How safe are private hospitals?

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Are private hospitals treating NHS patients equipped to deal with emergencies?

James Hartley died aged 79 after a routine hernia operation in October 2014.

His son Richard Hartley says: "The last time I saw my dad was the Sunday before the operation. He'd spent the day in the park with my two daughters.

"They came back full of amusement saying he'd been on the roundabout, and ridden their scooter on the way back. So he was young at heart and enjoying life."

Later that week James went into a privately-run hospital, The Yorkshire Clinic in Bingley. Although he was an NHS patient, he elected to be treated at the private clinic after being referred by his GP for hernia repair surgery.

His son says it seemed a more attractive option.

"My mother had been there some years previously for an operation and had a very positive experience. We thought the standard of care would be probably better than the NHS. We felt because it was a private clinic it would be probably a nicer environment. Why not benefit from a little bit more comfort and luxury?"

The operation was carried out as planned and his son says the family was told that "it couldn't have gone better."

However James suffered from post-operative urine retention and was kept in overnight. While staff were encouraging him to drink fluids he wasn't passing water and 14 hours passed before a catheter was inserted.

Richard says things began to deteriorate: "About five o'clock in the morning my father was found in the corridor in a state of undress, clearly confused."

Shortly after, he suffered a series of seizures and was transferred to Bradford Royal Infirmary where he died from multi-organ failure due to brain injury from water intoxication and sepsis from pneumonia.

At the inquest the coroner said the management of his fluid intake was "haphazard at the very least" and the overloading of fluid "went unnoticed and unmonitored".

Richard believes his father's case raises a serious issue. "There's a big question mark over the hospital's ability to deal with the crisis. Do they have the back up to deal with this type of emergency?

"I think one of the saddest things for the family is he would have celebrated his 80th birthday this February and also my mother and father would have celebrated their 50th wedding anniversary. So he's not been here for those big family landmarks."

Ramsay Healthcare which runs The Yorkshire Clinic describes James Hartley's death as an isolated incident which should not have happened: "We apologise for the shortcomings in the care that was given.

Identifying risks

They added: "A number of action plans have been put in place to ensure that this does not happen again."

A recent report by the think-tank, the Centre for Health and Public Interest, estimates that around 6,000 patients a year are admitted to the NHS from private hospitals. Around 2,500 of these transfers are emergencies.

One of the authors of the report, Prof Colin Leys, says most private hospitals are smaller than their NHS counterparts and do not have intensive care beds to treat patients when complications arise. He says 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 highlights concerns about the availability of safety and performance data relating to the private sector.

"The system for reporting serious incidents in the private sector is different and is a much less transparent model than in the NHS."

NHS hospitals are required to report serious incidents, including patient injuries and deaths, to the National Reporting and Learning System (NRLS), which makes the information publically available on a hospital-by-hospital basis. Safety experts then 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 NHS Partners Network, which represents independent providers of NHS services, supports the view that private providers should be subject to same reporting requirements as the NHS.

Their clinical director, Dr Howard Freeman, said: "We want complete transparency so we'll continue to push to see NRLS reporting brought in for the independent sector. We're already working with NHS England on this."

In response to questions over whether private hospitals have sufficient emergency capability Dr Freeman said: "In the unlikely circumstance where there is an unexpected complication the independent provider transfers the patient to the nearest specialist hospital to ensure the patient gets the best care for their specific needs.

"NHS hospitals also transfer patients to other NHS trusts where specialist care is available, so that patients receive the highest standard of care possible.

He added: "The overwhelming majority of NHS care delivered by independent sector hospitals is safe, efficient and of excellent quality."

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