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A BBC Panorama investigation found private hospitals are not reporting enough data on patient outcomes. Patients may be being put at risk by the failure of private hospitals to report serious incidents, the Royal College of Surgeons (RCS) has warned.

 

This means the private sector “cannot be as robust or as safe as the NHS”, RCS president Derek Alderson said.

The government says new guidelines will lead to tougher enforcement action against failing clinics.

The concerns, raised by the RCS, are focused on reporting serious incidents and so-called “never events” – extreme mistakes that should never happen.

These are not reported to national databases in a consistent way or at all, the RCS said.

It also warned that clinical audit data is lacking from the private sector, such as not submitting datasets on the outcomes of cancer surgery, despite undertaking many cancer procedures.

‘Not good enough’

Mr Alderson said: “We don’t know exactly what’s going on in the private sector.

“It cannot be as robust or as safe as the NHS at the moment for the simple reason that you do not have complete reporting of all patients who are treated.

“It’s not good enough. Things have to change,” he said.

The RCS also points to gaps in reporting on cosmetic surgery, where there is no dataset on the total number of operations.

Much of the private healthcare industry accepts there is a problem with data and transparency.

Brian O’Connor, of the Independent Doctors Federation, said: “It’s up to private hospitals to raise their game and to show the data and the excellence of care, because there is nothing for them to hide.”

Mr O’Connor, whose organisation represents 1,200 private doctors, added: “Those private hospitals which don’t have the data and are not transparent should be closed or not be allowed to conduct complex medical procedures.”

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Panorama heard from victims of rogue surgeon Ian Paterson, jailed for 20 years for intentionally wounding patients.

Although he was found to have harmed patients in the NHS, more than 700 people were harmed by him in private hospitals, including Beryl Parkes.

Paterson removed one of her breasts and she needed further operations to rectnify his mistakes.

Beryl Parkes

Ms Parkes said: “You believe a doctor, don’t you? They take oaths for people to do their best for them.”

But nobody was supervising Paterson.

And when Ms Parkes’s treatment was eventually reviewed, it turned out she should not have had any operations – because she did not have cancer in the first place.

“He should have got life,” she said. “And I think that’s too good for him, because it must have been basically all over money.”

Paterson’s supervisors at Spire Healthcare were criticised for failing to manage their high-earning surgeon.

The company told the BBC it is “truly sorry for the distress experienced by patients”.

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Panorama also learned that some patients are unable to get compensation if they are harmed by a private surgeon.

The hospital might refuse to accept liability because the surgeon is an independent contractor with “practising privileges”.

Lawyer Suzanne White said: “Any patient that goes through a private hospital will assume that they will be covered, and they are simply not. That is astonishing.”

Patients may not be able to get compensation from the surgeon’s insurance company either, because if the insurer decides that the surgeon has broken the rules, they can refuse to cover them.

‘Totally reprehensible’

It is a rare gap in the system, but disastrous for patients.

Mr O’Connor responded: “To say a patient who has had wrong done to them is not going to get proper compensation is totally reprehensible.”

He wants the government and private health organisations to ensure patients are compensated properly.

Panorama has discovered a case where a patient who had been harmed was unable to get compensation from the private hospital or the surgeon responsible.

He successfully sued the NHS instead, because his first consultation was in an NHS hospital.

Even the lawyer who won the case thinks it was wrong that the NHS was forced to pay up.

Suzanne White said: “I feel entirely uncomfortable about it and very cross, because I see it quite often.

“Why is it that a private hospital that has a doctor who has given negligent care – and profited – does not compensate those patients?

“Why is it the NHS has to foot the bill?”

Doctor at computer

Last year, more than 500,000 NHS patients were referred to private hospitals.

But the fastest growing area in the sector is self-pay, where people without insurance fund their own treatment to the tune of almost £900m annually.

Together, NHS referrals and self-pay patients make up nearly half the private health sector’s business.

‘Tougher enforcement’

The Association of Independent Healthcare Organisations said there is strong evidence that the independent sector is safe and patient safety is as much of a priority as it is for the NHS.

It said the Care Quality Commission has rated nearly 60% of private hospitals as either good or outstanding for safety.

The Department of Health said new standards have already set out clearer requirements for the delivery of safe care.

It said tougher enforcement action will be enabled against failing providers.

Cosmetic surgery clinics will now be rated by the CQC, and private hospitals must ensure ratings are displayed both within premises and online.

Susie Henley leads the free online course “The Many Faces of Dementia”, run by University College London (UCL). Here she explains the course and how you can sign up to learn more about rarer forms of dementia.

Susie Henley

Did you know that some forms of dementia can affect how people see the world around them? Or that they can cause problems with language and communication rather than just memory?

UCL’s popular, free online course, “The Many Faces of Dementia,” can teach you more about the lesser-known aspects of dementia.

The course uses videos from people with dementia, as well as discussions and articles from leading clinicians and researchers in the dementia field, to shed light on aspects of dementia that may come as a surprise.

It’s accessible, with jargon-free information; the online platform FutureLearn also means that you can dip in and out when you have time. You can complete the whole course by spending about two hours a week on it over the four-week run.

It’s a very sociable forum, with many learners commenting on the various steps and supporting each other as they learn about each other’s stories and reasons for being there.

Different aspects of dementia

Each week tackles a different aspect of dementia.

In week one, the course looks at Familial Alzheimer’s disease (FAD), rare forms of Alzheimer’s disease that are inherited, and how this affects the whole family. It also explores how research with members of these families has been enormously helpful in understanding the more common, non-inherited forms of Alzheimer’s disease.

Week two covers frontotemporal dementia (FTD), an umbrella term for a lesser-known cluster of young-onset dementias that can affect social skills and behaviour or language. In these forms of dementia, memory is relatively preserved in the early stages, so it’s very different to what most people think of as ‘dementia’. Often people with these forms of dementia have struggled to get a diagnosis and to understand what’s going on.

In the third week, we look at dementia with Lewy bodies (DLB), and typical features of this. This includes seeing things that aren’t there (hallucinations) or believing things that aren’t true (delusions). These symptoms can occur in other types of dementia, but tend to be a defining feature in dementia with Lewy bodies. We hear from families living with this dementia, and the professionals who try to help manage and minimise the impact of hallucinations.

Finally, week four talks about Posterior Cortical Atrophy (PCA), the rare variant of Alzheimer’s disease that author Terry Pratchett had. The course uses videos and pictures to show what life is like for someone with Posterior Cortical Atrophy, whose brain can no longer process visual and spatial information correctly.

 

Useful information for everyone

Whilst the course focuses on rarer dementia types, it’s also relevant to anyone working or living with people with all types of dementia. People with the more common forms of Alzheimer’s disease and vascular dementia can also experience these sorts of symptoms at some point.

Learners to date have been a mixture of professionals, family members, students and people with dementia. We’ve had lots of very positive feedback about how useful the new information they’ve gleaned from the course is, and how they’ve learned from each other too.

Expert staff from UCL also pop in to answer questions and comments during the week; there is a special ‘Q&A’ feature at the end of each week, where the most popular learner questions are answered online every Sunday night.

So if you are interested in exploring a bit more about these sides of dementia, or you know someone who is, encourage them to sign up and have a look.

It is very important to protect food from harmful bacteria that could be spread by other activities in the care home. Older people may be more likely to suffer from food poisoning and become ill because ageing weakens the immune system’s ability to fight infection. So it is important to take extra care when dealing with food intended for people in residential care. This supplement is for small residential care homes that prepare and cook food for people in either long-term or short-term residential care. It is not intended for use in nursing homes.

The safe methods in this supplement cover the following specific food safety issues found in care homes:

• Extra care: protecting food

• Mini-kitchens

• Gift food

These will help you to reduce the spread of harmful bacteria between the rest of the care home and the kitchen. You will need to use this supplement together with the Safer food, better business for caterers pack and not on its own.

If you have completed the SFBB caterers pack you will already be familiar with the safe methods and how to complete them. Work through the supplement and complete the relevant safe methods and the new safe method completion record. Then insert the safe methods into the appropriate colour-coded section of the pack. When you have completed all the sections, make sure you and your staff (this means anyone working with food in a care home setting): • follow the safe methods all the time • fill in the diary every day Remember, the safe methods in the supplement will not provide a food safety management system by themselves. The supplement should be used alongside your caterers pack.

As part of your registration as a care home provider, you will need to comply with the national minimum standards (NMS). You can get further information on the NMS from the Care Quality Commission (CQC) or the social services at your local authority. All care homes are also required to have an infection control policy. For further advice you can refer to the Department of Health’s ‘Infection control guidance for care homes’.

Where can I get more information ?

For information about Listeria, which is a type of bacteria that can cause serious problems for the elderly, see: www.food.gov.uk/science/microbiology/listeria More information on registering as a care home provider can be found at: www.cqc.org.uk/ Information on infection control within care homes is available at: www.dh.gov.uk/publications

The pack is available to download from the Food Standards Agency website at: www.food.gov.uk/business-industry/ caterers/sfbb/sfbbcaterers/