The Royal College of Surgeons (RCS) is calling for independent hospitals to collect and publish equivalent data to that which the NHS routinely provides on patient safety and clinical audits.
The RCS has published a position statement today (10 April) setting out the changes to standards in the independent sector it believes are required to prevent a repeat of the harm caused by rogue breast surgeon, Ian Paterson.
While progress has undoubtedly been made to improve the collection and publication of data in the independent sector, key issues remain. Further regulatory alignment is needed to bring independent sector hospitals’ reporting requirements for patient safety and outcomes data in line with the NHS.
Professor Derek Alderson, President of the Royal College of Surgeons, said:
“The surgical community was deeply shocked by the case of Ian Paterson, the surgeon convicted of intentionally wounding patients by carrying out unnecessary breast surgery operations.
“While the vast majority of doctors perform their work to a high standard with the utmost care for their patients, the case of Ian Paterson highlights the need for an urgent review of how we assure safety standards in the independent sector.
“There is no doubt that Ian Paterson was a rogue individual. That said, the entire healthcare sector must do more to prevent someone like him from ever causing harm again. This starts with being able to collect and analyse good quality patient safety and outcomes data. There must be stronger oversight and protection for patients, regardless of whether they have their operation in an NHS hospital or in the independent sector.”
Although the independent sector has a duty to report data around unexpected deaths, never events and serious injuries directly to the Care Quality Commission (CQC), the data is not routinely published by the CQC. The RCS says this needs to change.
The RCS positon statement also points out that the independent sector doesn’t yet have a data set equivalent to Hospital Episode Statistics – the dataset that publishes how many and what procedures have happened in the NHS – although discussions are occurring between Private Healthcare Information Network (PHIN) and NHS Digital to enable independent sector data to be included in these statistics.
The RCS says that the independent sector has to date not been enabled to contribute to the majority of national clinical audits that collect data on care outcomes, including cancer audits, despite the fact that many independent providers regularly offer cancer treatment. The RCS has been working with the Healthcare Quality Improvement Partnership (HQIP) and IHPN to review which existing national clinical audits the independent sector can contribute to and the barriers that need to be overcome.
Currently, the independent sector is able to contribute to the National Joint Registry (NJR) as it is funded by subscriptions paid by both NHS hospital trusts and private hospitals and clinics implanting prostheses, as well as by implant manufacturers. HQIP and IHPN plan to explore how the NJR works in the independent sector and pilot independent sector involvement in the cataract, breast cancer and possibly prostate cancer audits.
The RCS is also calling for more robust clinical governance procedures in the independent sector to cover the monitoring of consultants’ practising privileges and scope of practice, and better sharing of information about consultants’ performance between the NHS and independent sectors, particularly for the purposes of appraisal and revalidation. The RCS’s position is supported by the Independent Healthcare Providers Network (IHPN), the representative body for independent sector healthcare providers.
Other RCS recommendations for assuring standards in the independent sector are:
• All new surgical procedures and devices used in either the independent or NHS sectors should be registered, with related data collected in the appropriate national audits, before they are routinely offered to patients. This could be supported by national guidelines on the introduction of new procedures and technologies.
• Robust clinical governance procedures should be streamlined across the independent sector to enable consistently effective monitoring of consultants’ practising privileges. This should be supported by a clearer remit for Medical Advisory Committees to ensure they are better able to advise on patient safety standards.
• The appraisal process underpinning the medical revalidation system should be reviewed to improve the sharing of information about a doctor’s performance between the independent and NHS sectors.
• A single dataset or repository about a consultant’s practising privileges, indemnity cover, scope of practice, identity of Responsible Officer and appraisal status should be accessible to all independent and NHS hospitals where they work, to enable prompt action in response to concerns about a doctor’s performance.
• Multi-disciplinary team (MDT) working in the independent sector should be reviewed to ensure it includes arrangements for information sharing between the independent and NHS sectors.
• There should be appropriate service level agreements between independent hospitals and local NHS trusts for critical care support, along with robust on-call and emergency cover arrangements for surgeons and anaesthetists within independent hospitals to ensure continuity of care if patients experience post-operative complications.
A recent RCS position paper, Surgical training in the independent sector, outlined concerns that the transfer of a substantial volume of NHS work to the independent sector has negatively impacted surgical trainees, through a loss of training opportunities and a subsequent decrease in morale. Today’s position statement suggests funding is needed to encourage the independent sector to deliver more training. The RCS says this could take place in a tariff based system where the funding follows the patient, instead of hospitals receiving a block grant.
In order to improve surgical training opportunities in the NHS-funded independent sector, a national framework should be established to ensure consistent standards of training, streamlined funding and indemnity arrangements, and compliant hospital rotas.
The RCS has received endorsement for the recommendations in its position paper from the Academy of Medical Royal Colleges. The Academy’s Council has recognised that these standards would and should be applicable across different medical specialties operating in the independent sector.