On the up

They stand up to comparison with the better sort of hotel. The rooms are comfortable and the service is attentive.

But doubts have long existed about the independent healthcare sector's commitment to ensuring consistently high clinical standards and accountability.

How is the industry planning to prove that it puts safety before decor?

From next April, the Care Standards Act 2000, introduces the National Care Standards Commission to regulate independent healthcare and social care providers across England.

In July, the Department of Health published the consultation document Independent Health Care National Minimum Standards and Regulations and invited comments by 16 October.

1When determining if an independent hospital should be registered or have its registration cancelled, or whether to take action for breaches of regulations, the NCSC will look to what extent it complies with the standards.

The Consumers' Association says that despite having 'substantial criticisms' - particularly concerning redress, patient information and visits and inspections - the document is a 'good start and there are some good proposals'. These include looking for doctors who are employed to do procedures in the private sector to have substantive positions in the NHS in that area of work.

The Independent Healthcare Association believes the standards will ensure proper accountability. Head of operational policy Sally Taber points out that 'for the first time' registered managers in the private sector will have the 'same responsibilities chief executives in the NHS have for quality and outcomes'.

The IHA has set up working parties in preparation for the new regime. According to Ms Taber, one group is examining the use of resident medical officers, including 'their definition and what standards they are adhering to in conjunction with the working time directive'.

According to some user groups, RMOs are relatively junior and may lack the skills to deal with more challenging situations.

For critical care, last week the IHA launched draft guidance covering competency development, including 'early warning systems so patients do not deteriorate in wards without being noticed'.

Ms Taber says the IHA is also 'encouraging participation in the new critical care networks'.

The independent Yorkshire Clinic specialises in cardiac care and is part of the West Yorkshire critical care network. Its matron, Jo Townsend, believes her sector 'must be able to provide highdependency care'. She adds:

'They should either have highdependency facilities on-site or a very copper-bottomed agreement with the NHS for providing those services.'

On making performance indicators public, Ms Taber confirms the IHA is 'looking at what indicators people will agree to'. The timescale for performance indicators is to have final agreement by the end of the year and have them in the public domain by December 2002.

The 'vision' is to 'get aggregated data for the sector and we are well down the road with discussions with the providers and the insurers'.

The sticking points are that individual organisations have set up their own schemes and 'we have to make sure We have got one across the sector'.

For consultants who are employed by the NHS but also do work in the independent sector, 'we want a shared protocol' that would prove they were qualified and experienced through their NHS work to carry out the treatments they propose to do in private hospitals.

Independent providers would give the consultant a set of results - such as performance and patient satisfaction data - for presentation during their NHS appraisals to show what they were achieving outside.

A complaints code was implemented across acute hospitals and mental health a year ago and is to be replaced by a new one, accompanied by a leaflet on how to complain.

'We are making the system more user-friendly.'

Complaints are responded to first by internal review, but if the patient is not satisfied they get another review by the hospital manager.

Should patients still be unsatisfied, they are advised to go for 'independent external adjudication' - usually a day's hearing organised by the IHA.

If the complaint is upheld, there is the possibility of a payment of up to£5,000.

But the sector may continue having problems convincing user groups of the fairness of its complaints system, given that the chair of each adjudication panel is chosen by the IHA, with the costs borne by the association's members.

The Consumers' Association is still 'deeply dissatisfied' and has been pressing for private patients to have access to a system of independent review of their complaints and beyond that to the health service ombudsman, in the same way as NHS patients.

What is the likelihood of the health ombudsman investigating complaints?

Ms Taber refuses to be drawn.

'We have had discussions with the deputy ombudsman and are leaving our options open.'

In profile: the new regime The new National Care Standards Commission will be an independent non-governmental public body to regulate social care and healthcare services previously regulated by local councils and health authorities.

For independent healthcare, the NCSC replaces the current regime provided under the Registered Homes Act 1984.

According to the government, the new approach will ensure providers put in place appropriate safeguards and quality assurance systems and end the 'anomaly' of independent healthcare establishments being 'inappropriately registered as nursing homes to different standards by the 100 HAs across the country'.

Draft minimum standards issued by the DoH include the following key outcomes. Patients should:

receive treatment from appropriately trained, qualified and insured consultant medical practitioners;

receive clear information about their treatment;

be assured level 2 or 3 critical care is provided either within hospital or through agreed transfer arrangements;

not be misled by advertisements about the hospital and the treatments it provides;

not pick up infections;

be resuscitated appropriately and effectively;

be assured surgery procedures are safe and effective;

have access to an effective complaints process.