health now fiercely denies the story.

At present, health authorities register independent hospitals under the Registered Homes Act 1984, effectively demoting them to a nursing home plus operating theatre. The DoH proposes to consult widely on the future relevance of that.

The independent sector has also been calling for the Commission for Health Improvement and the National Institute for Clinical Excellence to apply to such hospitals.

In the House of Lords, Conservative peers managed to amend the Health Bill to make CHI apply to the independent sector. Whether that will survive the Commons reading remains to be seen.

Action for Victims of Medical Accidents told the committee: 'Many patients feel deeply aggrieved to discover that the treatment, post-operative care in particular, may well have been of a safer if not better standard

had they opted to receive care in the NHS.'

One member of the Association for the Proper Regulation of Private Hospitals is still campaigning after a junior doctor at a private hospital injected her mother with 10 times the appropriate dose of diamorphine. Her mother died four days later - in an NHS bed, to which she was transferred in an attempt to save her.

There is an inherent difficulty for a Labour-dominated committee like Mr Hinchliffe's in investigating the immediate issue of regulation, without becoming too bogged down in dogma.

Should you recommend measures like CHI and NICE - potentially boosting the credibility of independent hospitals - when you wholeheartedly disapprove of the private sector?

The Independent Healthcare Association, BUPA Hospitals, the General Healthcare Group, Nuffield, the Nursing Homes Trust and the Community Hospitals Group are as keen as the committee to ensure good standards in the sector.

Most already have their own complaints procedures or management quality standards in place. But the IHA is pulling out all the stops to introduce minimum standards sector-wide.

Speaking at the health select committee hearing, the witnesses were even prepared to accept that it was 'entirely appropriate and fair' for them to meet the cost of applying CHI to the independent sector. Words, no doubt, that Frank Dobson would be keen to hear. But applying them to a sector which may have different criteria to those of the NHS might not always be easy.

Take grommets. According to Labour committee member Dr Howard Stoate, grommet operations are more commonly practised privately than in the NHS. If NICE said that the operation was a waste of time, would the private sector stop doing it?

There was some hedging of bets on this one. 'We would certainly want consultants to talk through the pros and cons of treatment with the patient,' said Dr Andrew Vallance-Owen, group medical director of BUPA Hospitals.

But Charles Auld, chief executive of the General Healthcare Group, said the NICE guidelines would be just that - guidelines.

Private hospitals are also keen to monitor their doctors' performance, according to Dr Vallance-Owen, who told the committee he was concerned that doctors suspended from the NHS might still work in the private sector.

After years of a Conservative government which had been happy to let the market decide whether a service was any good, the independent sector is having to prove itself in new ways.

But John Lambie, chair of APROP, remains unconvinced. 'In future, will patients be in a better position with the complaints procedures? Are they likely to be safer or better treated in private hospitals?

'They have never published clinical data concerning what goes on in private hospitals. This sudden volte-face is difficult to believe. I think it is because they are pretty sure the government will not include them for reasons of its own - such as cost.'