There has been much written recently about Hinchingbrooke Hospital in Huntingdon following the high profile withdrawal on 9 January 2015 of Circle, the private company who were contracted to run the hospital, the first such arrangement in the NHS and an apparent trailblazer for the practical application of the concept of the running of an NHS hospital solely by a private company.
I think it is fair to say that the majority of the commentary would appear to have been focused on the political and economic aspects of Circle pulling out; and certainly it would be right to think that there is much to be discussed and debated on both fronts, given that the occurrence of such a situation is both of great financial and of great political significance, particularly in the lead-up to the general election.
Unsurprisingly, much commentary has been directed towards the usual issues of privatisation of the NHS (by stealth or otherwise) and the expected parlimentary ‘blame game’ fall out. However, amidst all the political sniping and financial analysing, there is a much more serious and fundamental issue to be considered: that of patient care.
When announcing that they were pulling out from Hinchingbrooke Hospital, Circle Healthcare, founded by a former Goldman-Sachs banker (who, coincidentally, left Circle in 2012), blamed cuts in funding, a £5 million loss and increased demand for A&E services as the reasons. Such justification was helpfully supported by national A&E statistics the week before the announcement which demonstrated that A&Es that week across England had sunk to their lowest ever performance levels, with only 79.8% of patients treated within 4 hours over New Year (over 15% less than the 95% demanded by the NHS constitution). It is, of course, no secret that A&Es are under ever-increasing pressure.
Funnily enough, shortly after Circle pulled out of Hinchingbrooke, the Care Quality Commission (CQC), the NHS ‘watchdog’ of care standards, published a damning report into the care at the Hospital. The CQC had carried out announced inspection visits of Hinchingbrooke between 16 and 18 September 2014 and unannounced inspection visits on 21 and 28 September 2014, and then published its formal Report a mere few hours after Circle had announced its withdrawal from Hinchingbrooke on 9 January 2015. A cynic might be forgiven for thinking that it was [the anticipation of] this Report rather than pressure on A&E that was the real reason for Circle beating its retreat; or perhaps it was a bit of both.
Regardless, the CQC highlighted in particular the ‘inadequate’ Medical care and Urgent and Emergency Services care, concluding an overall rating for the Hospital also of ‘inadequate’. For example, the CQC identified in its Report under Medical care that “Hand hygiene and infection control techniques were poor” and “Services were not effective because pressure ulcer prevention and treatment was not always provided in line with NICE guidelines” and, in A&E, “Daily checks on emergency resuscitation trollies were not carried out by staff”. Other aspects of the hospital ‘required improvement’, but happily there were also some areas that provided ‘good’ care (such as Critical Care and Maternity Services). Most importantly, though, its overall “safe” rating was found to be ‘inadequate’ and, as a result, the Hospital was put on (and currently remains on) “special measures”. The full CQC Report can be found at: http://www.cqc.org.uk/sites/default/files/new_reports/AAAA2986.pdf
On the assumption that the CQC’s findings are accurate (and, whilst they have been challenged, the CQC is standing firm), the Report yet again raises concerns about standards of care in English hospitals, especially in the light of the Mid Staffordshire Inquiry and other recent debacles. Whilst some may argue that the significant majority of hospital care in England is acceptable, or indeed even good, and that generally patients are satisfied, issues such as poor infection control techniques, the failure to adhere to NICE guidelines and the failure to check resuscitation equipment sufficiently often, three of the inadequate areas identified by the CQC in Hinchingbrooke, are basic and fundamental failings that can unhappily result in potentially wholly avoidable harm coming to patients. Such inadequacies are simply not acceptable.
Factor in that some hospitals and individuals within hospitals, be they managers and/or clinicians, still do not always voluntarily own up to their patients about such inadequacies or failings (notwithstanding the duty of candour: please see https://anthonygold.co.uk/latest/legal-insight/a-professional-duty-of-candour),
and it means that, at times, the only recourse to an injured patient will be either a formal complaint or, sadly, ultimately clinical negligence litigation.
Until both the NHS and private health sectors truly come to terms with what is required to minimise avoidable injuries to patients and to deal efficiently and effectively with such harm when it has occurred, there will remain an important role for clinical negligence litigation, both to compensate those injured patients and to help try to safeguard future patients from being injured. Recourse to the law may be regrettable, and not a step most patients would ever wish to take, but at present it remains a necessary side-effect of the currently inadequate ability of the health sector to manage efficiently avoidable patient harm when it has occurred as well as to reduce its occurrence.
In addressing its concerns about apparent rising clinical negligence costs, instead of depriving injured patients of access to justice by unnecessarily sweeping reforms to civil litigation, including clinical negligence, the government would do better to focus its energies on minimising fiascos such as Hinchingbrooke Hospital and preventing avoidable harm to patients in the first place. The effect of this would soon be to reduce the number of clinical negligence claims, and their cost, as there can only be a claim where there has been avoidable harm; the age-old health adage ‘Prevention is better than cure’ seems to be a phrase the government would do well to heed.