Private hospital mortality data is poor and getting worse, according to the latest report of the National Confidential Inquiry into Perioperative Deaths published this week.
The private and independent sectors have promised to be more open about performance, especially in the light of last month's 'concordat' which will mean more NHS patients are treated in those sectors.
But NCEPOD's report states: 'By far the most poor in respect of their return rates are the hospitals in the independent sector, where rates have not only fallen since the previous period (1997-98) but are lower than in 1990.'
It says that if the principles of clinical governance are to be applied, their compliance rates will need to improve 'dramatically'.
Compliance rates for surgical and anaesthetic questionnaires stood at 72 per cent and 88 per cent respectively in 1990, but had dropped to 67 per cent and 64 per cent last year.
NCEPOD principal clinical coordinator Ron Hoile said: 'The one issue for the private sector is the lack of compliance. They are signed up to clinical governance and have poor compliance. They have no excuse. They should be auditing their deaths.'
BUPA medical director Andrew Vallance-Owen was 'surprised by the findings' and said that he would investigate why returns had fallen away.
Independent Healthcare Association chief executive Barry Hassall could also offer no explanation. He said: 'This is an important matter that will need to be discussed between the IHA member hospitals and NCEPOD.'
Chief officer of London Health Link Elizabeth Manero was worried about the implications, given that more NHS patients were to be treated in the private sector. She said: 'We do not want them going to an accountability-free zone.'
The report also finds that in two out of every five hospitals, NHS as well as private, in which patients died following surgery last year there was no high-dependency unit. NCEPOD says that chief executives of acute hospitals should make the provision of such units their number one priority.
The report asks why some hospitals have a unit while neighbouring hospitals do not, and queries whether regional funding variations are to blame or the 'priority that individual hospitals give to different aspects of their activities'.
'Too often it is those with the loudest voice, or those placed closest to the chief executive's ear, who see their priorities met first.'
Mr Hoile said units 'ought to be the top priority in chief executives' business plans because ultimately people will die'.
Last year a bed in a unit was available round the clock in only 55 per cent of cases. NCEPOD calls for 'an urgent recruitment drive for nursing staff specialised in critical care activities'.
It says that even in those hospitals where critical-care facilities exist, they may not be available to patients due to lack of beds.