Future Healthcare

Private sector set to be safer

Consultant oversight framework

David Hare

The new Consultant Oversight Framework will act as a strong benchmark for all independent hospital operators to meet, says David Hare, chief executive of the Independent Healthcare Providers Network

Improving patient safety has risen to the top of the health agenda in the past few years. 

Everyone from the World Health Organisation through to former Health Secretary Jeremy Hunt has been calling on health services to do more to raise safety standards.

Independent Practitioner Today reported the launch of the framework in last month’s issue

Hunt himself declared it his mission to make the NHS ‘the safest healthcare system in the world’.

And for the independent sector, too, safety has been a key focus with much work taking place to drive continuous improvement. 

For example, after much lobbying, independent providers are now submitting vital patient safety data to the National Reporting and Learning System (NRLS) – the world’s largest national incident management system set up to identify trends to help improve levels of patient safety. 

Safety investigations

The Independent Healthcare Providers Network (IHPN ) was also successful in ensuring that the remit of the proposed Health Service Safety Invest­igations Body (HSSIB) should extend to all healthcare provision in England, including privately-funded care, to enable the learning and best practice from any safety investigations to be shared on a system-wide basis.

And the Care Quality Commis­sion (CQC), having inspected and rated over 200 independent acute hospitals for their safety and leadership, has been largely positive in its assessment of the safety of care delivered in the sector, despite some media commentary suggesting otherwise.

Overall, in its State of care in independent acute hospitals report released in April 2018, the CQC found over 60% of independent acute hospitals to be good or outstanding for safety, which compares very favourably to the wider health system. 

The sector also plays host to Nuffield Brentwood and HCA’s Christie Clinic, the only two acute hospitals – whether NHS or independent – to be rated as ‘outstanding’ for safety.  

But, for all of those that work in the independent acute sector, this must not be taken as a cue to sit back and relax. 

Problems, particularly around consistent application of the kind of excellence found in some parts of the sector, undoubtedly persist and nobody should be in any doubt that the sector is under considerable scrutiny. 

There are, of course, many ways to tackle poor and unsafe care. 

Accessing data

Improving transparency and ensuring that patients and the health system as a whole can access comparable data on the quality and outcomes of both the NHS and independent sector will be key to driving up safety standards. 

Equally, the move away from the current system of discretionary protection to fully comprehensive insurance indemnity cover would help ensure that no patient would ever lose out if affected by poor care in the independent hospital sector. 

We are therefore delighted that this is a priority for the Govern­ment, and we are working closely with the Department of Health to ensure that any new indemnity arrangements work for patients, providers and practitioners alike.

And, as the CQC noted in its State of care report, there is more work to be done to ensure that monitoring of medical governance processes are ‘more consistently robust’. 

This encompasses a number of key areas, including improving whole-practice appraisals by ensuring a two-way flow of information between the NHS and independent sector providers so that any concerns relating to consultants can be identified and dealt with. 

It is also about improving the functioning of medical advisory committees (MACs) and the account­ability of the MAC chairman and representatives’ roles at the local hospital level.

The IHPN recognises that delivering the consistency that is required is deliverable only where providers and consultants work together. 

Spreading best practice

At the end of last year, we were therefore delighted to announce that Sir Bruce Keogh, former national medical director at NHS England, will be leading on the development of a ‘Consultant Oversight Framework’, which will apply to consultants engaged on both practising privileges and employed arrangements. 

The framework is supported by an expert reference group made up of key figures across the medical profession, including the president of the Royal College of Surg­eons, the CQC deputy chief inspector of hospitals, the director of registration and revalidation at the GMC, and Federation of Ind­ependent Practitioner Organ­isations’ (FIPO) chairman Mr Richard Packard. 

It will enable individual providers to apply best practice in the way that best suits their culture and practice. 

And it will cover a number of key areas including:

 Governance around medical practitioners;

 Whole-practice appraisal and revalidation;

 Sharing of information across and within the sector;

 Monitoring scope of practice;

 Supported decision-making; 

 Multidisciplinary team-working.  

By dint of it being principles-based and non-mandatory, the document will act as a strong benchmark for all operators to meet, whether small, stand-alone local independent hospitals or those part of large international group hospital chains.

And in drawing on existing good practice, we strongly believe that this is the best way to improve the consistency of clinical governance around medical practitioners across the sector and to raise the bar in medical leadership. 

As health secretary Matt Hancock recently argued, to ensure the safest possible care for patients, ‘there is no room for complacency . . . we need a culture of humility, openness and learning’. 

Working with Sir Bruce Keogh, we believe the development of the Consultant Oversight Framework clearly demonstrates the sector’s commitment to quality and safety in the sector, building on the excellent care we know is already delivered and spreading this to ensure ever more patients can benefit.

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