• NHS Partners Network says the independent sector will improve on safety at a rapid pace
  • It has called for mandatory insurance cover for private clinicians and a clinical negligence taskforce
  • NHS organisations are sometimes ‘unwilling’ to sign agreements for patient transfers

Independent sector hospitals are “willing to learn and improve” and will do so faster than NHS providers, one of their national representatives has argued in response to concerns about safety. 

In an interview with HSJ, Howard Freeman, the NHS Partners Network medical director and a former GP, defended independent sector hospitals record on safety and rejected suggestions that the sector “cherry picked” profitable patients as an “unfair characterisation”.

He said the sector had “moved on” from the days of private companies running hotel facilities for clinicians to operate from, although he said the organisation was not opposed to “practising privileges” whereby consultants are not employed by providers, but use their hospitals.

Dr Freeman claimed the NHS was sometimes not willing to work with the independent sector, saying that NHS providers often refused to sign agreements about when and how patients are transferred from private hospitals.

His comments follow warnings by the Care Quality Commission in April about safety risks in the sector, and a warning this month from health and social care secretary Jeremy Hunt that the sector must get its house in order on quality and safety.

Responding to Mr Hunt’s challenge the NHS Partners Network, a trade body representing independent providers delivering NHS funded care, said it wanted the government to establish a clinical negligence taskforce, to understand how negligence payments work across both sectors, and to ensure providers are “fairly compensated”.

It also called for mandatory contractual insurance cover for practising clinicians; with the aim of preventing insurers withdrawing cover as happened in the case of rogue breast surgeon Ian Paterson, who was jailed for 20 years in 2017.

Dr Freeman said: “Of the [private] hospitals where the CQC found some issues, when they were re-inspected over half had improved. That shows two things. It shows speed… and it shows wanting to improve.

“The one thing I have learned about the independent sector is it moves much faster than the NHS.”

Dr Freeman, who was a GP for more than 35 years, said the CQC report and letter from the secretary of state “has made the sector reflect very carefully on what it does”.

He said: “It has brought [safety] into sharper focus and made [the sector] think very carefully and it is doing something. The sector tends to think and then do. The lever is much easier to pull than in the public sector.”

Addressing the main concerns raised by the CQC and Mr Hunt about critical care and deteriorating patients who are transferred to the NHS, Dr Freeman said it would be unsafe for private hospitals to operate their own critical care units.

“You have to select patients where you think in advance they aren’t going to need those facilities. That is no different to the NHS, it is exactly what the NHS does. When someone unexpectedly deteriorates how many people are transferred from district general hospitals because they can no longer be coped with?

“It is not about cherry picking. The independent sector does about 500,000 elective procedures a year, 7 per cent of the total. Those have got to be done safely so you cannot take someone where the anaesthetic risk is so great you can’t deal with it.

“We need to remember that all of the people who are being treated as NHS patients in independent hospitals are entitled to NHS care. Small ICUs [as they would be in independent hospitals] are simply not safe.”

On the issue of transfer arrangements between hospitals, he said: “It takes two to tango and quite often independent sector providers tell me they do have some difficulties with local acute trusts who are not as keen to set up a [service level agreement].

“The ideal should be that there should always be a transfer arrangement.”

He said the Partners Network did not “have a view” about whether consultants operating with practising privileges should become employees – a status which some private providers have argued means that they are not liable.

“One of the things we are asking for is mandatory contractual indemnity insurance. One of the issues with Paterson was the fact that the insurer removed their cover and that can’t be right,” he said.

He said this would be a similar model to the NHS where the costs of negligence are paid by NHS Resolution as the insurer, not the provider organisation itself.