High quality care for all in the UK

A report published by the UK Centre for Health and the Public Interest (CHPI) last week raised concerns about the quality of care in some private hospitals and highlighted the effect on the National Health Service (NHS) of these failings in care. The review describes inadequate reporting, both of patient safety incidents and of hospitals’ performance, preventing proper assessment of risk, problems with staffing, a lax safety culture, and inadequate record-keeping. Clinical governance, widely recognised as essential for the delivery of high quality care, has no statutory basis in private hospitals, and the overseeing committees have no legal duties, no power to enforce good practice, and potential conflicts of interest. Patients treated in private hospitals have little protection from direct and serious threats to their safety.

There are knock-on effects for the NHS too. 25% of patients treated in private hospitals are funded by the NHS, often referred by hospitals otherwise unable to meet the government's waiting-time targets. Many private hospitals lack the facilities to care for patients when things go wrong—leaving the NHS to pick up the pieces. 6000 patients per year are admitted to the NHS from private hospitals, but there are no data to explain why.

Poor quality care is not confined to private practice. Recent reports such as the Berwick Report, the Keogh Review, and investigations by the Care Quality Commission into East Kent University NHS Foundation Trust and Alder Hey Children's Hospital, highlight patient safety problems throughout the NHS. Incorrect priorities, lack of accountability, poor leadership, and failings in communication have led to a culture that accepts inadequate care.

Alarmingly, many of the recommendations made by the CHPI echo those of previous inquiries. Indeed, some reiterate recommendations made by the House of Commons Health Committee in 1999. Without a Minister for Health who makes quality of care for patients a main priority, the time and money spent on such reports and reviews is wasted. The UK Government must put learning, improvement, and patient safety at the heart of health-care delivery nationwide.

The Lancet, Volume 384, Issue 9945, Page 716, 30 August 2014