Private hospitals’ business model is archaic, unsafe and indefensible colin leys opinion the guardian arthroscopic hip surgery recovery

Hunt’s action was not in fact prompted by the Care Quality Commission’s recent report, but by a letter sent to him by a coroner in Manchester, to which the health secretary was obliged to reply by 15 May. In the letter, which the coroner also sent to the Centre for Health and the Public Interest, he called for action following the death of Peter O’Donnell, who died in an NHS hospital from complications following a routine hip replacement at a private hospital. O’Donnell’s deteriorating condition was not noted early enough, due to inadequate monitoring; and a single junior resident medical officer, provided and appraised by an outside agency and working literally 24/7, was in sole charge, says the coroner.

Further, there was no formal protocol governing communication with the surgeon requiring him to come back to see his patient if his condition deteriorated; and there was no agreed protocol for transferring an unwell patient to the nearest NHS hospital.


To make matters worse, two nurses were found to have altered O’Donnell’s case notes after he was transferred, the coroner revealed.

The reason why the coroner wrote to the secretary of state, rather than to the private hospital concerned, is that what happened to O’Donnell has happened before. There have been many other similar such deaths, and they result from the basic weaknesses of the private hospital business model, as a recent report by the CHPI which was extensively cited by the coroner, pointed out.

O’Donnell’s sister has said that if they had known the risks of being treated in a private hospital, they would not have agreed to the NHS sending him to one. The same sentiment has been bitterly expressed by some of the victims of Ian Paterson, the breast surgeon sent to prison last year after wilfully injuring hundreds of women while practising at a private hospital in Solihull.

So Hunt’s letter sent to private hospital company chief executives on Tuesday warning them to raise their standards is very welcome (even if belated). The question is whether his call for change will go to the root cause of the risks posed by the private hospital sector, or whether a series of notional “improvements” will be taken as sufficient. Of the six issues listed in Hunt’s letter only one touches on the key problem: the lack of a financial incentive for private hospitals to ensure that patient safety is genuinely prioritised.

A consultant at an NHS hospital is employed there, and the hospital is liable for everything that happens to his or her patients. But consultants who practise at private hospitals are not technically employees. This allows the hospitals to avoid liability when something goes wrong. If blame is established, it is the consultant’s insurers who pay. The private hospital thus has no financial incentive to minimise risk – for example by having two or three resident medical officers on the wards, with some seniority, or by paying anaesthetists to be on call, let alone by directly employing surgeons, instead of relying on NHS consultants, whom they do not even need to pay – all measures that would significantly raise their costs.

On the contrary, because private hospitals’ profits come mainly from the private patients the consultants bring to the hospital, bosses have an incentive not to look too closely at what the consultants do. That is not to say that they are indifferent. But responsibility for ensuring that consultants operate safely is entrusted to a medical advisory committee drawn from the consultants who work there.

Hunt does note: “When something goes wrong, the private hospital provider is able to point to the fact they were not an employee, and thereby avoid liability.” But he doesn’t say that this needs to change. And he fails even to mention the manifestly unsafe long-hour shifts of resident medical officers, even though this was among the issues raised by the Manchester coroner. Hunt’s letter could be read as offering the private sector an opportunity to make a series of marginal changes, leaving its risk-laden but profitable business model unchanged.

The private hospital companies, most of which are foreign-owned, and some of which have paid multimillion-dollar fines for fraud in the US, hope to become an accepted alternative to the NHS for routine elective surgery while continuing to use NHS-trained surgeons, continuing to let them work alone, and continuing to rely on the NHS to cope when things go wrong – while still being allowed to avoid liability. It is these distinctive features of the private sector in the UK that have led some to call it the “red light district” of medicine. Allowing patients – including the large and growing number of NHS-funded patients – to run the risks involved, now that they have been officially acknowledged, is impossible to defend.