At the end of April this year the Care Quality Commission (CQC) published a report into the state of care in independent acute hospitals. As you may have seen in the national press, the report received a large amount of coverage as it was found that out of 206 independent hospitals 62 hospitals (30%) were rated as requiring improvement. In particular, the report expressed concerns surrounding hospital governance, clinical audits and identified a culture of failing to learn from incidents. It is the latter point which is of greatest concern to this writer.
All practicing medical professionals, be they at a private hospital or working within a NHS trust, are subject to the duty of candour. The duty of candour puts the principle of openness and honesty front and centre: it is a professional’s duty to be candid with patients when things go wrong and where the patient suffers harm and distress as a consequence. GMC practical guidance on the duty of candour emphasises that doctors should report errors at an early stage in order that lessons can be learned quickly so that patients are protected from harm in the future. Why then does this appear to be happening less in private practice?
In considering why it is that private hospitals are failing to learn from their mistakes, the CQC identified a number of specific factors:
- Some providers did not have a formalised governance process in place, instead relying on informal arrangements based on longstanding relationships;
- Lack of effective oversight of practising privileges with providers treating consultants as “customers” bringing business to the hospital; and,
- An overall informality surrounding medical governance.
Looking at those factors it appears, at least to this writer, the issue lies in the fact (and this was acknowledged by the CQC to some extent) that private hospitals are ultimately a commercial enterprise. They need to maintain their profitability and financial viability and are operating in a competitive market. It is this market and the fact that their patients and the various medical insurance companies are their “customers” that appears to be driving a culture of lack of transparency about clinical outcomes and discourages the sharing of information when things go wrong.
How then can we address this? I feel that the CQC report is a start as it is shedding light upon some of the practises within private hospitals. It is encouraging to see from the report that since the investigation out of the 13 locations that were re-inspected all four of those initially rated as inadequate had improved; and two of those are now rated as good. However, I do wonder whether this is all a PR exercise following the Ian Paterson affair and once the media storm quietens down will private hospitals return to their old habits. This writer hope that the CQC will continue to keep applying pressure on private hospitals to change their governance procedure, as ultimately until there is a positive culture shift from keep quiet and cover up to openness and transparency it may only be through the litigation process that private hospitals may learn from their mistakes.