The private sector is to get its own equivalent to the Commission for Health Improvement. Barbara Millar gauges reaction to the proposal

Proposals to overhaul the regulation of private healthcare will 'stop hospitals undertaking procedures that they are not equipped or qualified to do', health secretary Frank Dobson promised last week.

The new, private sector equivalent of the Commission for Health Improvement his plans will entail is not exactly what the private sector had in mind.

'But at least Frank Dobson acknowledged he is secretary of state for health, not just for the NHS,' says Tim Evans, policy director for the Independent Healthcare Association.

'He has acknowledged that Britain does have a mixed economy of health and social care and that the government has a role to protect all patients, irrespective of where they are treated.'

The main thrust of the consultation document, Regulating Private and Voluntary Healthcare, has been welcomed by private healthcare providers (see box). But their objection remains the same.

They want a single regulatory system for all providers, whether NHS or private sector, and believe it should include single-handed practitioners. They also want to come under the scope of the health service commissioner.

At present, private and voluntary healthcare is regulated under the Registered Homes Act 1984, which the Department of Health describes as 'out of date, unsatisfactory and not sufficiently


It argues that the system fails to reflect the growth in the scale and complexity of treatment in the private sector and does not provide the protection to which the public is entitled.

'The proposals aim to replace the existing hospital inspection regime with a new one with a slightly broader base,' says Dr Adrian Bull, medical director with PPP Healthcare Group.

'Unfortunately, this seems to miss the key issue of moving beyond an inspection regime to a system which addresses clinical accountability and the quality and appropriateness of clinical practice.

'The consultation document is also weak on the issue of setting standards of best clinical practice in the private sector.

'We believe such standards must be evidence-based and equivalent to, or the same as, the standards which are being used in the inspection of NHS facilities by

the Commission for Health Improvement.'

Dr Andrew Vallance-Owen, group medical director at BUPA, says that, ideally, CHI would cover both sectors.

Ministers have made clear that 'they do not consider the CHI is the right body to regulate the private and voluntary sector' because it has been designed and given powers to operate 'in the existing, managed system of the NHS'.

But Dr Vallance-Owen seizes on a paragraph in the document which says it may be 'appropriate' for a future private sector regulatory body 'to contract with another body, such as the CHI' when appointing inspection teams.

'This is a move in the right direction,' says Dr Vallance-Owen. 'It is there. They have made the connection. We think it is crucial there are cross-linkages between the sectors.' It is also important that activity and performance data are shared between the NHS and the independent sector, he adds.

'We are prepared to share our data with the NHS and we think this should happen in reverse.'

The consultation document says ministers are concerned that staff, especially doctors, can work in the independent sector when they have been suspended by the NHS on clinical grounds.

It suggests 'a rigorous approach' to ensuring 'alert' letters warning employers of concerns about a clinician's performance are sent to all independent hospitals with which a suspended clinician may have a contract.

'Of course we support the government's desire to safeguard patients in this way, but this solution fails to take into account doctors' private practice outside private hospitals,' says Dr Bull of PPP.

Dr Vallance-Owen adds that the 'alert' letter misses out a major point. 'We need NHS trusts to give us more detailed information on why a clinician was suspended,' he says.

He is 'surprised' that the government should even ask whether regulation needs to cover premises used by physiotherapists, chiropodists, complementary practitioners or those carrying out cosmetic treatments.

'Anywhere a patient is paying for some sort of treatment needs to have proper protection.'

PPP Healthcare Group is seeking more detail about the costs of regulation. The private sector will be expected to fund both the complaints procedure and the inspection and regulation system so that taxpayers' money is not used.

'This should not be an obstacle to the initiative's success, but we do need to have a much closer understanding of its magnitude and apportionment among private healthcare providers,' suggests Dr Bull.

Other private sector providers are holding back from expressing a view until the Health Bill has received royal assent, and until a forthcoming health select committee report on private sector regulation is published.

Select committee chair David Hinchliffe says the final report is now being drafted for likely publication in mid July. He too is reluctant to say what he thinks of the government's proposals.

He says: 'I can't comment on this consultation document at this stage because it would give an indication of how the select committee is thinking, and that would be inappropriate.'

Regulating Private and Voluntary Healthcare.