The BBC this week ran an investigation asking whether private hospitals treating NHS patients were properly equipped to deal with emergencies. It is an issue that has risen in importance as more and more private hospitals and clinics are sub-contracted into providing NHS care.
The BBC’s investigation focused on one patient, James Hartley, who died after a routine hernia operation in October 2014.
James had been admitted to The Yorkshire Clinic, a privately run hospital in Bingley, for hernia repair surgery. He was an NHS patient but had elected to be treated at the private clinic after being referred by his GP. The operation was carried out as planned and the family was told afterwards “it couldn’t have gone better.”
Unfortunately, in the post-operative period, James developed urinary retention and was kept in overnight. Staff at the clinic encouraged him to drink fluids even though he was unable to pass water.
14 hours passed before a catheter was inserted. Shortly afterward, James suffered a series of seizures. The Yorkshire Clinic did not have the emergency facilities to treat him so he was transferred to Bradford Royal Infirmary where he died from multi-organ failure due to brain injury from water intoxication and sepsis from pneumonia.
The BBC highlighted the family’s primary concern: whether the private clinic was able to cope when things went wrong. It also identified a major failing in the monitoring and assessment of private clinics providing NHS service, namely their requirement to report safety failings.
The investigation made reference to a recent report by the Centre for Health and Public Interest which stated that around 6,000 patients a year are admitted to the NHS from private hospitals and that around 2,500 of these are as emergencies.
One of the authors of the report, Professor Colin Leys, was reported as saying that most private hospitals are smaller than their NHS counterparts and do not have intensive care beds to treat patients when complications arise. He went on to say that staffing levels also differ: “Typically private hospitals will only have one doctor on site to take care of all post-operative patients. In an NHS hospital there are specialist teams available in every speciality.”
He also highlighted concerns about the availability of safety and performance data relating to private sector providers of NHS care. Professor Leys said: “The system for reporting serious incidents in the private sector is different and is a much less transparent model than in the NHS.”
Under the system as it currently exists NHS hospitals are required to report serious incidents, including patient injuries and deaths, to the National Reporting and Learning System (NRLS). The NRLS makes the information publically available on a hospital-by-hospital basis with the intention that safety experts will identify common risks to improve patient safety. Although private hospitals must report safety incidents to the Care Quality Commission and the regulator Monitor, they aren’t required to inform the NRLS.
The private sector provision of NHS care is a necessity in this era of an under resourced state provider. That said, patients who are treated in the private sector should be afforded the same level of care as their counterparts in the NHS. Many will be surprised to learn that if things go wrong during the course of their treatment they may not have the same degree of emergency care available to them as if they had stayed inside the NHS.