Private hospitals must share more data with NHS, says top surgeon

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By Sarah Boseley Health editor

The leader of the Royal College of Surgeons of England is calling for private hospitals to be encouraged to publish information on their safety to prevent another scandal like the one involving jailed breast cancer surgeon Ian Paterson.

“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,” said Prof Derek Alderson, president of the organisation.

“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.”

Paterson worked at the Heart of England NHS Foundation Trust and also at private hospitals Spire Parkway and Spire Little Aston. In 2017, he was sentenced to 15 years in prison, later increased to 20, after being found guilty of 17 charges of intentionally wounding his patients.

Paterson was said to have carried out unnecessary mastectomies and to have invented or exaggerated cancer risks to justify payments for operations that were not required. In September 2017, the high court approved payments to 750 patients totalling £37m.

Alderson told the Guardian that the absence of data passed between the independent sector and the NHS meant no one could be sure big the problem was.

He said: “The real problem is that we have something of an unknown issue here about the scope or the size of the problem. We do know that it’s difficult at the moment to transfer information – data – between the independent sector and the NHS.

“We do know that the governance arrangements between NHS hospitals and the independent sector are highly variable in terms of the information that is transmitted between the two parties about surgeons who function in the independent sector and in the NHS. So the worry here is that we’re not sure about the exact size of this problem. We just don’t have that information.”

Unexpected deaths, “never events” – incidents that are entirely preventable – and serious injuries have to be reported by private hospitals to the Care Quality Commission, but the data is not routinely published, although the Royal College of Surgeons says it should be. The independent sector also does not publish data on its outcomes, although talks are ongoing.

More information should be shared with the NHS about the operations surgeons are undertaking in the independent sector and how they are performing, says the college. The Independent Healthcare Providers Network (IHPN), which represents the sector, agrees.

The college’s recommendations have been submitted to the independent inquiry into the issues raised by Paterson, set up by the government and chaired by the Bishop of Norwich, the Right Reverend Graham James.

They include concern that not all independent hospitals have arrangements for transferring patients who become suddenly very ill to an NHS hospital. Most independent hospitals do not have critical care facilities on the basis they are carrying out routine operations on patients who are expected to do well. There have, however, been tragedies. “The problem is that there are often no formal arrangements between the independent provider and the local NHS hospitals,” said Alderson.

The dangers were also highlighted in a report to the Paterson inquiry by the Centre for Health and the Public Interest, which warned that “there are a number of systemic patient safety risks which are specific to the private hospital sector”, which must be addressed.

David Hare, the chief executive of the Independent Healthcare Providers Network, said it had successfully lobbied to be allowed to have safety and other data included in NHS systems. “Providing safe, high-quality care for patients is the top priority for independent healthcare providers, and in their recent report the Care Quality Commission rated over 70% of acute independent hospitals as good or outstanding,” he said.

“However, the case of Ian Paterson – who worked in both the NHS and the independent sector – highlighted the need to ensure that governance processes across the healthcare system are more effectively mitigating against any criminal or negligent practice from clinicians. This includes ensuring that data systems are more effectively aligned across the NHS and independent sectors, building on the extensive amount of data already submitted by NHS and independent providers to flag up issues or concerns.”

 This article was amended on 10 April 2019 to clarify that Derek Alderson is president of the Royal College of Surgeons of England.

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