Clinical governance in private hospitals

‘How safe is your operation’ (BBC Panorama, 16.10.17) questions safety of surgical procedures in private sector.

Prof. Wishart, CMO at Check4Cancer discusses whether failures in clinical governance are restricted to the private sector.

 ‘How safe is your operation’ (BBC Panorama, 16.10.17) has questioned the safety of having surgical procedures in the private sector. This is not surprising given the recent criminal and civil litigation of Ian Paterson, the Birmingham-based breast surgeon, for harm caused to hundreds of patients over an 18-year period. Many viewers however, might have been misled into thinking that the failures of clinical governance and lack of outcome data as presented in this programme are restricted only to the private sector. In the case of Paterson these failures extended across both NHS and private sectors, with a lack of communication between senior management on both sides, and it is too simple to conclude that the private sector may be less safe as there is less data available. In fact, as a consultant breast surgeon I am aware that most NHS breast units do not record their local recurrence or survival data, both key outcome measures in my specialty. It is clear to me that many surgical specialties require to improve data collection so that patients can be reassured that they are in safe hands, whether as a NHS or private patient.

Since the introduction of annual NHS appraisal for all consultants from 2001 onwards, private hospitals have relied on the NHS appraisal summary to ensure the fitness to practice of consultant surgeons who see private patients at their facility. The Kennedy Report highlighted many failing in the NHS appraisal of Ian Paterson from 2001-2011, with little evidence of a formal appraisal process, and as a result the private hospitals where he worked received little more than a letter to say that the appraisal had been satisfactory. While I agree that the transfer of the appraisal summary from NHS to private sector should continue, my own view is that the private healthcare providers should also introduce their own appraisal or performance development process that is focused only on that consultant’s private practice. If combined with a random case notes review, much of Paterson’s malpractice would have come to light sooner.

Strong clinical governance of any clinical service relies on accountability of those managing and delivering that service, as well as audit data to ensure that the service is safe and effective. I will leave the issue of vicarious liability, and whether private hospitals should be accountable for any substandard care provided by consultants who have practising privileges in that hospital, to the legal profession. However, I think the time has come for insurers and healthcare providers to take more responsibility to ensure that their insured members treated in private hospitals receive clinical best practice by auditing clinical pathways. To address this failing, my own company, Check4Cancer, has introduced a national network of One Stop diagnostic breast clinics through our BreastHealth UK brand, with audit of the diagnostic process including breast imaging performed and biopsy results. This pathway is now being used by several major UK PMI companies as well as self-funding patients, and a similar protocol for skin cancer diagnosis has now been established by SkinHealth UK.

The Calman-Hine report (1995) established the infrastructure for the creation of cancer units and cancer centres in order to ensure that best practice is available to all cancer patients. More than twenty years later there is still much to do in both NHS and private sectors to level the playing field, and ensure that clinical excellence is available to all not just the few.

Professor Gordon Wishart

Chief Medical Officer of Check4Cancer

Professor of Cancer Surgery at Anglia Ruskin University