• Jeremy Hunt accuses some independent sector hospitals of having “coasted” on patient safety
  • Also says he wants to ensure NHS is fairly compensated for being the “hospital of last resort” when patients are transferred for emergency care
  • The intervention follows concerns about care in private hospitals highlighted by HSJ
  • Lack of transparency and published data also a concern

Jeremy Hunt has accused some private sector hospitals of having “coasted” on safety, and warned they could be made to pay costs when the NHS has to take over care of their patients, in a strongly-worded intervention.

The health and social care secretary has today written to independent sector hospital provider chief executives to demand action. He told HSJ some “had coasted” on improving safety standards.

His comments apply both to independent hospitals treating NHS-funded patients, and to non-NHS funded care.

With reference to the appearance of some private hospitals, he told HSJ: “It’s sadly not the case that just because you have a nice reception and carpeted corridors that automatically means that care is going to be of an equally high quality.”

In the highly unusual intervention, he also said he wanted the sector to recognise its responsibilities and to be fair to the NHS for providing what he described as the “hospital of last resort… safety net” for patients.

His letter today (see full text below) says: “I am not convinced that in those cases where the NHS is obliged to deal with the consequences of negligent care from the independent sector that NHS hospitals are getting fair remuneration.”

He told HSJ: “Most private hospitals do elective work on the basis that the NHS is the hospital of last resort if things go wrong and there are complications, and they need to understand that if the NHS is providing that safety net for their work that they need to be fair as a profit making organisation in their use of NHS resources.”

His letter says officials at the Department of Health and Social Care are drawing up “proposals to ensure that where NHS organisations bear the costs of negligence, they are better able to secure payment that reflects actual costs from your sector”.

The letter also says: “We need urgent assurances that you will get your house in order on quality and safety.”

It hints at plans to strengthen regulation, and demands more transparency, including publishing more data on quality. It also seeks assurances over the care of deteriorating patients and the monitoring of medical consultants’ work in private hospitals.

Last month, the Care Quality Commission highlighted “major concern” over safety in the sector. Mr Hunt’s letter tells chief executives: “A situation where [the sector] is potentially letting down patients on safety and quality is unacceptable.”

Mr Hunt told HSJ that private hospitals’ ability to select medical consultants with strong reputations may have given them “a false sense of security”, and indicated some were failing to take responsibility for the care they provide. He added: “It’s not acceptable that just because a consultant might be operating on an independent contract rather than as an employee that a private hospital says they don’t have responsibility for the safety of care delivered to patients in that trust. They do.”

Mr Hunt’s intervention comes after HSJ highlighted the death of 77-year-old Peter O’Donnell, whose treatment the health secretary references in his letter. Mr O’Donnell developed sepsis when his hospital-acquired pneumonia was not escalated or treated at BMI Healthcare’s Beaumont Hospital last year. Mr O’Donnell was transferred to Royal Bolton Hospital by a 999 ambulance shortly before his death, prompting a coroner to raise concerns with Mr Hunt.

The coroner cited a report by the Centre for Heath and Public Interest which has repeatedly highlighted the systemic risks raised by Mr Hunt in his letter today.

Explaining what triggered his move, Mr Hunt told HSJ the NHS had made significant progress on improving safety “but this was never meant to be something directed at just one part of our health economy… and we want to know that where we are spending money outside the NHS family of hospitals patients are being treated safely”.

He added: “But we also have a responsibility to consumers who pay for their care privately to make sure this is a market in which they can be confident their care is safe and it’s sadly not the case that just because you have a nice reception and carpeted corridors that automatically means that care is going to be of an equally high quality.”

Asking providers to respond within two weeks with clear actions they will take, Mr Hunt says in his letter: “Like many of my predecessors on both sides of the political divide, I believe that the independent sector can play a useful role in adding capacity, promoting innovation and offering patients choice.

“However, if the sector is to partner with the NHS and benefit from our world-leading medical training, we need urgent assurances that you will get your house in order on quality and safety, as well as a commitment to take rapid action to match the NHS’s world-recognised progress on transparency.”

Jeremy Hunt’s letter in full

Dear chief executive,

I am sure you will have read the recent CQC report on the state of care in independent acute hospitals. Urgent action is needed in response.

The NHS has been on a long and hard journey to transform the safety and quality of care in the wake of Mid Staffs, and has now been ranked the safest health system in the world. The CQC report suggests that there is a real risk this progress is not being matched by equally high standards in parts of the independent sector. Given that the sector employs many NHS consultants who have benefited from NHS training, relies on the NHS as a safety net for emergency care, and holds a number of NHS contracts, a situation where it is potentially letting down patients on safety and quality is unacceptable. As such, I am seeking your co-operation on a number of vital safety and quality issues:

  1. Where an NHS trust is rated ‘inadequate’, we take rapid enforcement action, including special measures, leadership changes and extra oversight. We have a duty of care to all patients - whether NHS, self-pay or insured - so we will also look at what similarly robust action could be taken to ensure rapid improvement from private providers offering inadequate care.
  2. We need much greater transparency from your sector. From the publication of surgical outcomes by clinician to the publication of avoidable deaths by hospital trust, the NHS is leading the world on transparency, and I am disappointed by the variation in voluntary progress to address the disparity of information on standards in private settings. I am aware of the positive impact that the Private Healthcare Information Network is starting to have, but I believe the Independent Sector needs to move much faster to achieve alignment with NHS standards. I would like specific assurances that every provider is submitting comprehensive data sets to PHIN, and we will explore whether the reporting requirements need to be strengthened to make them comparable with the NHS.
  3. As you will be aware, in cases of proven negligence, the NHS is able to claim back costs from the negligent party. However, I am not convinced that in those cases where the NHS is obliged to deal with the consequences of negligent care from the Independent Sector that NHS hospitals are getting fair remuneration. I have asked my officials to develop proposals to ensure that where NHS organisations bear the costs of negligence, they are better able to secure payment that reflects actual costs from your sector.
  4. Critical care and transfers to the NHS. The CQC’s finding that many private providers lack appropriate escalation processes or transfer agreements is unacceptable. This has been brought into sharp focus again with the case of Peter O’Donnell - on which I received a disturbing report from the Manchester West Coroner. All healthcare providers dealing with more routine procedures need to have clear processes for managing deterioration and for escalation.
  5. The case of Ian Paterson has highlighted the issue of consultants with practising privileges effectively acting without proper monitoring of their work or standards as they are technically not employees. More broadly, CQC identified a lack of formalised governance procedures, meaning that hospitals were not effectively monitoring the work of consultants, and when something goes wrong the private hospital provider is able to point to the fact they were not an employee and thereby avoid liability.
  6. Apprenticeships. We would like to see your sector making a meaningful contribution to the Government’s apprenticeship program where organisations meet the turnover and other thresholds, and would be grateful for an update on your work in this area.

Like many of my predecessors on both sides of the political divide, I believe that the independent sector can play a useful role in adding capacity, promoting innovation and offering patients choice. However, if the sector is to partner with the NHS and benefit from our world-leading medical training, we need urgent assurances that you will get your house in order on quality and safety, as well as a commitment to take rapid action to match the NHS’s world-recognised progress on transparency. I would therefore ask you to provide a response to this letter - with clear actions set out - within two weeks.

Jeremy Hunt