Patient Safety and Private Hospitals. The Known and Unknown Risks

auenL safeLy ln prlvaLe
hosplLals - Lhe known and

Lhe unknown rlsks
August 2014
1he Centre for nea|th and the ub||c Interest
(CnI) |s an |ndependent th|nk tank comm|ued
to hea|th and soc|a| care po||c|es based on
accountab|||ty and the pub||c |nterest.
1he Centre seeks to frame the po||cy debate |n a way that |s ev|dence-based and open and
access|b|e to c|nzens.
1he authors
1hls reporL was produced by rofessor Colln Leys and rofessor 8rlan 1o.
rofessor Co||n Leys
Colln Leys ls an emerlLus professor aL Cueen's unlverslLy, Canada, and an honorary professor aL ColdsmlLhs,
unlverslLy of London. Slnce 2000 he has wrluen exLenslvely on healLh pollcy.
rofessor 8r|an 1oh
LducaLed aL Lhe unlverslues of LancasLer, LxeLer, Cambrldge and Cardl 8rlan 1o ls Lhe rlnclpal of 8lsk
arLnershlps, LmerlLus rofessor of auenL SafeLy aL CovenLry unlverslLy, vlslung rofessor of auenL
SafeLy aL 8rlghLon and Sussex Medlcal School, and holds several senlor advlsory posluons lncludlng
membershlp of Lhe World PealLh Crganlsauon's Luropean 8eglonal Advlsory Councll on pauenL safeLy
and healLhcare.
8rlan was Lhe rsL non-physlclan Lo chalr an exLernal lnqulry lnLo Lhe deaLh of a pauenL ln Lhe nauonal
PealLh Servlce. Pe was presenLed wlLh Lhe 8oyal College of 8adlologlsLs Clyn Lvans Memorlal LecLure
Medal for hls work on 'lnvolunLary auLomauclLy' and awarded an C8L for hls servlces Lo healLhcare ln Lhe
2010 Cueen's 8lrLhday Ponours LlsL.
ubllshed by CPl
Lmall: |nfoQchp|.org.uk
www.chp|.org.uk
anent safety |n pr|vate hosp|ta|s - the known and the unknown r|sks
3
Contents
Lxecunve summary 4
Introducnon 8
What treatments do pr|vate hosp|ta|s prov|de to panents and
what |s the re|anonsh|p between these hosp|ta|s and the NnS? 10
What |s known about morta||ty rates and ser|ous panent safety
|nc|dents |n pr|vate hosp|ta|s? 13
What are the known r|sk factors |n pr|vate hosp|ta|s? 1S
What |nformanon |s pub||c|y ava||ab|e to panents and
comm|ss|oners on the qua||ty of care |n pr|vate hosp|ta|s? 23
Conc|us|ons and recommendanons 26
keferences 29
4
Lxecunve summary
1here are 1.61 mllllon admlsslons Lo prlvaLe hosplLals for surglcal procedures
each year ln Lhe uk. A quarLer of Lhese are now funded by Lhe nPS. ?eL llule ls
known abouL Lhe quallLy and safeLy of care provlded Lo Lhese pauenLs, due Lo a
dearLh of lndependenLly verlable performance daLa. 1he lack of rellable daLa
means LhaL regulaLors are unable Lo assess Lhe rlsk of harm posed Lo pauenLs ln
Lhese hosplLals, and pauenLs are unable Lo make lnformed cholces abouL where
Lo recelve Lhelr care.
1hls reporL seLs ouL whaL ls known abouL Lhe rlsks, buL also whaL remalns
unknown. 1hrough a revlew of Care CuallLy Commlsslon (CCC) lnspecuon
reporLs lnLo prlvaLe hosplLals, daLa from nauonal cllnlcal audlLs, lreedom of
lnformauon requesLs and parllamenLary quesuons we found Lhe followlng:
!"#$%%$&'% )*&# +*$,-./ 0&%+$.-1% .& .0/ 234
- rlvaLe hosplLals now recelve 28 of Lhelr lncome from Lreaung nPS
pauenLs. 1hey also rely on nPS hosplLals Lo LreaL many of Lhose who
develop compllcauons whllsL belng LreaLed ln prlvaLe hosplLals. Around
6,000 pauenLs a year are admlued Lo Lhe nPS from prlvaLe hosplLals,
alLhough we have noL been able Lo esLabllsh Lhe reasons behlnd Lhese
admlsslons, nor Lhe cosL Lo Lhe nPS.
5'/6+/7./" "/-.0% -'" %/*$&8% $'98*$/% $' +*$,-./
0&%+$.-1%
- 8eLween CcLober 2010 and Aprll 2014, 802 unexpecLed deaLhs and 921
serlous ln[urles were reporLed by prlvaLe hosplLals. 8ecause of Lhe llmlLed
reporung requlremenLs for prlvaLe hosplLals we are unable Lo sLaLe wheLher
Lhese deaLhs and ln[urles should be a cause for concern. We do know LhaL
compared Lo nPS hosplLals, prlvaLe hosplLals malnly LreaL pauenLs who
are 'low rlsk' pauenLs - Lhose who are less llkely Lo develop compllcauons
followlng surgery.
5ite ond foci/ines of privote hospito/s
- MosL prlvaLe hosplLals are slgnlcanLly smaller Lhan nPS hosplLals and do
noL have lnLenslve care beds Lo LreaL pauenLs lf compllcauons arlse. Less
Lhan half of Lhe hosplLals provldlng cosmeuc surgery ln 2010 - mosL of
whlch were prlvaLe - had a fully-equlpped operaung deparLmenL. CCC
reporLs on prlvaLe hosplLals oen ldenufy problems wlLh faclllues or
equlpmenL whlch pose rlsks Lo pauenL safeLy.
S
5tognq orronqements in privote hospito/s
- 1he consulLanL surgeons and anaesLheusLs who work aL prlvaLe hosplLals
Lend Lo operaLe ln lsolauon from oLher medlcally qualled colleagues.
unllke Lhe slLuauon ln nPS hosplLals Lhere are no Lralnee surgeons presenL
Lo observe Lhelr work and asslsL Lhem, and Lhey cannoL rely on Lhe poLenual
supporL of any senlor colleagues on Lhe slLe. osL-operauve care ls normally
Lhe lmmedlaLe responslblllLy of relauvely [unlor 8esldenL Medlcal Cmcers.
lurLher, a 2012 lnvesugauon of Lhe resusclLauon of pauenLs followlng ln-
hosplLal cardlo-resplraLory arresL found LhaL ouL of Lhe 132 prlvaLe hosplLals
whlch responded Lo Lhe enqulry, 14 had no dedlcaLed resusclLauon Leam.
kecord-keepinq
- 1here ls also evldence from CCC lnspecuon reporLs LhaL some pauenL
records are noL always kepL ln Lhe hosplLal where Lhey are belng LreaLed buL
lnsLead o-slLe wlLh Lhe consulLanL. 1hls has been ldenued as poor pracuce
and a rlsk Lo pauenLs lf someLhlng goes wrong.
c/inico/ qovernonce
- 8ecause prlvaLe hosplLals do noL employ Lhe surgeons and anaesLheusLs
who operaLe aL Lhem a dlerenL Lype of cllnlcal governance exlsLs from
LhaL whlch operaLes ln Lhe nPS. A Medlcal Advlsory Commluee - whose
members are drawn from, and usually elecLed by, Lhe consulLanLs who
operaLe aL Lhe hosplLal - ls responslble for ensurlng LhaL only surgeons who
meeL Lhe requlred sLandards are granLed 'pracuslng prlvlleges' Lo operaLe
aL Lhe hosplLal. 1he consuLuuon and responslblllues of Medlcal Advlsory
Commluees are noL seL ouL ln law, buL Lhey can remove Lhe pracuslng
prlvlleges of consulLanLs lf lssues of concern come Lo llghL.
- erformlng Lhls role can be dlmculL glven LhaL Lhere can be well over 100
dlerenL consulLanLs who have pracuslng prlvlleges ln a small 30 Lo 30-bed
prlvaLe hosplLal, and conlcLs of lnLeresL can arlse. 1he recenL case of lan
aLerson, who performed poLenually dangerous surgery on pauenLs aL
Lwo prlvaLe hosplLals, and one procedure he was noL qualled Lo perform,
ralses serlous quesuons abouL Lhe emcacy of Lhese cllnlcal governance
arrangemenLs.
!,-$1-:$1$.; &) +/*)&*#-'7/ "-.-
- 1he Compeuuon and MarkeLs AuLhorlLy recenLly found LhaL Lhe daLa
avallable on Lhe performance of prlvaLe hosplLals for pauenLs was 'poor'
and 'lnsumclenL Lo promoLe compeuuon beLween prlvaLe healLhcare
faclllues.' 1he CCC has sLaLed LhaL lL 'currenLly has access Lo relauvely llule
lnformauon LhaL relaLes Lo prlvaLe healLhcare'. 1he lnformauon whlch ls
avallable ls slgnlcanLly less comprehenslve Lhan LhaL whlch ls avallable
for nPS hosplLals, and ls collaLed and publlshed by Lhe prlvaLe healLhcare
lndusLry lLself, raLher Lhan by an lndependenL body.
6
- ln complllng Lhls reporL we soughL Lo nd on Lhe nPS Cholces webslLe
Lhe publlshed CuallLy AccounLs (slgned sLaLemenLs of Lhe quallLy of care
provlded Lo nPS pauenLs) for nlne ma[or prlvaLe hosplLal provlders. 1hls ls
a legal requlremenL under Lhe PealLh AcL 2009 for all hosplLals whlch LreaL
nPS pauenLs. Powever we were unable Lo do so for all of Lhem, and we
were unable Lo deLermlne wheLher any regulauons have been breached
ln falllng Lo le Lhese AccounLs. WhllsL nPS hosplLals are requlred Lo have
Lhelr AccounLs lndependenLly audlLed, Lhe same does noL apply Lo prlvaLe
hosplLals. 1he reporL also nds LhaL concerns have been expressed abouL
prlvaLe hosplLal paruclpauon ln nauonal cllnlcal audlLs.
kecommendanons:
ln order Lo address Lhe above rlsks and Lhe lack of lnformauon Lhe reporL
makes elghL recommendauons.
I|rst, prlvaLe provlders should be sub[ecL Lo exacLly Lhe same requlremenLs
Lo reporL pauenL safeLy lncldenLs (lncludlng morLallLy daLa) as nPS LrusLs and
foundauon LrusLs. All of Lhe lnformauon should be publlshed ln Lhe same way
as lL ls for nPS provlders and Lhls should be a requlremenL of reglsLrauon wlLh
Lhe CCC.
Second, prlvaLe hosplLals should be requlred Lo reporL on Lhelr performance ln
Lhe same way as nPS provlders. 1he PealLh and Soclal Care lnformauon CenLre,
raLher Lhan Lhe prlvaLe healLhcare lndusLry, should be Lasked wlLh maklng Lhls
daLa avallable Lo pauenLs and commlssloners Lhrough nPS Cholces or anoLher
dedlcaLed pauenL lnformauon webslLe. 1he requlremenLs seL ouL ln Secuon 8
of Lhe PealLh AcL 1999 for all provlders of nPS servlces Lo publlsh Lhelr CuallLy
AccounLs on Lhe nPS Cholces webslLe should be properly enforced by Lhe
governmenL and all CuallLy AccounLs should be exLernally audlLed, noL [usL
Lhose produced by nPS hosplLals.
1h|rd, Lhe remlL of Lhe arllamenLary and PealLh Servlce Cmbudsman should
be exLended Lo cover Lhe whole prlvaLe healLhcare secLor. 1he scope of Lhe
lreedom of lnformauon AcL should also be exLended Lo cover prlvaLe hosplLals
ln respecL of anyLhlng relaLed Lo Lhe LreaLmenL of nPS pauenLs.
Iourth, glven Lhe falllngs deLecLed by numerous CCC lnqulrles and Lhe aLerson
case, Lhe cllnlcal governance of lndependenL hosplLals needs Lo be sub[ecL Lo
a wlder revlew by Lhe CCC Lo deLermlne wheLher Lhe currenL arrangemenLs
are eecuve ln proLecung pauenLs. 1he revlew should cover Lhe duues and
powers of Medlcal Advlsory Commluees as well as Lhe duues and powers of
Lhe hosplLal dlrecLor ln relauon Lo pauenL safeLy. ln addluon, ln order Lo reduce
Lhe poLenual for conlcLs of lnLeresL beLween cllnlclans, owners, and pauenLs,
Medlcal Advlsory Commluees should have exLernally appolnLed cllnlcal and lay
members wlLh no connecuon Lo Lhe hosplLals concerned. 1he responslblllues
and consuLuuon of Medlcal Advlsory Commluees should be made sLaLuLory.
7
I|hh, full paruclpauon ln all nauonal cllnlcal audlL and daLa collecuon
programmes should be a requlremenL for reglsLrauon wlLh Lhe CCC.
S|xth, lL ls lmporLanL LhaL pauenLs are made aware of Lhe dlerenL rlsk facLors
beLween belng LreaLed ln a small prlvaLe hosplLal and a much larger nPS
hosplLal. lor pauenL consenL Lo be lnformed consenL, Lhe consenL forms glven
Lo pauenLs aL prlvaLe hosplLals should deLall noL only Lhe rlsks lnherenL ln Lhe
procedure belng oered buL also any LhaL sLem from Lhe dlsuncuve naLure of
Lhe faclllues, equlpmenL and sLamng of Lhe hosplLal.
Seventh, Lhe regulauons governlng Lhe provlslon of care ln hosplLals need
Lo lnclude some whlch are prlvaLe hosplLal-speclc and unamblguous. ln
parucular Lhere should be an on-slLe reglsLrar-level surgeon or docLor qualled
ln each speclalLy for whlch pauenLs are LreaLed, and nurses wlLh quallcauons
ln Lhe same speclalues, and arrangemenLs for an anaesLheusL Lo be on call. lL
should also be a requlremenL LhaL all pauenL records are kepL on Lhe ward.
L|ghth, glven LhaL Lhere are some 6,000 admlsslons Lo nPS hosplLals from
prlvaLe hosplLals every year a revlew should be carrled ouL by Lhe ueparLmenL
of PealLh of Lhe naLure and cosL of Lhese admlsslons.
Many of Lhe recommendauons made here have been made prevlously ln oLher
lnqulrles or reporLs, lncludlng by Lhe Pouse of Commons PealLh Commluee
and Lhe nPS Medlcal ulrecLor, buL have noL been acLed upon. Clven whaL
ls now consldered good pracuce, Lhe lack of any clear plcLure of Lhe rlsks Lo
pauenLs ln prlvaLe hosplLals ouLllned ln Lhls reporL suggesLs LhaL acuon on
Lhose recommendauons ls overdue.
8
Introducnon
1. 1he role played by prlvaLe hosplLals ln Lhe uk healLhcare sysLem has changed
slgnlcanLly ln Lhe lasL Len years, wlLh greaLer rellance on prlvaLe hosplLals Lo
provlde surglcal care and LreaLmenL for nPS pauenLs. Slnce 2004 Lhe amounL
spenL by Lhe nPS on LreaLmenL for pauenLs ln prlvaLe hosplLals has quadrupled,
Lo Lhe polnL where Lhe nPS ls now Lhe second largesL source of lncome for Lhe
prlvaLe secLor aer prlvaLe medlcal lnsurance. Cf an esumaLed 1.61 mllllon
admlsslons for surglcal procedures ln uk prlvaLe hosplLals ln 2013, 420,000
were esumaLed Lo be funded by Lhe nPS.
1

2. 1he secLor ls domlnaLed by ve ma[or hosplLal chalns, buL unllke Lhe prlvaLe
hosplLal secLor ln many oLher counLrles lL ls characLerlsed by small faclllues and
relles on Lhe nPS Lo provlde Lhe hlghly skllled healLhcare professlonal needed
Lo run lLs buslness. ln 2013 Lhere were 463 prlvaLe acuLe hosplLals ln Lhe uk.
201 of Lhese had overnlghL beds enabllng Lhem Lo oer surgery requlrlng
lnpauenL sLays. AparL from cenLral London, where Lhere are elghL prlvaLe
hosplLals wlLh an average of 137 beds each, prlvaLe hosplLals ln Lhe resL of Lhe
uk are very small, wlLh beLween 30 and 30 beds each ln 2013
2
. lor comparlson
Lhe number of beds ln a Lyplcal nPS general acuLe hosplLal ranges from around
300 Lo over 1,000.
3
1he greaLer parL of Lhe care provlded ln Lhese hosplLals ls
surglcal. 1he surgeons and anaesLheusLs who do Lhe surgery are normally noL
employed by Lhe hosplLals buL lnsLead are granLed 'pracuslng prlvlleges' aL
Lhem and work ln a self-employed capaclLy. AlmosL all of Lhem are consulLanLs
aL nearby nPS hosplLals, worklng prlvaLely ln Lhelr non-nPS hours.
3. 1he avallable daLa on Lhe performance and quallLy of care ln prlvaLe hosplLals,
however, are very llmlLed compared Lo Lhe daLa avallable for nPS hosplLals.
1hls lack of robusL and rellable daLa has Lwo maln consequences. llrsL, lL
prevenLs a proper assessmenL of Lhe naLure of rlsk ln healLhcare semngs. As
has been shown by recenL lnvesugauons of falllngs aL nPS hosplLals (mosL
noLably Lhe lrancls 8eporL on Mld SLaordshlre nPS loundauon 1rusL and Lhe
keogh revlew of 14 nPS LrusLs ln 2013), accuraLe and accesslble performance
daLa are cruclal lf Lhe rlsks Lo pauenLs are Lo be addressed by commlssloners
and regulaLors of healLhcare. 1hls concluslon has been endorsed by Lhe 8erwlck
8evlew of pauenL safeLy.
4
?eL as Lhe Care CuallLy Commlsslon has polnLed ouL,
'1he CCC currenLly has access Lo relauvely llule lnformauon LhaL relaLes Lo
prlvaLe healLhcare compared Lo some of Lhe oLher secLors LhaL lL regulaLes'.
3
4. Second, lf pauenLs, or commlssloners acung on behalf of nPS pauenLs, are
Lo make lnformed cholces abouL whlch hosplLals oer good LreaLmenL Lhey
musL have access Lo rellable performance daLa from auLhorlLauve sources. 1he
'lnformauon asymmeLrles' whlch exlsL ln healLhcare - Lhe dlmculLy LhaL pauenLs
and commlssloners have ln deLermlnlng wheLher a healLhcare provlder ls llkely Lo
provlde hlgh quallLy LreaLmenL aL a reasonable cosL - means LhaL Lhe avallablllLy
of robusL performance daLa produced by an auLhorlLauve source ls a necessary
condluon for cholce Lo be exerclsed, and for healLhcare markeLs Lo work.
Cf an esumaLed 1.61
mllllon admlsslons for
surglcal procedures ln
uk prlvaLe hosplLals
ln 2013, 420,000
were esumaLed Lo be
funded by Lhe nPS
9
S. As Lhere ls very llule llLeraLure on prlvaLe hosplLals anywhere ln Lhe uk Lhls
reporL alms Lo seL ouL whaL ls known abouL Lhem, lncludlng Lhelr relauonshlp
wlLh Lhe nPS, and areas of rlsk LhaL have been ldenued as belng speclc Lo Lhe
operauon of prlvaLe hosplLals. lL also seeks Lo ouLllne whaL ls noL known. lL uses
daLa from Lhe nauonal Condenual Lnqulry lnLo erloperauve ueaLhs (nCLCu)
- Lhe mosL auLhorlLauve source of survey daLa on Lhe LreaLmenL of pauenLs
who have undergone surgery ln Lhe uk - and from lnspecuon reporLs on prlvaLe
hosplLals by Lhe CCC ln Lngland, supplemenLed by responses Lo lreedom of
lnformauon requesLs and answers Lo arllamenLary Cuesuons.
6. lL reveals a number of speclc rlsks for pauenLs recelvlng care ln prlvaLe
hosplLals, compared Lo nPS hosplLals, and makes a serles of recommendauons
whlch healLh care regulaLors should conslder when developlng Lhelr
approaches Lo Lhe regulauon of Lhls secLor. Some of Lhese recommendauons,
such as LhaL prlvaLe hosplLals should have Lo publlsh Lhe same daLa as nPS
hosplLals, and have cllnlcal governance arrangemenLs underplnned by law, have
been made by prevlous lnqulrles lnLo pauenL safeLy ln prlvaLe hosplLals, buL
Lhey have yeL Lo be lmplemenLed.
7. 1he reporL hlghllghLs Lhe currenL lack of accuraLe and robusL performance daLa
for prlvaLe hosplLals whlch makes an assessmenL of Lhe rlsks Lhey presenL hard
Lo esLabllsh. We make a number of recommendauons Lo address Lhls declL.
10
What treatments do pr|vate hosp|ta|s prov|de
to panents and what |s the re|anonsh|p
between these hosp|ta|s and the NnS?
*
8. As of !une 2013 Lhere were an esumaLed 1.61 mllllon admlsslons a year for
surglcal procedures ln uk prlvaLe hosplLals.
6
1he range of LreaLmenLs provlded
ln Lhese hosplLals ls slgnlcanL, as 1able 1 shows. 1helr sLrong emphasls on
elecuve or planned surgery reecLs one of Lhe maln reasons why people
enuLled Lo be LreaLed by Lhe nPS have hlsLorlcally chosen Lo be LreaLed
prlvaLely, namely Lo be LreaLed more qulckly (Lhe oLher prlnclpal reasons belng
Lo be LreaLed by a consulLanL of Lhelr cholce, and Lo have a prlvaLe room).
rlvaLe pauenLs who pay for Lhemselves, or Lhe lnsurers of Lhose who have
lnsurance, have a conLracL wlLh Lhe prlvaLe hosplLal. nPS-funded pauenLs
LreaLed aL prlvaLe hosplLals remaln Lhe responslblllLy of Lhe nPS.
1ab|e 1: Spec|a|nes oered by pr|vate hosp|ta|s |n the Uk
Spec|a|ty 40-*/ &) 0&%+$.-1%
ogerinq the
%+/7$-1.;
40-*/ &) .&.-1
-"#$%%$&'%
{inponent ond doy
7-%/<
40-*/ &) .&.-1
revenue {inponent,
"-; 7-%/ -'"
outponent)
CbsLeLrlcs and gynaecology 93.4 7.6 6.9
Ceneral surgery 93.3 13.3 9.3
1rauma and orLhopaedlcs 93.0 27.0 30.3
AnaesLheucs 93.0 2.3 0.9
urology 91.6 6.7 4.1
CasLroenLerology 88.9 6.1 3.0
CphLhalmology 88.8 3.8 2.3
CLolaryngology 88.4 3.6 2.2
uermaLology 86.3 0.3 0.6
lasuc surgery 86.3 4.0 3.1
Cardlology 83.6 1.3 4.3
Ceneral medlclne 83.3 3.2 3.3
neurology 82.8 0.3 1.1
Cral and maxlllofaclal surgery 80.9 3.2 0.8
8heumaLology 80.9 0.1 0.3
Cllnlcal radlology 80.0 1.1 1.3
1oLal n/A 86.1 74.6
Source: Compeuuon and MarkeLs AuLhorlLy rlvaLe healLhcare markeL lnvesugauon: nal reporL
Aprll 2014 1able 3.2 page 3-12
* lndependenL SecLor 1reaLmenL CenLres or lS1Cs are noL covered ln Lhls reporL because Lhey operaLe
on a dlerenL basls from prlvaLe secLor acuLe hosplLals, employlng cllnlcal sLa lncludlng surgeons and
anaesLheusLs seconded from nPS hosplLals, Lo whlch some of Lhem are physlcally auached.
11
9. 1he relauonshlp beLween Lhe nPS and prlvaLe hosplLals has Lwo aspecLs. llrsL,
Lhe nPS relles lncreaslngly on prlvaLe hosplLals Lo LreaL nPS pauenLs. ln Lhe
lasL Len years Lhe number of nPS-funded admlsslons Lo prlvaLe hosplLals for
elecuve surgery has lncreased from 19,620 ln 2004-03 Lo 394,260 ln 2012-13,
prlmarlly referred by nPS hosplLals Lo meeL Lhe governmenL's walung ume
LargeL.
7
Cver Lhls perlod Lhe nPS's spendlng on prlvaLely-funded healLhcare
servlces has more Lhan quadrupled ln real Lerms, ln 2012, lL spenL 1.193 bllllon
on Lhe LreaLmenL of nPS pauenLs ln prlvaLe hosplLals, and Lhe nPS ls now
Lhe second blggesL source of revenue for prlvaLe hosplLals ln Lngland.
8
As Lhe
Compeuuon and MarkeLs AuLhorlLy has puL lL, 'Lhe growLh of nPS revenue has,
Lo some exLenL aL leasL, shelLered prlvaLe hosplLals from Lhe weak sLaLe of Lhe
prlvaLely pald for healLhcare secLor.'
9
1ab|e 2: Sources of fund|ng of pr|vate acute hea|thcare at pr|vate
hosp|ta|s 2012
Source of fund|ng ercentage kevenue
rlvaLe Medlcal Cover 33.1 2,397.9m
nPS 27.3 1,196.8m
Self ay 14.3 631.0m
Cverseas 3 130.6m
Source: rlvaLe AcuLe Medlcal Care 2013, Lalng and 8ulsson, p.13
10. 8ecause few prlvaLe hosplLals have faclllues for hlgh-rlsk pauenLs, ln mosL of
Lhem only low-rlsk nPS pauenLs (up Lo ASA 2, l.e. wlLh aL mosL a mlld sysLemlc
dlsease)
10
are accepLed for LreaLmenL.
11

11. 1he second aspecL of Lhe relauonshlp ls LhaL pauenLs who are LreaLed ln prlvaLe
hosplLals are someumes Lransferred Lo nPS hosplLals. 1hls usually happens
where compllcauons arlse followlng surgery, or where cerLaln forms of posL-
operauve care or rehablllLauon are noL funded by Lhe pauenL's prlvaLe medlcal
lnsurance or from Lhelr own resources.
12. 1he daLa LhaL are avallable, however, on how many pauenLs are admlued Lo
nPS hosplLals followlng LreaLmenL ln prlvaLe hosplLals, are llmlLed Lo whaL ls seL
ouL ln 1able 3. 1hls suggesLs LhaL on average around 6,000 admlsslons of Lhls
naLure occur each year. As Lhe daLa do noL glve Lhe reasons for Lhe admlsslons,
or wheLher compllcauons followlng surgery were Lhe cause of Lhe admlsslon,
or Lhe age or healLh sLaLus of Lhe Lransferred pauenLs, lL ls dlmculL Lo know
Lhe cosL of Lhls, or lLs lmpacL on nPS servlces. lor example, Lhe CovernmenL
has recenLly admlued LhaL no lnformauon ls held cenLrally on Lhe number of
pauenLs who are LreaLed ln nPS hosplLals as a resulL of problems resulung from
correcuve laser eye surgery provlded ln prlvaLe hosplLals - daLa whlch would
provlde valuable lnformauon on Lhe safeLy and emcacy of LhaL procedure.
12
13. lL ls also noL posslble Lo deLermlne from Lhe daLa ln 1able 3 Lhe exLenL of Lhe
rlsks posed, or wheLher Lhese Lrends oughL Lo requlre nPS commlssloners or
regulaLors Lo Lake sLeps Lo prevenL harm Lo pauenLs.
12
1ab|e 3: Count of hn|shed adm|ss|on ep|sodes for NnS prov|ders
where the source of adm|ss|on was a non-NnS run hosp|ta| for
the years 2003-04 to 2012-13 by adm|ss|on method*
ear L|ecnve Lmergency Cther 1ota|
2003-04 1,314 3,919 1,784 7,217
2004-03 1,362 3,341 1,622 6,723
2003-06 1,737 2,339 1,338 3,834
2006-07 1,637 2,647 1,466 3,730
2007-08 1,879 3,006 1,608 6,493
2008-09 1,868 2,443 1,661 3,974
2009-10 1,902 2,340 1,331 3,993
2010-11 1,302 2,138 1,331 3,191
2011-12 1,369 2,440 1,427 3,436
2012-13 1,697 2,622 1,748 6,067
Source: Pouse of Commons Wrluen Answer 6 lebruary 2014 Pansard column 370W
14. noneLheless Lhe daLa do suggesL LhaL Lhe nPS ls used by prlvaLe secLor hosplLals
as a 'provlder of lasL resorL', ralslng Lhe posslblllLy LhaL a form of 'moral hazard'
may exlsL ln LhaL prlvaLe hosplLals and Lhe consulLanLs operaung ln Lhem know
LhaL anoLher parL of Lhe sysLem wlll lf need be deal wlLh Lhe consequences of
any errors or shorLcomlngs ln Lhelr pauenLs' LreaLmenL. ln hls revlew of cosmeuc
surgery, for example, nPS Medlcal ulrecLor Slr 8ruce keogh, has commenLed
LhaL 'lL can be argued LhaL Lhe buslness model of cosmeuc surgery provlders
relles Lo some exLenL on Lhe nPS belng Lhere Lo acL as a safeLy neL Lo LreaL
cllnlcal compllcauons.'
13
1he nPS also bears slgnlcanL cosLs as a resulL of Lhls
relauonshlp, alLhough a full audlL of Lhe cosLs has never been underLaken.
!
* uenluons ln 1able 3:
- !"#"$%&' )'*"$$"+# &,"$+'&$- Lhe rsL perlod of ln-pauenL care under one consulLanL wlLhln one
healLh care provlder. Lplsodes are counLed agalnsL Lhe year or monLh ln whlch Lhe admlsslon eplsode
nlshes. 1he same ln-pauenL may have more Lhan one admlsslon wlLhln Lhe perlod.
- ./0 ,1+2"'&1$: one of Lhe followlng: Care 1rusL, loundauon 1rusL, rlmary Care 1rusL, nPS PosplLal
1rusL, nPS PosplLal 1rusL 1reaLmenL CenLre.
- 0+314& +5 )'*"$$"+#- where Lhe pauenL was lmmedlaLely prlor Lo admlsslon for example pauenLs
admlued from home and pauenLs Lransferred from anoLher hosplLal provlder or lnsuLuuon
- Assessloq qtowtb tbtooqb ume (lo-poueots) changes Lo Lhe gures over ume need Lo be lnLerpreLed
ln Lhe conLexL of lmprovemenLs ln daLa quallLy and coverage (parucularly ln earller years),
lmprovemenLs ln coverage of lndependenL secLor acuvlLy (parucularly from 2006-07) and changes ln
nPS pracuce. lor example, changes ln acuvlLy may be due Lo changes ln Lhe provlslon of care.
- 6'*"$$"+# *&7%+' ldenues how Lhe pauenL was admlued Lo hosplLal. Llecuve admlsslons lnclude
where Lhe pauenL was on a walung llsL and where Lhe admlsslon was booked or planned. Lmergency
admlsslons lnclude admlsslons vla A&L vla a C, vla 8ed 8ureau lncludlng Lhe CenLral 8ureau, vla
consulLanL ouL-pauenL cllnlc, and by oLher means. All admlsslon meLhods whlch do noL L ln Lo Lhe
above caLegorles, lncludlng maLernlLy relaLed admlsslons, have been caLegorlsed as 'oLher'.
0+314&- PosplLal Lplsode SLausucs (PLS), PealLh and Soclal Care lnformauon CenLre
1 1he keogh revlew clLed some daLa on Lhe cosLs borne by Lhe nPS of Lreaung pauenLs whose cosmeuc
surgery had gone wrong, 'surgeons aL Lhe Chelsea & WesLmlnsLer PosplLal ln London showed LhaL, over
a 13 monLh perlod, 12 pauenLs presenLed Lo A&L needlng LreaLmenL for compllcauons from cosmeuc
procedures. 1hls resulLed ln 34 ouLpauenL vlslLs and 66 lnpauenL nlghLs, cosung a LoLal of 43,000'
(para 3.22) hups://www.gov.uk/governmenL/uploads/sysLem/uploads/auachmenL_daLa/le/192028/
8evlew_of_Lhe_8egulauon_of_Cosmeuc_lnLervenuons.pdf
13
What |s known about morta||ty rates and
ser|ous panent safety |nc|dents |n pr|vate
hosp|ta|s?
1S. Cne of Lhe key lndlcaLors of Lhe safeLy and performance of any healLhcare
semng ls Lhe number of serlous ln[urles and unexpecLed deaLhs whlch occur
ln lL each year. 1hese daLa, when ad[usLed for Lhe populauon from whlch
pauenLs are drawn, as well Lhe case-mlx of Lhe pauenLs LreaLed (lncludlng
Lhelr age, healLh sLaLus and deprlvauon scores), can be used Lo develop an
lndlcaLor of safeLy and performance ln LhaL hosplLal. 1hls lndlcaLor ls known
as a 'sLandardlsed hosplLal morLallLy lndlcaLor'.
"
8ecenLly Lhese daLa - whlch
are avallable for every nPS hosplLal ln Lngland - were used as Lhe basls for
Lhe keogh revlew lnLo pauenL safeLy ln 14 hosplLal LrusLs whlch Lhe lndlcaLor
showed had hlgher Lhan expecLed deaLhs.
14
16. nPS hosplLals are requlred Lo reporL serlous lncldenLs (whlch lnclude ln[urles
Lo pauenLs and pauenL deaLhs) Lo Lhe CCC, MonlLor, commlssloners and Lhe
nauonal 8eporung and Learnlng SysLem (n8LS), whlch makes Lhese daLa
publlcly avallable on a hosplLal-by-hosplLal basls. rlvaLe hosplLals are requlred
Lo reporL all serlous lncldenLs Lo Lhe CCC and MonlLor, and for nPS-funded
pauenLs, Lo commlssloners, buL Lhey are noL requlred Lo reporL Lhem Lo Lhe
n8LS. AlLhough Lhe CCC does noL publlsh serlous lncldenLs reporLed by prlvaLe
hosplLals we were able Lo obLaln Lhrough Lhe lreedom of lnformauon AcL Lhe
aggregaLe daLa for all prlvaLe hosplLals reglsLered wlLh Lhe Commlsslon whlch
provlded surglcal LreaLmenL. 1hls ls seL ouL below ln 1able 4.
* '1he lndlcaLor ls Lhe rauo beLween Lhe acLual number of pauenLs who dle followlng hosplLallsauon aL Lhe
LrusL and Lhe number LhaL would be expecLed Lo dle on Lhe basls of average Lngland gures, glven Lhe
characLerlsucs of Lhe pauenLs LreaLed Lhere.' PealLh and Soclal Care lnformauon CenLre,
hup://www.hsclc.gov.uk/SPMl. See also ur losLer 1oolklL on sLandardlsed hosplLal morLallLy rauos
hup://drfosLerlnLelllgence.co.uk/wp-conLenL/uploads/2011/10/PSM8-1oolklL-verslon-6-
CcLober-2011.pdf
14
1ab|e 4: Nonhcanons for death of serv|ce user and other
|nc|dents for |ndependent hosp|ta| |ocanons reg|stered w|th the
Care ua||ty Comm|ss|on s|nce 1st Cctober 2010
*

Number of nonhcanons from |ndependent hosp|ta|s 1ota|
Deaths of serv|ce users Cther Inc|dents
ear Lxpected death
*
Unexpected
death
keason for
death not stated
Ser|ous |n[ury
2010 236 39 13 16 326
2011 988 220 18 130 1,336
2012 1,329 276 0 223 1,830
2013 1,088 197 3 403 1693
2014 242 70 1 147 460
1ota| 3,903 802 39 921 S66S
Source: lreedom of lnformauon requesL Lo CCC- daLa accessed on 17 Aprll 20141
17. lL ls noL posslble Lo sLaLe from Lhese daLa wheLher Lhese raLes of deaLh and
serlous ln[ury are slgnlcanL, as we do noL know ln whlch hosplLals Lhey
occurred, Lhe healLh sLaLus of Lhe pauenLs concerned, nor Lhe Lypes of
LreaLmenLs LhaL were belng provlded. lL ls also noL posslble Lo sLaLe wheLher
Lhe raLes are unusually hlgh or Lo be expecLed, nor wheLher Lhe noucauons
Lo Lhe CCC are compleLe and cover all deaLhs and serlous ln[urles. A furLher
shorLcomlng of Lhe daLa ls LhaL mosL pauenLs who develop llfe-LhreaLenlng
condluons ln prlvaLe hosplLals are Lransferred Lo an nPS hosplLal where Lhere
are lnLenslve care beds and speclallsL Leams capable of Lreaung Lhem, so LhaL
lf Lhey dle Lhelr deaLhs are recorded as deaLhs ln Lhe nPS hosplLal. 1hls could
mean LhaL Lhe morLallLy raLes of prlvaLe hosplLals are acLually hlgher Lhan
reporLed here, and Lhe morLallLy raLes for nPS hosplLals could lnclude deaLhs
whlch were Lhe resulL of procedures carrled ouL ln prlvaLe hosplLals.
18. 1he lack of lnformauon on Lhe 802 unexpecLed deaLhs and Lhe 921 serlous
ln[urles reporLed slnce 2010 Lhus reveals a general lack of knowledge abouL Lhe
performance and safeLy records of prlvaLe hosplLals, and Lhe lnablllLy of Lhe
publlc, parllamenL and regulaLors Lo properly assess Lhe rlsks posed.
* When lndependenL healLhcare provlders submlL a noucauon advlslng Lhe CCC of Lhe deaLh of a
pauenL, Lhey are requlred under Lhe regulauons Lo lnform Lhe CCC wheLher Lhey conslder Lhe deaLh was
expecLed or unexpecLed. 8egulauon 16 of Lhe Care CuallLy Commlsslon 8eglsLrauon 8egulauons sLaLes
LhaL Lhe deaLh musL be noued Lo CCC lf lL: 'cannoL, ln Lhe reasonable oplnlon of Lhe reglsLered person,
be aurlbuLed Lo Lhe course whlch LhaL servlce user's lllness or medlcal condluon would naLurally have
Laken lf LhaL servlce user was recelvlng approprlaLe care or LreaLmenL' hup://www.cqc.org.uk/slLes/
defaulL/les/documenLs/care_quallLy_commlsslon_reglsLrauon.pdf
1 1o avold Lhe rlsk of double counung we have excluded a handful of deaLhs and ln[urles LhaL have been
reporLed by provlder companles raLher Lhan by Lhe hosplLal where Lhey occurred.
lL ls noL posslble Lo
sLaLe from Lhese daLa
wheLher Lhese raLes
of deaLh and serlous
ln[ury are slgnlcanL,
as we do noL know ln
whlch hosplLals Lhey
occurred, Lhe healLh
sLaLus of Lhe pauenLs
concerned, nor Lhe
Lypes of LreaLmenL
LhaL were belng
provlded
1S
What are the known r|sk factors |n pr|vate
hosp|ta|s?
19. 1he nauonal Condenual Lnqulry lnLo erl-Cperauve ueaLhs (nCLCu)
13
does,
however, provlde some lnformauon abouL Lhe naLure of Lhese rlsks, and some
recenL CCC lnspecuon reporLs also provlde an auLhorlLauve source of lnformauon.
We seL ouL below Lhe varlous rlsk facLors whlch have been ldenued ln boLh
Lhese Lypes of reporL. Powever, we are agaln unable Lo correlaLe Lhese rlsk facLors
wlLh elLher Lhe deaLhs and serlous ln[urles reporLed above, or Lhe admlsslons Lo
nPS hosplLals from prlvaLe hosplLals, so as Lo bulld up an overall plcLure of rlsk
across Lhe secLor. As 8ox 1 shows, Lhe daLa publlshed by Lhe nCLCu also suers
from some llmlLauons because prlvaLe hosplLals have noL always complled wlLh
requesLs Lo Lake parL ln nCLCu enqulrles. ln addluon, CCC lnspecuons of prlvaLe
hosplLals whlch have focused closely on safeLy lssues have oen been underLaken
as a resulL of concerns broughL Lo Lhelr auenuon Lhrough a complalnL or a whlsLle-
blower, so Lhere may be oLher rlsks whlch have noL been deLecLed.
8ox 1: concerns obout privote hospito/ pornciponon in
nonono/ c/inico/ oudits
1here have been a number of lnsLances where Lhe lack of responses from
prlvaLe hosplLals Lo nCLCu surveys, and Lhe quallLy of responses LhaL have
been recelved, have caused concern. lor example:
1he nCLCu's 2003 overvlew reporL 8%+ 9,&1)7&$ 8%&#: noLed LhaL 'one
large lndependenL group lnformed nCLCu before Lhe sLudy sLarLed LhaL Lhey
were noL wllllng Lo paruclpaLe and Lhls accounLs for Lhe ma[orlLy [of Lhe 31
non-paruclpaung lndependenL hosplLals].' 93 of nPS hosplLals and 63 of
lndependenL hosplLals paruclpaLed.
1he same reporL also noLed LhaL Lhe responses showed LhaL 'ln Lhe
lndependenL secLor all sLa had recelved resusclLauon Lralnlng wlLhln Lhe
pasL 12 monLhs. Powever, ln Lhe plenary sesslon some advlsors expressed
reservauons abouL Lhls gure. Cf Lhe 23 consulLanL surgeons and
anaesLheusLs presenL aL Lhe plenary sesslon, only seven (30) had undergone
resusclLauon Lralnlng wlLhln Lhe prevlous 12 monLhs.'
16

lor nCLCu's 2010 enqulry lnLo care recelved by Lhe elderly, only 24 of
prlvaLe hosplLals reLurned Lhe organlsauonal quesuonnalre.
17

Commenung on Lhe 2013 nCLCu reporL on cosmeuc surgery Slr 8ruce keogh
noLed LhaL some provlders had 'falled Lo meeL Lhelr obllgauons Lo paruclpaLe
ln condenual enqulrles - only 32 responded Lo Lhe quesuonnalre -
suggesung LhaL Lhere ls a general lack of undersLandlng among some
provlders of Lhe lmporLance of such work ln ensurlng Lhe pauenL's safeLy.'
18
16
loci/ines ond equipment
20. Lven Lhough prlvaLe hosplLals underLake some complex surgery Lhelr faclllues can
presenL rlsks Lo pauenLs, parucularly lf Lhlngs go wrong. 1he maln rlsk ls due Lo Lhe
facL LhaL LhaL few of Lhe 201 prlvaLe hosplLals ln Lngland wlLh overnlghL beds have
lnLenslve care or 'level 3' beds. As 1able 3 shows ln relauon Lo prlvaLe hosplLals ln
London - Lhe besL-resourced ln Lhe counLry - Lhere are 83 level 3 lnLenslve care
beds ouL of a LoLal of 1318 overnlghL beds. lorLy of Lhem belong Lo Lwo hosplLals.
1ab|e S: Capac|ty |n pr|vate hosp|ta|s prov|d|ng |npanent serv|ces |n centra| London, 2011
nosp|ta| Cvern|ght beds 1heatres Consu|nng rooms Cr|nca| care beds
|eve| 3
Number Number Number Number
Aspen PlghgaLe PosplLal 28 1.8 3 3.8 12 2.8 0
0
8MI
8lackheaLh 69 4.3 4 3 21 4.9 0 0
llLzroy Square 16 1.0 1 1.3 7 1.6 0 0
London lndependenL 38 3.6 4 3 10 2.3 6 7.1
WeymouLh 10 0.6 4 3 0 0.0 0 0
1oLal 8Ml 133 9.6 13 16.3 38 8.8 6
7.1
nCA
Parley SLreeL Cllnlc 104 6.3 4 3 31 11.9 20 23.3
LlsLer PosplLal 74 4.6 4 3 31 7.2 2 2.4
London 8rldge PosplLal 111 7.0 7 8.8 36 13.0 8 9.4
orLland PosplLal 87 3.3 4 3 39 9.1 3 3.3
rlncess Crace PosplLal 114 7.2 8 10 38 8.8 4 4.7
WelllngLon PosplLal 226 14.2 11 13.8 20 4.7 20 23.3
nPS venLures uCLP 24 1.3 - - - - -
-
SL !ohn & SL LllzabeLh 49 3.1 3 6.3 36 8.4 0 0
klng Ldward vll's SlsLer Agnes 60 3.8 3 3.8 6 1.4 4 4.7
1he 8upa Cromwell 118 7.4 3 6.3 29 6.7 7 8.2
1he London Cllnlc 170 10.7 13 16.3 74 17.2 11 12.9
1oLal rlvaLe hosplLals 1318 82.8 80 430 83
Source: Compeuuon and MarkeLs AuLhorlLy rlvaLe healLhcare markeL lnvesugauon: nal reporL Aprll 2014
21. Accordlng Lo Lhe nCLCu, ouL of Lhe 138 prlvaLe hosplLals whlch performed
cosmeuc surgery ln 2010 only 24 had level 3 (lnLenslve care) beds,
19
and ouL
of 62 whlch dld barlaLrlc surgery (a LreaLmenL for Lhose seeklng welghL loss) ln
2012 only 17 had Lhem.
20
A quarLer of Lhose dolng barlaLrlc surgery had no level
2 (hlgh dependency) beds elLher. CuLslde London few prlvaLe hosplLals have
any level 3 beds.
22. Agaln, accordlng Lo Lhe nCLCu reporL lnLo barlaLrlc surgery more Lhan half of
all hosplLals dolng barlaLrlc surgery ln 2010 (of whlch 60 were prlvaLe) dld noL
have adequaLe lmaglng faclllues for morbldly obese pauenLs.
21
ln Lhe case of
cosmeuc surgery, whlch ls malnly done ln prlvaLe hosplLals, only 101 ouL of 226
hosplLals (44.6) had a fully-equlpped operaung deparLmenL.
22

17
23. As 8ox 2 shows, Lhe CCC has found LhaL Lhe faclllues and equlpmenL ln some
prlvaLe hosplLals posed poLenually serlous rlsks Lo pauenLs.
8ox 2: 1he sofety risks from equipment in privote
0&%+$.-1%
AL a prlvaLe hosplLal ln WorLhlng ln 2012 Lhe CCC found LhaL a pauenL
'susLalned a serlous ln[ury because of obsoleLe equlpmenL. SLa had ralsed
concerns abouL Lhe equlpmenL several monLhs before as lL was ouLdaLed
and spare parLs were no longer made for lL. 1he equlpmenL had feaLured
on Lhe hosplLal's rlsk reglsLer for several monLhs however lL had noL been
Laken ouL of acuon unul a person had been severely ln[ured by lL.'
23

ln Lhe same year aL a prlvaLe hosplLal ln 8aslngsLoke Lhe CCC reporLed LhaL
'hundreds of lLems' of porLable equlpmenL had noL been LesLed for over
Lwo years. '1he unLesLed lLems lncluded equlpmenL operaLed by hosplLal
sLa and used for Lhe care and LreaLmenL of people uslng Lhe servlces, and
so presenLed a poLenual rlsk Lo Lhe safeLy of boLh.'
24

ln anoLher hosplLal a surgeon lnslsLed, agalnsL Lhe ob[ecuons of Lhe LheaLre
sLa, on performlng surgery ln an ambulaLory care semng because of
problems wlLh Lhe maln operaung LheaLre faclllues, wlLh Lhe resulL LhaL
when Lhe pauenL suered a severe haemorrhage blood supplles could
noL be found ln good ume and Lhere was a serlous rlsk of Lhls and oLher
pauenLs dylng.
23
AL Lhe same hosplLal CCC lnspecLors reporLed LhaL
'a wrluen sLaLemenL from an anaesLheusL showed LhaL a pauenL had
been puL aL very serlous rlsk of deaLh or braln ln[ury because essenual
emergency equlpmenL was noL avallable ln Lhe operaung LheaLres'.
26
5tog
24. AnoLher dlsuncuve safeLy rlsk posed by surgery ln prlvaLe hosplLals sLems from
Lhe facL LhaL Lhey do noL usually employ surgeons or anaesLheusLs Lhemselves,
for surgery Lhey provlde only LheaLre nurslng sLa. 1he surgeons, almosL all
of whom are currenL or reured nPS consulLanLs, are responslble for ndlng
consulLanL anaesLheusLs Lo work wlLh Lhem.
2S. 1he rsL rlsk Lo whlch Lhls glves rlse comes from worklng alone. As Lhe 8oyal
College of Surgeons polnLs ouL, Lhere ls a cruclal dlerence beLween surgery
done ln prlvaLe hosplLals and LhaL done ln Lhe nPS: 'When a surgeon has
pauenLs under Lhelr care wlLhln Lhe nPS, Lhe pauenLs Lend Lo be looked aer
by a large Leam, lncludlng a varleLy of grades of Lralnees. Medlcal care ln Lhe
prlvaLe secLor ls generally dellvered enurely by Lhe consulLanL.'
27
1he Assoclauon
of AnaesLheusLs says Lhe same: 'racuslng anaesLhesla ln prlvaLe hosplLals
commonly lnvolves worklng ln lsolauon, oen belng Lhe only anaesLheusL ln an
operaung LheaLre sulLe or ln Lhe whole hosplLal.'
28
1hls means LhaL lf a problem
arlses durlng an operauon nelLher Lhe surglcal nor Lhe anaesLheuc consulLanL
has a [unlor colleague ln Lralnlng Lo provlde asslsLance, nor can Lhey call for
advlce or asslsLance from anoLher consulLanL, as would normally be Lhe case ln
an nPS hosplLal where several oLhers wlll Lyplcally be aL work nearby.
18
26. 8elaLed Lo Lhe facL of worklng wlLhouL Lralnee surgeons ln auendance ls Lhe
rlsk LhaL surgeons may noL follow safe pracuce as consclenuously as Lhey
would when worklng wlLh Lralnee colleagues ln an nPS LheaLre. 1he CCC has
found a number of lnsLances where Lhe WPC Surglcal SafeLy CheckllsL was noL
belng fully lmplemenLed ln Lhe prlvaLe hosplLals lL lnspecLed, even Lhough lLs
lmporLance for reduclng errors, when used properly, ls well esLabllshed.
"
lL has
also ldenued a number of cases where surgeons have vlolaLed baslc prlnclples
of safe pracuce, for example by falllng Lo wash Lhelr hands or remove Lhelr
waLches or [ewellery, even when asked by members of Lhe LheaLre sLa,
29
or
falllng Lo compleLe consenL forms
30
or Lo ensure LhaL Lhere ls a compleLe and
accuraLe record of Lhe operauon.
31
A lax safeLy culLure has been found Lo have
developed ln some prlvaLe hosplLals whlch can aecL anaesLheusLs Loo. ln one
prlvaLe hosplLal Lhe CCC found LhaL an anaesLheusL had covered Lwo LheaLre
llsLs slmulLaneously, rlsklng Lhe llves of Lwo seLs of pauenLs.
32

27. Modern safe pracuce also emphaslses Lhe vlLal lmporLance of Leam work, buL
ln prlvaLe hosplLals a Leam culLure, ln whlch all Lhe LheaLre sLa feel equally
parL of Lhe Leam, can be hard Lo bulld.
33
A small prlvaLe hosplLal may have y
or more surgeons wlLh pracuslng prlvlleges, and an equal number of dlerenL
anaesLheusLs, so Lhe leadershlp of Lhe Leam ln any one of lLs LheaLres changes
consLanLly.
!
8rlengs before surgery beglns, whlch are cruclal for eecuve
Leam work, can someumes be perfuncLory. Cne CCC reporL on a prlvaLe
hosplLal commenLed LhaL 'Lhe Leam brlef we observed was lnadequaLe as
Lhe anaesLheusL was noL presenL and Lhe only slgnlcanL dlscusslon from Lhe
surgeon was LhaL Lhe llsL order had changed.'
34

28. 1eam work of anoLher klnd ls parucularly lmporLanL ln barlaLrlc surgery, where
good pracuce calls for Mulu ulsclpllnary 1eam (Mu1) meeungs Lo deLermlne
wheLher surgery ls approprlaLe. 8uL nCLCu's 2012 enqulry showed LhaL fewer
Lhan a Lhlrd of prlvaLe hosplLals, ln whlch mosL of Lhls surgery ls done, held
Mu1 meeungs.
33
29. ln order Lo be proclenL and safe ln a parucular form of surgery lL ls necessary
for surglcal sLa Lo have Lhe opporLunlLy Lo underLake Lhe procedures lnvolved
on a regular basls.
36
lor some prlvaLe hosplLals, however, Lhls ls noL posslble
* ALul Cawande, ;%& <%&4=>"$7 ?)#"5&$7+, chapLer 7, Charles vlncenL, loueot 5ofety, Wlley/8lackwell and
8M! 8ooks, 2nd ed,, 2010, pp. 332-36. As ln nPS hosplLals, Lhe ve largesL prlvaLe hosplLal chalns requlre
Lhe WPC checkllsL Lo be used ln all Lhelr hosplLals, buL Lhe exLenL Lo whlch Lhey are used as lnLended ls
unknown. rlvaLe hosplLals where Lhe checkllsL and Lhe nPS-recommended 'llve SLeps Lo Safer Surgery'
have been found noL properly lmplemenLed lnclude 8Ml MounL Alvernla PosplLal, Culldford, 8Ml 1he
8lackheaLh PosplLal, MounL SLuarL PosplLal (8amsay), 1orquay, Splre Llule AsLon PosplLal, and 8Ml 1he
London lndependenL PosplLal, where Lhe CCC found LhaL 'ln Lwo cases Lhe ume ouL" dld noL occur aL
Lhe end of Lhe procedure, alLhough paperwork lmplled lL had been done. ln one lnsLance a sLa member
found an anaesLheusL ln Lhe recovery room/sulLe Lo check LhaL everyLhlng on Lhe checkllsL was correcL.
We found LhaL Lhe WPC checkllsL was noL fully embedded wlLh some cllnlclans as a posL-surgery process.'
(CCC 8eporL March 2014, p.11) hup://www.cqc.org.uk/slLes/defaulL/les/old_reporLs/1-128766963_
8Ml_1he_London_lndependenL_PosplLal_lnS1-767233383_Scheduled_28-03-2014.pdf
1 8Ml's 36 hosplLals each have an average of 123 consulLanLs wlLh pracuslng prlvlleges. lor example ln 2012
8Ml's 1he Carden PosplLal ln norLh London had Lwo operaung LheaLres, 30 beds and over 130 consulLanLs
wlLh pracuslng prlvlleges hup://www.cqc.org.uk/slLes/defaulL/les/old_reporLs/1-102643300_8Ml_
PealLhcare_LlmlLed_1-128766778_8Ml_1he_Carden_PosplLal_20120224.pdf
19
due Lo Lhe low volume of some of Lhe operauons whlch Lhey perform each
year. 1he 2010 nCLCu enqulry lnLo cosmeuc surgery, for example, found
LhaL 79 per cenL of Lhe cenLres dolng cosmeuc surgery performed fewer Lhan
20 of Lhe procedures Lhey oered per year, whlle 84 cenLres were only dolng
beLween 1 and 10 breasL reducuons (a relauvely complex procedure) a year.
37

As Slr 8ruce keogh noLed ln hls 2013 reporL, Lhese gures suggesL LhaL 'some
cosmeuc surglcal Leams may be performlng operauons Loo lnfrequenLly Lo
malnLaln compeLence, leL alone excellence'.
38

30. Cnce pauenLs have recovered from surgery and have been reLurned Lo
Lhe wards lL ls lmporLanL LhaL Lhey recelve good posL-operauve care Lo ald
rehablllLauon and Lo ensure LhaL no compllcauons arlse.
"
1o oversee Lhls phase
of care prlvaLe hosplLals employ 8esldenL Medlcal Cmcers (8MCs), aL leasL
one of whom ls on duLy aL any one ume. 1hese are relauvely [unlor docLors,
who musL look aer all Lhe pauenLs ln Lhe hosplLal. 1he pauenLs wlll oen
have experlenced a range of procedures underLaken by qulLe a large number
of dlerenL consulLanLs, who are usually no longer on slLe. 8MCs also do
noL have speclalLy reglsLrars (surgeons and physlclans ln Lralnlng Lo become
consulLanLs) Lo Lurn Lo for supervlslon and advlce, as a [unlor docLor would ln
an nPS hosplLal, lf Lhey are noL sure wheLher Lo conLacL Lhe consulLanL or Lhe
consulLanL ls noL lmmedlaLely accesslble.
!
31. A furLher posL-operauve rlsk arlses from Lhe facL LhaL ln a small prlvaLe hosplLal
a hlgh proporuon of Lhe sLa musL be able Lo provlde resusclLauon lf needed.
CuL of 132 prlvaLe hosplLals LhaL responded Lo a 2012 nCLCu enqulry lnLo
Lhe resusclLauon of pauenLs followlng ln-hosplLal cardlo-resplraLory arresL, 14
had no dedlcaLed resusclLauon Leam.
39
ln addluon CCC reporLs lnLo prlvaLe
hosplLals have found cases where nurslng sLa fall Lo keep Lhelr Lralnlng up Lo
daLe, lncludlng Lralnlng ln resusclLauon.
#
ln prlvaLe hosplLals where concerns
have emerged, sLamng levels have also someumes been below whaL CCC
lnspecLors conslder adequaLe, wlLh a relauvely hlgh rellance on agency sLa
belng noL uncommon.
40
* ln Lhe case of prlvaLe pauenLs Lhe ongolng cllnlcal responslblllLy may be llmlLed by Lhelr conLracLual
relauonshlp wlLh Lhelr surgeon and/or anaesLheusL. 1he Assoclauon of AnaesLheusLs of CreaL 8rlLaln and
norLhern lreland sLaLes LhaL Lhe posL-operauve perlod covered by an anaesLheusL's conLracL ls 'llmlLed'
Lo a maxlmum of '24 Lo 48 hours'. AnyLhlng beyond Lhls can be chargeable Lo Lhe pauenL loJepeoJeot
ltocuce, Aprll 2008, pp.6-7 hup://www.aagbl.org/slLes/defaulL/les/lndependenL_pracuce_08_0.pdf
1 SpeclalLy reglsLrars are surgeons wlLh Lwo years of Lralnlng ln general surgery and up Lo 8 years of Lralnlng
ln a speclalLy before belng ellglble Lo become consulLanLs. 1he lmporLance of good access by [unlor
docLors and nurses Lo advlce from senlor cllnlclans when a pauenL's condluon deLerloraLes ls one of Lhe
polnLs sLressed by Slr 8ruce keogh ln hls revlew of pauenL safeLy aL 14 nPS LrusLs ln 2013 @&2"&A "#7+
tbe poollty of cote ooJ tteotmeot ptovlJeJ by 14 bospltol ttosts lo oqlooJ. ovetvlew tepott, p. 21, hup://
www.nhs.uk/nPSLngland/bruce-keogh-revlew/uocumenLs/ouLcomes/keogh-revlew-nal-reporL.pdf
1 See for example CCC reporLs on: 8Ml 1he ark PosplLal, nomngham, 2014 and 8Ml 1he Plgheld
PosplLal, 8ochdale, 2012., where 'alLhough mandaLory Lralnlng was Laklng place, Lhe ma[orlLy of sLa had
noL yeL recelved mandaLory Lralnlng ln key areas such as safeLy, healLh and envlronmenL, safeguardlng,
lnfecuon conLrol, movlng and handllng, re safeLy, equallLy and dlverslLy and baslc llfe supporL.'-
hup://www.cqc.org.uk/slLes/defaulL/les/old_reporLs/1-102643300_8Ml_PealLhcare_
LlmlLed_1-128766862_8Ml_1he_Plgheld_PosplLal_20121207.pdf
CuL of 132 prlvaLe
hosplLals LhaL
responded Lo a 2012
nCLCu enqulry lnLo
Lhe resusclLauon of
pauenLs followlng
ln-hosplLal cardlo-
resplraLory arresL,
14 had no dedlcaLed
resusclLauon Leam
20
c/inico/ qovernonce
32. Slnce Lhe lnqulry lnLo Lhe 8rlsLol PearL scandal ln 1993 lL has been wldely
recognlsed LhaL wlLhln a healLhcare semng a sysLem of overslghL (known as
cllnlcal governance) needs Lo be ln place Lo ensure LhaL Lhe performance of
healLhcare professlonals and Lhe overall sysLem ls able Lo dellver hlgh sLandards
of cllnlcal care. ln parucular Lhere needs Lo be one speclc body whlch can
be held Lo accounL for ensurlng Lhese sLandards, and for ensurlng LhaL cllnlcal
performance ls audlLed, LhaL procedures are eecuve, LhaL rlsks are managed
and LhaL Lhere ls a culLure of open reporung. 1he boards of all nPS hosplLals
are under a sLaLuLory duLy Lo carry ouL Lhese funcuons as well as Lo ensure LhaL
healLhcare professlonals keep Lhelr skllls up Lo daLe.
41
33. WlLhln prlvaLe hosplLals Lhe slLuauon ls dlerenL. Whlle Lhe manager of any
hosplLal whlch ls reglsLered wlLh Lhe CCC ls responslble for Lhese measures,
lncludlng ensurlng LhaL Lhe necessary appralsals of all cllnlclans worklng aL Lhe
hosplLal are up Lo daLe, he or she ls expecLed Lo exerclse Lhese cllnlcal governance
funcuons on Lhe advlce of a Medlcal Advlsory Commluee (MAC),

whlch has no
sLaLuLory basls and ls lLself under no legal duues.
"
1he MAC ls drawn from, and
usually elecLed by, Lhe consulLanLs who have pracuslng prlvlleges aL Lhe hosplLal,
oen wlLh one or more co-opLed members from Lhe managemenL and Lhe senlor
nurslng sLa.
42
1here ls Lhus a poLenual conlcL beLween Lhe lnLeresLs of Lhe
professlonals and Lhose of pauenLs, wlLh no exLernal member or represenLauve
of pauenL lnLeresLs.
!
1hey usually meeL once every Lwo or Lhree monLhs.
43
MACs
have no powers Lo enforce good cllnlcal pracuce, shorL of advlslng Lhe hosplLal
managemenL Lo suspend a colleague's pracuslng prlvlleges. Powever, Lhere ls
an lncenuve for prlvaLe hosplLals noL Lo Lake Lhls acuon as Lhere are nanclal
lmpllcauons noL [usL for Lhe consulLanL concerned, buL also for Lhe hosplLal whlch
sLands Lo lose Lhe revenue LhaL Lhe consulLanL generaLes for Lhem. 1hls problem
ls famlllar ln Lhe unlLed SLaLes.
44

34. 1he emcacy of Lhe cllnlcal governance arrangemenLs ln ensurlng pauenL
safeLy ln prlvaLe hosplLals has been quesuoned ln recenL reporLs. lan aLerson
underLook dangerous breasL surgery, and colonoscoples whlch he was noL
qualled Lo perform, aL Lwo prlvaLe hosplLals ln Sollhull, causlng acLual
or poLenual harm Lo a slgnlcanL number of pauenLs. ln March 2014 an
lndependenL revlew of Lhe case found LhaL Lhe Medlcal Advlsory Commluee
aL one of Lhe prlvaLe hosplLals 'was noL able Lo ldenufy any Lrends or wheLher
* '1he overall hosplLal governance ls Lhe responslblllLy of Lhe reglsLered manager (l.e. Lhe CLC). Powever,
cllnlcal and professlonal governance can only Lake place lf managed and led by consulLanLs... . Cllnlcal
governance [..]wlll Lhus lnvolve all cllnlcal records, audlLs, revlews, cllnlcal lncldenLs, deaLhs and
complalnLs. 1hls ls Lhe professlonal responslblllLy of Lhe MAC.'
(lederauon of lndependenL racuuoner Crganlsauons,ColJelloes fot MeJlcol AJvlsoty commluee
cboltmeo ooJ Membets lo tbe loJepeoJeot 5ectot)
1 llC B3"'&>"#&$ para 3 sLaLe LhaL: 'lL ls lmporLanL Lo remember LhaL Lhe MAC has Lwo ma[or roles - one
Lo advlse hosplLal managemenL and Lhe oLher Lo represenL professlonal (and Lhus pauenL) lnLeresLs.
1here ls Lherefore a poLenual for occaslonal conlcLs and Lhe Chalrman needs Lo be sensluve Lo Lhe
balance.' 1he assumpuon LhaL professlonal lnLeresLs colnclde wlLh pauenLs' lnLeresLs ls open Lo quesuon
when professlonals have a nanclal lnLeresL LhaL ls noL colncldenLal wlLh LhaL of pauenLs.
21
consulLanLs have a greaLer Lhan expecLed number of adverse evenLs' because
lL only consldered 'adverse evenLs whlch had been anonymlsed and [were] noL
aurlbuLable Lo lndlvldual consulLanLs'.
43
3S. CCC reporLs lnLo prlvaLe hosplLals from 2012 and 2013 have also found LhaL
some of Lhe prlvaLe hosplLals LhaL Lhey lnspecLed had noL been vlgllanL ln
ensurlng LhaL consulLanLs wlLh pracuslng prlvlleges have up-Lo-daLe appralsals of
Lness Lo pracuce or up Lo daLe legal lndemnlLy.
46
ln Lhe case of Lhe anaesLheusL
ln a prlvaLe hosplLal who covered Lwo surglcal llsLs slmulLaneously, Lhe CCC
found LhaL Lhe hosplLal had noL puL ln place 'eecuve lnLerlm measures' Lo
prevenL Lhe lncldenL recurrlng and 'no noucauon of Lhe lncldenL had been
made Lo Lhe Ceneral Medlcal Councll [Lhe professlonal regulaLor] or Lo oLher
reglsLered provlders [l.e. hosplLals] who used Lhe servlces of Lhe anaesLheusL.'
47
kecord-keepinq
36. 8ecord-keeplng ls apL Lo be a problem aL prlvaLe hosplLals because Lhe
consulLanLs are malnly worklng o-slLe, lncludlng when seelng Lhelr prlvaLe
pauenLs as ouLpauenLs, and because Lhere ls oen no sLandardlsed form
for records. 1he rsL problem was summarlsed ln a CCC reporL on 8amsay's
Caks PosplLal, where Lhe hosplLal managemenL lLself ralsed lL: '1here was
no comblned medlcal and cllnlcal record for any prlvaLe pauenLs aL Lhe Caks
PosplLal. [...] 1he [hosplLal managemenL] sLaLed LhaL Lhere was a lack of archlve
of prlvaLe-ouLpauenL consulLanL records due Lo cusLom and pracuce ln Lhe
lndependenL healLh care secLor. Some consulLanLs held Lhelr prlvaLe ouLpauenL
pracuce lnformauon separaLe Lo Lhe hosplLal ln whlch Lhey pracuced. lor
example, Lhe cllnlcal noLe of a prlvaLe consulLauon may noL be held on Lhe
hosplLal slLe buL held by Lhe consulLanL'.
48
AL anoLher hosplLal 'SLa Lold [Lhe
CCC lnspecLors] Lhere was no one formally recognlsed sysLem for docLor's
records, each docLor ''dld Lhelr own Lhlng.'''
49
oor record-keeplng recurs as a
Lheme ln CCC reporLs.
22
What |nformanon |s pub||c|y ava||ab|e to
panents and comm|ss|oners on the qua||ty of
care |n pr|vate hosp|ta|s?
37. As noLed above Lhe avallablllLy of daLa abouL prlvaLe hosplLals has Lwo maln
consequences. lL prevenLs regulaLors and commlssloners from belng able Lo
ldenufy any rlsks Lo pauenLs ln prlvaLe hosplLals buL lL also lmpedes Lhe ablllLy
of pauenLs Lo choose Lhelr healLhcare provlder.
1he compennon ond Morkets 4uthority invesnqonon
ond the Privote neo/thcore lnformonon Network
38. 1he Compeuuon and MarkeLs AuLhorlLy lnvesugauon lnLo prlvaLe healLhcare
provlders looked aL Lhe avallablllLy of performance daLa abouL prlvaLe
hosplLals and consulLanLs from Lhe perspecuve of consumers chooslng ln a
compeuuve markeL. lL recenLly came Lo Lhe concluslon LhaL lnformauon on
Lhe performance of prlvaLe healLhcare faclllues has been poor ln Lhe pasL and
below Lhe sLandard of Lhe lnformauon avallable on nPS hosplLals and LhaL
Lhe lnformauon LhaL ls currenLly publlcly avallable 'ls lnsumclenL Lo promoLe
compeuuon beLween prlvaLe healLhcare faclllues.'
30
39. As well as noL belng under any requlremenL Lo reporL morLallLy daLa Lo Lhe
nauonal 8eporung and Learnlng Servlce, prlvaLe hosplLals are noL requlred Lo
publlsh Lhe same daLa seLs abouL Lhemselves as nPS hosplLals.
40. As parL of Lhe response Lo Lhe Compeuuon and MarkeLs AuLhorlLy lnvesugauon
Lhe prlvaLe hosplLal secLor has soughL Lo address Lhls lnformauon declL by
esLabllshlng a rlvaLe PosplLal lnformauon neLwork (Pln). Powever, whllsL
nPS hosplLals are expecLed Lo make avallable on Lhe nPS Cholces webslLe a
seL of lndlcaLors, ranglng from daLa abouL reporung of pauenL safeLy alerLs
and sLamng levels Lo Lhe lncldence of healLhcare-assoclaLed lnfecuons, Lhe
daLa avallable abouL prlvaLe hosplLals on Lhe rlvaLe PealLhcare lnformauon
neLwork (as of !uly 2014) ls llmlLed Lo Lhe Lypes of servlces whlch are provlded
aL each hosplLal and daLa from Lhe lrlends and lamlly 1esL.
31
41. Moreover, unllke Lhe PealLh and Soclal Care lnformauon CenLre, an lndependenL
sLaLuLory body whlch collaLes and publlshes daLa on Lhe performance of nPS
hosplLals, Lhe rlvaLe PealLhcare lnformauon neLwork ls funded and overseen
by members or former members of Lhe prlvaLe hosplLal secLor.
32
1hls lack of
lndependence has Lhe poLenual Lo lnLroduce a conlcL of lnLeresL and a poLenual
dlsLoruon of Lhe publlshed daLa. As Slr 8oberL lrancls CC polnLed ouL ln hls
rsL reporL lnLo Mld SLaordshlre nPS loundauon 1rusL, 'lL ls parucularly
lmporLanL LhaL [healLhcare performance] lnformauon should be avallable from
unlmpeachably lndependenL and rellable sources.'
33
unllke Lhe PealLh
and Soclal Care
lnformauon CenLre, an
lndependenL sLaLuLory
body whlch collaLes
and publlshes daLa
on Lhe performance
of nPS hosplLals, Lhe
rlvaLe PealLhcare
lnformauon neLwork
ls funded and
overseen by members
or former members
of Lhe prlvaLe hosplLal
secLor
23
=8-1$.; !77&8'.%>
42. Secuon 8 of Lhe PealLh AcL 2009 requlres all provlders of nPS servlces,
lncludlng prlvaLe provlders, Lo publlsh CuallLy AccounLs on Lhe nPS Cholces
webslLe by 30 !une of each year. 1hese accounLs musL be slgned o by Lhe
mosL senlor manager of Lhe organlsauon who musL be saused LhaL Lhe
daLa are accuraLe, LhaL he or she ls aware of Lhe quallLy of nPS servlces LhaL
Lhe organlsauon provldes, and whaL lmprovemenLs are needed. 1he CuallLy
AccounLs provlde lnformauon on how Lhe healLhcare provlder measures
how well lL ls dolng, how lL seeks Lo conunuously lmprove Lhe servlces lL
provldes, and how lL responds Lo checks made by regulaLors such as Lhe CCC.
CuallLy AccounLs should also lnclude a sLaLemenL from Lhe provlder's maln
commlssloner and a sLaLemenL on whaL Lhey have learned from nauonal and
cllnlcal audlLs.
34
43. AlLhough nPS and nPS loundauon 1rusLs are requlred Lo have Lhelr CuallLy
AccounLs audlLed exLernally before Lhey are publlshed, Lhls requlremenL does
noL apply Lo prlvaLe provlders, even when Lhey provlde nPS servlces.
44. nPS Cholces have descrlbed CuallLy AccounLs as provldlng 'addluonal
accounLablllLy abouL Lhe quallLy of an organlsauon's servlces'.
33
Slr 8oberL
lrancls CC, ln hls reporL on Mld SLaordshlre, wenL furLher, seelng CuallLy
AccounLs as enabllng Lhe CCC Lo ldenufy rlsks wlLhln hosplLals.
36
Pe also
recommended LhaL lL should be a crlmlnal oence Lo publlsh false and
mlsleadlng lnformauon ln Lhese accounLs, and LhaL Lhey should no longer be
conned Lo reporLs 'on achlevemenLs as opposed Lo a falr represenLauon of
areas where compllance has noL been achleved'.
37
4S. ln !uly 2014 we looked aL Lhe nPS Cholces webslLe Lo see lf Lhe nlne ma[or
prlvaLe hosplLal provlders menuoned ln Lhe recenL Compeuuon and MarkeLs
AuLhorlLy reporL on prlvaLe hosplLals had submlued and publlshed Lhelr CuallLy
AccounLs ln Lhe pasL Lhree years whlch we assumed were requlred by Lhe
PealLh AcL 2009. We also checked Lhls lnformauon wlLh Lhe CuallLy lramework
1eam aL nPS Lngland.
46. Clven LhaL Lhe Compeuuon and MarkeLs AuLhorlLy found LhaL prlvaLe hosplLal
provlders generaLe a slgnlcanL amounL of Lhelr revenue from Lreaung nPS
pauenLs we would expecL LhaL Lhe organlsauons llsLed ln 1able 6 would fall
under Lhe obllgauon Lo publlsh quallLy accounLs on nPS Cholces. Powever we
cannoL be sure of whlch of Lhem are requlred Lo do so by Lhe PealLh AcL, whlch
exempLs provlders whlch earn less Lhan 130k nPS lncome per annum, and
have less Lhan 30 sLa members. 1he exempuon seems llkely Lo apply only
Lo PCA and Lhe London Cllnlc, whlch Lhe Compeuuon and MarkeLs AuLhorlLy
found dld noL recelve slgnlcanL revenues from Lhe nPS, buL lnformauon on
how much revenue each provlder generaLes from nPS conLracLs ls proLecLed
by commerclal condenuallLy and nPS Lngland do noL hold a llsL of Lhose
24
organlsauons whlch are requlred Lo comply wlLh Lhe regulauons.
*
1he Lable
shows LhaL ouL of Lhe nlne prlvaLe hosplLal provlders llsLed only ve dld so ln
2013-14, Lhree ln 2012-2013 and one ln 2011-2012.
1ab|e 6: ua||ty Accounts h|ed by pr|vate hosp|ta| prov|ders
2011-2014
ua||ty Accounts h|ed on NnS Cho|ces webs|te
rov|der 2013-2014 2012 - 2013 2011-2012
1. Aspen PealLhcare ?es ?es no
2. 8Ml PealLhcare no no no
3. 8upa Cromwell no no no
4. Clrcle ?es, no no
3. PCA no no no
6. London Cllnlc no no no
7. numeld PealLh ?es no no
8. 8amsay PealLh Care uk ?es ?es no
9. Splre PealLhcare ?es ?es ?es
Source: nPS Cholces webslLe, accessed 7 !uly 2014
* Accordlng Lo Lang and 8ulsson by March 2013 nPS-funded work accounLed for 70 of 8amsay's
admlsslons, 32 of 8Ml's, 23 of Splre's, and 'Lhe ma[orlLy of Clrcle's revenues'. lor PCA Lhe nPS-funded
gure was 'no more Lhan 1', for 1he London Cllnlc 'only a few percenL represenLs nPS-funded work',
and 8uA Cromwell was 'belleved Lo carry ouL only a modesL amounL of nPS work' (8lackburn, C1"2)7&
6437& ?&'"4)> <)1&, llgure 2.2 and pp 47-74). ln relauon Lo numeld, Lhe Compeuuon and MarkeLs
AuLhorlLy found LhaL beLween 2007 and 2011 'growLh ln Lhe number of nPS pauenLs oseL[..] a decllne
ln Lhe number of prlvaLe pauenLs"
2S
Conc|us|ons and recommendanons
47. auenL safeLy ln surgery has become a ma[or concern only relauvely recenLly.
lL developed ln Lhe 1990s wlLh Lhe reallsauon LhaL surglcal lnLervenuons have
become so common LhaL Lhe average Amerlcan wlll undergo seven ln Lhe
course of hls or her llfeume, wlLh Lhe average 8rlLon probably noL far behlnd,
38

LhaL Lhe raLe of compllcauons (generally esumaLed aL 8-12 ln advanced
healLhcare sysLems) ls Loo hlgh,
39
and LhaL abouL half of Lhese are prevenLable
by sysLemauc measures Lo prevenL Lhem.
60
48. As Lhls reporL shows, ln Lhe clrcumsLances of mosL prlvaLe hosplLals ln Lngland
such measures can be hard, and ln some respecLs perhaps lmposslble, Lo enforce.
1he resulung rlsk Lo pauenLs ls reduced by admlmng few hlgher-rlsk pauenLs Lo
Lhese hosplLals.
"
8uL 'all surgery ls rlsky and dangerous wherever lL ls done'.
61

Lven Lhe healLhlesL lndlvldual can experlence an adverse evenL durlng or aer
surgery, and Lhe rlsk ls helghLened lf Lhe condluons under whlch Lhe LreaLmenL
occurs make lL more llkely LhaL someLhlng wlll go wrong, or LhaL remedlal acuon
wlll be less prompL and eecuve lf lL does.
49. 1o address Lhe known and Lhe unknown rlsks ln prlvaLe hosplLals ldenued ln
Lhls reporL we make a number of recommendauons.
S0. llrsL, prlvaLe provlders should be sub[ecL Lo exacLly Lhe same requlremenLs Lo
reporL pauenL safeLy lncldenLs (lncludlng deaLhs) as nPS LrusLs and foundauon
LrusLs. All of Lhe lnformauon should be publlshed ln Lhe same way as lL ls
for nPS provlders and Lhls should be a requlremenL of reglsLrauon wlLh Lhe
CCC. 1hls recommendauon was made by Ceorge Csborne M ln 2003 when
he lnLroduced a prlvaLe member's blll Lo 'requlre prlvaLe hosplLals Lo publlsh
lndependenLly audlLed lnformauon on cllnlcal performance and on complalnLs
from pauenLs on Lhe same basls as LhaL requlred of nPS hosplLals'.
62
lL was
also made by Slr 8ruce keogh ln relauon Lo prlvaLe provlders of cosmeuc
surgery.
63
And Slr lan kennedy, ln hls revlew of Lhe lan aLerson case ln Sollhull
ln 2013, made Lhe same recommendauon, polnung ouL LhaL Lhls lnformauon
ls lmporLanL for Lhe safeLy of pauenLs ln nPS hosplLals as well as ln Lhe prlvaLe
ones ln whlch nPS consulLanLs operaLe, slnce oLherwlse Lhe daLa on any
lndlvldual consulLanL's work ls lncompleLe and may be mlsleadlng.
64
S1. Second, prlvaLe hosplLals should be requlred Lo reporL on Lhelr performance ln
Lhe same way as nPS provlders. 1he PealLh and Soclal Care lnformauon CenLre,
raLher Lhan Lhe prlvaLe healLhcare lndusLry, should be Lasked wlLh maklng Lhls
daLa avallable Lo pauenLs and commlssloners elLher Lhrough nPS Cholces or
anoLher dedlcaLed pauenL lnformauon webslLe. Slnce Lhe rlvaLe PealLhcare
* ln 2003 fewer Lhan 4 of pauenLs undergolng surgery ln prlvaLe hosplLals ln Lngland, Wales and
norLhern lreland for whom an ASA sLaLus was recorded were hlgher Lhan ASA 2. See Lhe 2003 8eporL of
Lhe nauonal Condenual Lnqulry lnLo erloperauve ueaLhs, 1able 4.1,
hup://www.ncepod.org.uk/pdf/2003/03full.pdf
26
lnformauon neLwork ls noL 'unlmpeachably lndependenL' (as 8oberL lrancls
puL lL ln relauon Lo Mld SLaordshlre) from prlvaLe hosplLal provlders, Lhere
wlll always be quesuons abouL Lhe daLa LhaL lL chooses Lo make avallable Lo
pauenLs. 1he requlremenLs seL ouL ln Secuon 8 of Lhe PealLh AcL 1999 for all
provlders of nPS servlces Lo publlsh Lhelr CuallLy AccounLs on Lhe nPS Cholces
webslLe should be properly enforced by Lhe CCC and all CuallLy AccounLs
should be exLernally audlLed, noL [usL Lhose produced by nPS hosplLals.
S2. 1hlrd, as recommended by Slr 8ruce keogh ln hls revlew of Lhe regulauon
of cosmeuc surgery, Lhe remlL of Lhe arllamenLary and PealLh Servlce
Cmbudsman should be exLended Lo cover Lhe whole prlvaLe healLhcare
secLor.
63
1he scope of Lhe lreedom of lnformauon AcL should also be exLended
Lo cover prlvaLe hosplLals ln respecL of anyLhlng relaLed Lo Lhe LreaLmenL of
nPS pauenLs.
S3. lourLh, glven Lhe falllngs deLecLed by numerous CCC lnqulrles and Lhe aLerson
case, Lhe cllnlcal governance of lndependenL hosplLals needs Lo be sub[ecL Lo
a wlder revlew by Lhe CCC Lo deLermlne wheLher Lhe currenL arrangemenLs
are eecuve ln proLecung pauenLs. 1he revlew should cover Lhe duues and
powers of Medlcal Advlsory Commluees, as well as Lhe duues and powers of
Lhe hosplLal dlrecLor ln relauon Lo pauenL safeLy. ln addluon, ln order Lo reduce
Lhe poLenual for conlcLs of lnLeresL beLween cllnlclans, owners, and pauenLs,
Medlcal Advlsory Commluees should have exLernally appolnLed cllnlcal and lay
members wlLh no connecuon Lo Lhe hosplLals concerned. And, as Lhe Pouse of
Commons PealLh Commluee recommended ln 1999, Lhe responslblllues and
consuLuuon of Medlcal Advlsory Commluees should be made sLaLuLory.
66

S4. llh, as also recommended by Slr 8ruce keogh ln relauon Lo cosmeuc surgery,
full paruclpauon ln all nauonal cllnlcal audlL and daLa collecuon programmes
should be parL of CCC reglsLrauon requlremenLs.
67
SS. SlxLh, lL ls lmporLanL LhaL pauenLs are made aware of Lhe dlerenL rlsk facLors
beLween belng LreaLed ln a small prlvaLe hosplLal and a much larger nPS
hosplLal. lor pauenL consenL Lo be lnformed consenL, Lhe consenL forms glven
Lo pauenLs aL prlvaLe hosplLals should deLall noL only Lhe rlsks lnherenL ln Lhe
procedure belng oered buL also any LhaL sLem from Lhe dlsuncuve naLure of
Lhe faclllues, equlpmenL and sLamng of Lhe hosplLal.
S6. SevenLh, Lhe regulauons governlng Lhe provlslon of care ln hosplLals need Lo
lnclude some whlch are prlvaLe hosplLal-speclc and unamblguous. ln parucular
Lhere should be an on-slLe reglsLrar-level surgeon or docLor qualled ln each
speclalLy for whlch nPS pauenLs are LreaLed, and nurses wlLh quallcauons
ln Lhe same speclalues, and arrangemenLs for an anaesLheusL Lo be on call. lL
should also be a requlremenL LhaL all pauenL records are kepL on Lhe ward.
S7. llnally, glven LhaL Lhere are some 6,000 admlsslons Lo nPS hosplLals from
prlvaLe hosplLals every year a revlew should be carrled ouL by Lhe ueparLmenL
of PealLh of Lhe naLure and cosL of Lhese admlsslons.
27
S8. 8oLh Lhe Pouse of Commons PealLh Commluee ln 1999 and Lhe recenL keogh
revlew of cosmeuc surgery recommended LhaL lf a pauenL who has recelved
LreaLmenL ln a prlvaLe hosplLal subsequenLly needs LreaLmenL ln an nPS
hosplLal due Lo a fallure by Lhe prlvaLe hosplLal, Lhe nPS should have Lhe power
Lo recoup any cosLs.
68
Some recouplng of cosLs Lo Lhe nPS arlslng from 'never
evenLs' ln prlvaLe hosplLals ls already provlded for ln nPS pollcy.
69
LxLendlng
Lhls pollcy Lo oLher cases where Lhe nPS lncurs expense aer a prlvaLe provlder
has falled a pauenL may also reduce Lhe rlsk of 'moral hazard' whereby Lhe
'safeLy neL' provlded by Lhe nPS may encourage rlskler behavlour ln some
prlvaLe hosplLals.
S9. Many of Lhe recommendauons made here have been made prevlously by oLher
lnqulrles or reporLs. Clven whaL ls now consldered good pracuce, Lhe lack of
any clear plcLure of Lhe rlsks Lo pauenLs ln prlvaLe hosplLals ouLllned ln Lhls
reporL suggesLs LhaL acuon on Lhose recommendauons ls overdue.
28
keferences
1 hlllp 8lackburn, rlvaLe AcuLe Medlcal Care: uk MarkeL
8eporL, Lalng and 8ulsson 2013, p. 123.
2 8lackburn, C1"2)7& 6437& ?&'"4)> <)1&D 1able 3.2.
3 PealLh and Soclal Care lnformauon CenLre, nospltol stotes
ooJ loclllues 5tousucs, hup://www.hefs.lc.nhs.uk/L8lC.asp
4 nauonal Advlsory Croup on Lhe SafeLy of auenLs ln Lngland,
A ptomlse to leoto - o commltmeot to oct. lmptovloq tbe
5ofety of loueots lo oqlooJ, AugusL 2013. hups://www.gov.
uk/governmenL/uploads/sysLem/uploads/auachmenL_daLa/
le/226703/8erwlck_8eporL.pdf
3 Care CuallLy Commlsslon commenLs Lo Lhe Compeuuon
and MarkeLs AuLhorlLy lnvesugauon lnLo rlvaLe PealLhcare
MarkeL, SepLember 2013 hups://asseLs.dlglLal.cablneL-omce.
gov.uk/medla/3329dd69ed913d0e60000131/130930_cqc.pdf
6 8lackburnD C1"2)7& 6437& ?&'"4)> <)1& 2013, p.123. 1he LoLal
number of admlsslons (ln-pauenL and day case) for elecuve
surgery aL all hosplLals (nPS and prlvaLe) ln Lhe uk was
esumaLed ln 2013 Lo be 10.38 mllllon a year.
7 8lackburn, C1"2)7& 6437& ?&'"4)> <)1& 2013 1able 2.4.
8 8lackburn, C1"2)7& 6437& ?&'"4)> <)1& 2013, p.19.
9 compeuuoo ooJ Motkets Aotbotlty ?C1"2)7& %&)>7%4)1& *)1=&7
lovesuqouoo llool kepott, para 2.33
10 1he Amerlcan SocleLy of AnaesLhlologlsLs physlcal sLaLus
raung. ASA 1: PealLhy pauenL. Locallsed surglcal paLhology
wlLh no sysLemlc dlsLurbance, ASA 2: Mlld / moderaLe
sysLemlc dlsLurbance (surglcal paLhology or oLher dlsease
process), ASA 3: Severe sysLemlc dlsLurbance from any cause,
ASA 4: Llfe LhreaLenlng sysLemlc dlsorder. Severe acuvlLy
llmlLauon, ASA 3: Morlbund pauenL wlLh llule chance of
survlval.
11 Anne Mason, Marlsa Mlraldo,Lulgl Slclllanl, eLer Slvey and
Andrew SLreeL, 'LsLabllshlng a lalr laylng lleld for aymenL
by 8esulLs', CenLre for PealLh Lconomlcs, unlverslLy of ?ork,
uk, !uly 2008, 1able 9. hup://www.york.ac.uk/medla/che/
documenLs/papers/researchpapers/rp39_paymenL_by_
resulLs.pdf
12 Pouse of Commons Wrluen Answer 29 !anuary 2014 /)#$)1'
Column 384W
13 Slr 8ruce keogh kevlew of tbe keqolouoo of cosmeuc
lotetveouoos. llool kepott, ueparLmenL of PealLh Aprll 2013
paragraph 3.2.1 hups://www.gov.uk/governmenL/uploads/
sysLem/uploads/auachmenL_daLa/le/192028/8evlew_of_
Lhe_8egulauon_of_Cosmeuc_lnLervenuons.pdf
14 Slr 8ruce keogh, kevlew loto tbe poollty of cote ooJ tteotmeot
ptovlJeJ by 14 bospltol ttosts lo oqlooJ. ovetvlew tepott,
16 Ioly 201J, hup://www.nhs.uk/nPSLngland/bruce-keogh-
revlew/uocumenLs/ouLcomes/keogh-revlew-nal-reporL.pdf
13 Accordlng Lo Lang and 8ulsson by March 2013 nPS-funded
work accounLed for 70 of 8amsay's admlsslons, 32 of
8Ml's, 23 of Splre's, and 'Lhe ma[orlLy of Clrcle's revenues'.
lor PCA Lhe nPS-funded gure was 'no more Lhan 1', for
1he London Cllnlc 'only a few percenL represenLs nPS-funded
work', and 8uA Cromwell was 'belleved Lo carry ouL only
a modesL amounL of nPS work' (8lackburn, C1"2)7& 6437&
?&'"4)> <)1&, llgure 2.2 and pp 47-74). ln relauon Lo numeld,
Lhe Compeuuon and MarkeLs AuLhorlLy found LhaL beLween
2007 and 2011 'growLh ln Lhe number of nPS pauenLs
oseL[..] a decllne ln Lhe number of prlvaLe pauenLs"
16 hup://www.ncepod.org.uk/pdf/2003/03full.pdf
17 Ao Aqe OlJ ltoblem. A tevlew of tbe cote tecelveJ by elJetly
poueots ooJetqoloq sotqety hup://www.ncepod.org.
uk/2010reporL3/downloads/LLSL_full8eporL.pdf
18 ueparLmenL of PealLh, kevlew of tbe keqolouoo of cosmeuc
lotetveouoos, 2013, p. 9
19 nCLCu, Oo tbe foce of lt. A tevlew of tbe otqoolsouoool
sttoctotes sottoooJloq tbe ptocuce of cosmeuc sotqety,
1able 37. hup://213.198.120.192/2010reporL2/downloads/
CS_reporL.pdf,
20 nCLCu 1oo leoo o 5etvlce? A tevlew of tbe cote of poueots
wbo ooJetweot botlottlc sotqety, 1able 3.13 hup://www.
ncepod.org.uk/2012reporL2/downloads/8S_fullreporL.pdf
21 nCLCu, ;++ >&)# ) $&12"4&: p. 33
22 nCLCu, 9# 7%& 5)4& +5 "7, p. 39. AL 8amsay's Caks PosplLal
ln ColchesLer, ln 2012, for example, 'due Lo Lhe low levels
of cosmeuc surgery aL Lhe hosplLal. LheaLres had llmlLed
numbers of cosmeuc speclc lnsLrumenL seLs. Powever, sLa
could geL addluonal seLs where needed from Sprlngeld
PosplLal ln Chelmsford or Lhe sLerlle servlces hub lf
necessary.' (CCC reporL)
23 8Ml Corlng Pall PosplLal, CCC reporL Aprll 2013, p.9.
hup://www.cqc.org.uk/slLes/defaulL/les/medla/
reporLs/1-102643300_8Ml_PealLhcare_LlmlLed_1-128766799_
8Ml_Corlng_Pall_PosplLal_20130420.pdf
24 8Ml 1he Pampshlre Cllnlc, CCC reporL uecember 2012,
p.10, hup://www.cqc.org.uk/slLes/defaulL/les/medla/
8Ml_1he_Pampshlre_Cllnlc_20130103.pdf
23 AL 8Ml MounL Alvernla, CCC reporL !une 2013, pp. 10-11.
hup://www.cqc.org.uk/slLes/defaulL/les/medla/
reporLs/1-128767043_8Ml_MounL_Alvernla_PosplLal_lnS1-
371177028_8esponslve_-_Concernlng_lnfo_13-06-2013.pdf
26 8Ml MounL Alvernla PosplLal, CCC reporL !une 2013, p. 24.
27 8oyal College of Surgeons, Surglcal Careers: rlvaLe racuce
hup://surglcalcareers.rcseng.ac.uk/surgeons/pracuslng-as-a-
surgeon/lndependenL-pracuce, accessed 4 !uly 2014
28 1he Assoclauon of AnaesLheusLs of CreaL 8rlLaln and lreland,
loJepeoJeot ltocuce, 2008, hup://www.aagbl.org/slLes/defaulL/
les/lndependenL_pracuce_08_0.pdf, accessed 4 !uly 2014
29
29 lor example aL 8Ml MounL Alvernla, 8Ml 1he London
lndependenL PosplLal, and Splre Llule AsLon, Sollhull.
30 lor example aL 1he ?orkshlre Cllnlc, 8lngley (8amsay) and 8Ml
Lhe Saxon Cllnlc, MllLon keynes.
31 lor example aL 8Ml 1he Saxon Cllnlc (CCC reporL !anuary
2013) and 8Ml 1he Corlng Pall PosplLal (CCC reporL Aprll
2013). lrom several CCC reporLs lL would appear LhaL
responslblllLy for Lhls ls oen le Lo Lhe LheaLre nurslng sLa.
32 1hls happened aL 8Ml 1he rlory PosplLal 8lrmlngham ln
uecember 2012: CCC reporL lebruary 2013, p. 9. 128767127_
8Ml_1he_rlory_PosplLal_20130301.pdf
33 lL ls hard enough ln ma[or hosplLals, even Lhough Lhe vlLal
lmporLance of Leam work for pauenL safeLy ln surgery ls
sLressed by all auLhorlues. lor Lhe vlews of a ploneer of
pauenL safeLy see e.g. eLer ronovosL and Lrlc vohr, 0)5&
loueots, 5mott nospltols, enguln 8ooks, 2011, ChapLer 4.
34 CCC reporL on 8Ml 1he 8lackheaLh PosplLal, uecember
2013, p.10, hup://www.cqc.org.uk/slLes/defaulL/les/medla/
reporLs/1-128738347_8Ml_1he_8lackheaLh_PosplLal_lnS1-
336168760_Scheduled_24-12-2013.pdf
33 nCLCu ;++ >&)# ) $&12"4&: llgures 3.3 and 4.3.
36 keogh, kevlew of tbe keqolouoo of cosmeuc lotetveouoos,
para 3.18
37 nCLCu, 9# 7%& 5)4& +5 "7, p. 3.
38 keogh, kevlew of tbe keqolouoo of cosmeuc lotetveouoos,
2013, para 3.4.
39 nCLCu, 1lme to lotetveoe? A tevlew of poueots wbo
ooJetweot cotJlopolmoooty tesoscltouoo os o tesolt of oo
lo-bospltol cotJlotespltototy ottest, 1able 2.2, hup://www.
ncepod.org.uk/2012reporL1/downloads/CA_fullreporL.pdf
40 See CCC reporLs on e.g. numeld PealLh norLh SLaordshlre
PosplLal, 2014, where Lhere was a shorLage of LheaLre sLa, wlLh
some sLa dolng procedures Lhey were noL cerued compeLenL
Lo do hup://www.cqc.org.uk/slLes/defaulL/les/medla/
reporLs/1-113374639_numeld_PealLh_norLh_SLaordshlre_
PosplLal_lnS1-649347338_Scheduled_20-02-2014.pdf, and 8Ml
1he Clemenune Churchlll PosplLal, 2014, pp. 18-19, hup://www.
cqc.org.uk/slLes/defaulL/les/medla/reporLs/1-128738633_
8Ml_1he_Clemenune_Churchlll_PosplLal_lnS1-664782319_
Scheduled_01-03-2014.pdf,
41 PealLh AcL 1999, Secuon 18.
42 llC B3"'&>"#&$ para 28: 'lL ls generally agreed LhaL Lhe MAC
comprlses elecLed" consulLanLs and co-opLed managemenL,
nurslng or oLher consulLanL members.'
43 llC ColJelloes AppeoJlx 2, cluoq tbe cote 5tooJotJs Act
2000, '1he MAC meeLs quarLerly as a mlnlmum and formal
mlnuLes are kepL of meeungs.'
44 Suzanne Cordon, aLrlck Mendenhall and 8onnle 8lalr
C'Connor, 8eyond Lhe CheckllsL, London: Cornell unlverslLy
ress 2013, pp. 199-200.
43 verlLa, loJepeoJeot tevlew of tbe qovetoooce ottooqemeots
ot 5plte lotkwoy ooJ llule Astoo bospltols lo llqbt of coocetos
tolseJ oboot tbe sotqlcol ptocuce of Mt loo lotetsoo, para
1.78, referrlng Lo Lhe MAC aL Splre arkway. ' hup://www.
splrehealLhcare.com/uocumenLs/CorporaLe20docs/Splre20
-20Lxecuuve20summary20and20recommendauons.pdf
46 CCC reporLs on Splre Wellesley, May 2012 , on Splre LelcesLer,
november 2012, on 8Ml 1he Saxon Cllnlc, !uly 2013.
47 CCC reporL on 8Ml 1he rlory PosplLal, 8lrmlngham, lebruary
2013, p. 12-13, hup://www.cqc.org.uk/slLes/defaulL/les/medla/
8Ml_1he_rlory_PosplLal_20130301.pdf
48 CCC reporL on Lhe Caks PosplLal (8amsay), ColchesLer,
lebruary 2012, p.19, hup://www.cqc.org.uk/slLes/defaulL/
les/medla/reporLs/1-102643438_8amsay_PealLh_Care_uk_
Cperauons_LlmlLed_1-128733030_Caks_PosplLal_20120213.
pdf
49 CCC reporL on Splre orLsmouLh, lnspecLed leb 2013.
30 Compeuuon and MarkeLs AuLhorlLy, C1"2)7& %&)>7%4)1&
motket lovesuqouoo. llool kepott , 2 Aprll 2014, para 9.82
and para 9.83 hups://asseLs.dlglLal.cablneL-omce.gov.uk/
medla/333af063e3274a3660000023/rlvaLe_healLhcare_
maln_reporL.pdf
31 nPS Cholces 'AbouL Lhe lndlcaLor facLs you can see on nPS
Cholces' hup://www.nhs.uk/Scorecard/ages/PosplLallacLs.
aspx lor comparlson see rlvaLe PealLhcare lnformauon
neLwork hup://www.phln.org.uk/ (Accessed !une 30 2014)
32 1he 8oard of ulrecLors aL Pln: hup://www.phln.org.uk/
AbouL.aspx
33 8oberL lrancls CC, 1be MlJ 5to[otJsblte Nn5 loooJouoo
1tost lopolty. loJepeoJeot lopolty loto cote ptovlJeJ by MlJ
5to[otJsblte Nn5 loooJouoo 1tost Iooooty 2005 - Motcb
2009, volume l para 39. hup://webarchlve.nauonalarchlves.
gov.uk/20130107103334/hup://www.dh.gov.uk/prod_
consum_dh/groups/dh_dlglLalasseLs/[dh/[en/[ps/
documenLs/dlglLalasseL/dh_113447.pdf
34 1he nauonal PealLh Servlce (CuallLy AccounLs 8egulauons)
2010, Lhe nauonal PealLh Servlce (CuallLy AccounLs)
AmendmenL 8egulauons 2011, and Lhe nauonal PealLh
Servlce (CuallLy AccounLs) AmendmenL 8egulauons 2012,
seL ouL prescrlbed lnformauon LhaL musL be lncluded wlLhln
arL 2 of Lhe CuallLy AccounLs. (nPS Cholces 'AbouL CuallLy
AccounLs')
33 nPS Cholces WebslLe hup://www.nhs.uk/ages/Pomeage.
aspx
36 MlJ 5to[otJsblte Nn5 loooJouoo 1tost lobllc lopolty volume
2: recommendauon 49. hup://www.mldsLaspubllclnqulry.
com/slLes/defaulL/les/reporL/volume202.pdf
37 MlJ 5to[otJsblte Nn5 loooJouoo 1tost lobllc lopolty volume
2: recommendauon 37. hup://www.mldsLaspubllclnqulry.
com/slLes/defaulL/les/reporL/volume202.pdf
38 ALul Cawande,;%& <%&4=>"$7 ?)#"5&$7+, pp. 31 and 87.
39 Charles vlncenL, loueot 5ofety, p, 37.
60 '.aL leasL 30-30 of ma[or compllcauons for pauenLs
undergolng surglcal procedures are LhoughL Lo be avoldable'
(vlncenL, loueot 5ofety, p.37).
61 Cawande, ;%& <%&4=>"$7 ?)#"5&$7+, p. 143.
62 Commons /)#$)1' 8 May 2002, col. 137.
hup://www.publlcauons.parllamenL.uk/pa/cm200102/
cmhansrd/vo020308/debLexL/20308-04.hLm
30
63 8ecommendauons 3 and 10. 1he governmenL's response
lgnored Lhls speclc recommendauon. B+2&1#*&#7 @&$,+#$&
to tbe kevlew of tbe keqolouoo of cosmeuc lotetveouoos,
Cm 8776, lebruary 2014, pp. 3-6, www.gov.uk/governmenL/
uploads/sysLem/uploads/auachmenL_daLa/le/279431/
CovernmenL_response_Lo_Lhe_revlew_of_Lhe_regulauon_
of_cosmeuc_lnLervenuons.pdf
64 kevlew of tbe kespoose of neott of oqlooJ Nn5 loooJouoo
1tost to coocetos oboot Mt loo lotetsoos 5otqlcol ltocuce,
lessoos to be leotoeJ, ooJ kecommeoJouoos, paras 14.72-
73, hup://www.hearLofengland.nhs.uk/wp-conLenL/uploads/
kennedy-8eporL-llnal.pdf
63 keogh 8evlew of Lhe 8egulauon of Cosmeuc lnLervenuons, p.
8 and recommendauon 34 hups://www.gov.uk/governmenL/
uploads/sysLem/uploads/auachmenL_daLa/le/192028/. 1he
CovernmenL's response accepLed Lhe prlnclple of 'a slngle,
lndependenL polnL of redress for all prlvaLely funded healLhcare
complalnLs' buL sLopped shorL of agreelng Lo exLend Lhe role
of Lhe Cmbudsman Lo achleve Lhls B+2&1#*&#7 @&$,+#$& 7+
tbe kevlew of tbe keqolouoo of cosmeuc lotetveouoos, Cm
8776, lebruary 2014, p.16. www.gov.uk/governmenL/uploads/
sysLem/uploads/auachmenL_daLa/le/279431/CovernmenL_
response_Lo_Lhe_revlew_of_Lhe_regulauon_of_cosmeuc_
lnLervenuons.pdf
66 Commons PealLh Commluee, 1be keqolouoo of ltlvote ooJ
Otbet loJepeoJeot neoltbcote, llh 8eporL, 1999, aras 126-
7. hup://www.publlcauons.parllamenL.uk/pa/cm199899/
cmselecL/cmhealLh/281/28113.hLm#a27
67 keogh kevlew of tbe keqolouoo of cosmeuc lotetveouoos,
8ecommendauon 9. 1he governmenL's response lgnored Lhls
recommendauon B+2&1#*&#7 @&$,+#$& pp. 6-7 www.gov.
uk/governmenL/uploads/sysLem/uploads/auachmenL_daLa/
le/279431/CovernmenL_response_Lo_Lhe_revlew_of_Lhe_
regulauon_of_cosmeuc_lnLervenuons.pdf
68 Commons PealLh Commluee, 1be keqolouoo of ltlvote ooJ
Otbet loJepeoJeot neoltbcote, llh 8eporL of Sesslon 1998-
99, para 130, keogh 8evlew of Lhe 8egulauon of Cosmeuc
lnLervenuons, recommendauon 38. 1he governmenL
response Lo Lhe keogh 8evlew expressed sympaLhy wlLh
Lhls recommendauon and underLook Lo explore lL. hup://
www.publlcauons.parllamenL.uk/pa/cm199899/cmselecL/
cmhealLh/281/28114.hLm#a28
69 'never evenLs are serlous, largely prevenLable pauenL safeLy
lncldenLs LhaL should noL occur lf Lhe avallable prevenLauve
measures have been lmplemenLed by healLhcare provlders'
ueparLmenL of PealLh,1be oevet eveots pollcy ftomewotk
2012, pp.22-3. hup://webarchlve.nauonalarchlves.gov.
uk/20130107103334/hups://www.wp.dh.gov.uk/publlcauons/
les/2012/10/never-evenLs-pollcy-framework-updaLe-Lo-
pollcy.pdf
8eglsLered charlLy number 1137077
www.chp|.org.uk

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