It's not just Mid Staffordshire. Private hospitals fail, too

It's not just Mid Staffordshire. Private hospitals fail, too For-profit healthcare groups depend on NHS contracts for their revenue, yet they are not forced to be transparent.

After a long summer of stories about Mid Staffordshire it occurred to me to wonder why we have heard so little about another hospital which had also been putting patients' lives at risk. The failings at the Stafford hospital led to two major inquiries by Robert Francis and a review of 14 NHS hospitals by Sir Bruce Keogh. But the failings at the private BMI Mount Alvernia hospital in Guildford have led to no inquiry, even though BMI is the largest private hospital group in the UK, and a significant share of its revenues comes from treating NHS patients. Unlike Mid Staffs, Mount Alvernia has not become an emblem of the failings of private hospitals.

Yet when the Care Quality Commission (CQC) inspected the hospital in January this year it found that "medical, surgical and some nursing practices were so poor that people were put at significant risk. This risk was, on some occasions, life-threatening".

The CQC report gave many examples, such as when "one person had a nerve block on the wrong side of their body". Or in another incident, "on 20 November 2012 a patient stopped breathing. Resuscitation was started and the emergency team arrived but the attempt was stopped after the Resident Medical Officer telephoned the consultant … A DNAR [Do Not Attempt to Resuscitate] form was completed after the patient had died". And another time "when, due to a ventilation failure in the main suite, theatres were unable to be used … a consultant surgeon had insisted two patients admitted for investigative procedures under general anaesthetic be transferred to the ambulatory care area … "

Enough already? Certainly. But there was much, much more. There were not enough nurses, staff were not properly trained, records were not being kept, samples were incorrectly labelled, out-of-date blood was used in a transfusion, resuscitation equipment was broken, no checks were made that all instruments had been removed at the end of operations. One surgeon reportedly refused to wash his hands between patients, saying he had "low infection rates".

Yet, until the CQC's concerns were made known, both private and NHS patients were being sent there for surgery. Like Mid Staffs, Mount Alvernia was no doubt an extreme case. The chief executive of BMI has since apologised and assured everyone that all the failings have been fully addressed. But a follow-up inspection in May found it still failing to meet three minimum safety standards; and six other BMI hospitals have also recently had less serious but significant adverse CQC reports on matters affecting patient safety.

The problems at Mid Staffs arose primarily from a crude and mismanaged drive to cut costs. The problems at Mount Alvernia may also have stemmed in part from BMI's financial problems, but the worst failings seem to have been due to the absence of the clinical governance structures that are standard in NHS hospitals. Private hospitals, with typically fewer than 50 beds and only a junior doctor on regular duty, don't offer the safeguards provided by the clinical teams led by salaried senior doctors in NHS hospitals. Clinical authority over the part-time consultants who come in to perform operations, and who are responsible for patients' subsequent care, rests solely with a committee of their colleagues meeting every two to three months. And the hospital management has a disincentive to intervene, since it is the consultants who bring in the private patient income on which they depend.

More than half the private hospitals in the UK are foreign-owned, with average pre-tax returns in 2012 of 24%, although some of the parent companies have been so loaded with debt or rent obligations that they make minimal trading profits, and even losses – risking a Southern Cross-style collapse that could have a big impact on some parts of the NHS. One of the four largest for-profit groups, Ramsay, relies primarily on NHS patient income, while BMI and Spire each get 20% or more of their revenue from treating NHS patients. A rapid increase in their NHS business – private hospitals are now treating almost one in five of all NHS knee and hip replacement cases – has kept all three groups afloat during the recession.

Exactly how they get this business is a bit of a mystery. Private hospitals have successfully resisted publishing information which would allow them to be compared with NHS hospitals. The Choose and Book website, which provides performance data for every NHS hospital, includes private hospitals but provides no performance data for them. NHS patients who choose private hospitals are acting on private advice from their GPs. Not surprisingly, perhaps, it turns out these patients tend to be drawn from the same social class as private patients. Given that their treatment is paid for out of public funds the lack of openness involved seems indefensible.

If NHS patients are to continue being treated at private hospitals this gross imbalance of transparency must end. NHS hospitals treat everyone – including the dangerously ill, accident victims, the old and frail, people with multiple illnesses – on steadily shrinking budgets. Some of them – again unsurprisingly – present "serious concerns". Private hospitals take only low-risk patients, do a limited range of elective surgery and make a lot of money. They should present no concerns whatever. Yet as the CQC reports show, they can sometimes be dangerous places. The Guardian