• CQC report highlights significant concerns over safety at independent sector hospitals
  • Governance and oversight of doctors with practising privileges is major concern
  • Royal College of Surgeons calls for sector to publish more data

Overreliance on informal arrangements by independent hospitals and doctors is a “major concern” and could put patients at risk, the Care Quality Commission has warned.

Following inspections of more than 200 private sector hospitals, the regulator said there was evidence of “substantial variation in the quality and effectiveness of governance arrangements and a number of examples of poor practice”.

In a report published today, the CQC warned: “There is a real danger that poor practices are not picked up or challenged in the way they should be. This can have a significant impact on the safety of services, in particular where familiarisation and subsequent informality in processes may mean that systematic and robust safety procedures are not sufficiently in place to protect patients from harm.”

The CQC highlighted its “major concern” over the way consultants with practising privileges were managed. These consultants are granted the right to admit and treat patients in a private hospital but are not technically employees of the company.

This was the basis of practise between rogue surgeon Ian Paterson and Spire Healthcare. Paterson was jailed for 15 years last year after being convicted of 17 counts of wounding with intent and three counts of unlawful wounding.

The CQC said private companies could be reluctant to challenge consultants. The report said: “It is essential that providers demonstrate that they are proactively auditing and monitoring consultants’ work, and have real oversight of services in order to protect patients and ensure they are being treated safely and effectively. In many cases they could not.”

It also highlighted a “lack of a culture of learning from incidents” in some private hospitals.

The NHS Partners Network estimates more than 500,000 cases of NHS funded elective care were treated in private sector hospitals in 2017 – 6 per cent of total NHS elective admissions.

The CQC warned some private hospitals “were not set up to anticipate and handle emergency situations” with only 15 critical care services across 206 hospital sites. Where private hospitals had no critical care services, the CQC said it “sometimes found a dependence on 999 NHS emergency services if an inpatient deteriorates”.

The CQC said by January 2018, out of a total of 206 hospitals 128 were rated as good and 16 were rated outstanding. There were 62 rated requires improvement and none were inadequate.

Two fifths of private hospitals were rated as requires improvement on safety, with one rated as inadequate. On governance and leadership, 30 per cent of hospitals were rated requires improvement and 3 per cent rated inadequate.

Chief inspector of hospitals Professor Ted Baker said much of the care seen by inspectors was good but: “Too often, safety was viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes. In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust.”

Royal College of Surgeons president Professor Derek Alderson said: “The recent Ian Paterson case demonstrated there is no room for complacency and further actions should be taken to minimise harm to patients in both the NHS and private sector.

“The private sector should report similar safety and quality data to the NHS to enable effective monitoring and transparency. It should also be better at taking part in clinical audits – this could become a condition of all NHS and private organisations’ registration with the CQC. The outcomes of cancer patients being treated in the private sector are not known, for example, and cosmetic surgery, which happens almost entirely in the private sector, needs to be better regulated.”

Howard Freeman, clinical director at the NHS Partners Network, said: “Where the CQC has identified areas for further improvement in independent hospitals it is encouraging that it has found that providers have been quick to respond to inspection findings, with over half of the independent acute hospitals re-inspected improving their rating.”