Improving transparency and performance of private hospitals
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m577 (Published 14 February 2020) Cite this as: BMJ 2020;368:m577
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Dear Editor,
The Editorial (BMJ 2020;368:m 577) takes up considerable space in the Journal to discuss the Paterson case but like many others before I fear it entirely misses the point.
The key question is that in oder to be able to practise and despite the many criminal offences committed in the operating theatre, Paterson must be assumed to have had an impeccable record of Appraisal and to have been revalidated.
The GMC introduced the cumbersome and time consuming system of Revalidation after Shipman with the intention of catching the rotten apples in the medical profession. Yet it is clear based on this case and many others before that it has failed most spectacularly.
I am sure that I am not alone in saying that the system is not fit for purpose and should be scrapped.
Yours sincerely
Dr G Spoto FRCPsych MA FAcadMEd
Consultant Psychiatrist
giuseppe.spoto@ntlworld.com
Competing interests: No competing interests
Dear Editor,
Anderson et al (BMJ2020;368:m577) cite transparency (which they do not define) as the primary problem in UK private hospitals that led to the disaster inflicted upon Ian Paterson's patients.
As a surgeon who has been involved in assisting the Care Quality Commission with inspections of both NHS and private hospitals over some years, I would agree that the private sector is poor in collating and making available its clinical performance statistics and urgently needs to do much better. However, there is a much more important route to the identification of clinical outliers such as Paterson. It is that first and foremost, clinicians police themselves, which they are signally not doing in the private sector.
For centuries, indeed since medieval times, ancient trades and guilds, of which the medical profession is but one example, have rigourously set and enforced their own standards. At the sharp end in modern secondary healthcare, mutual enforcement is represented by the case conference, by audit and governance meetings and by MDTs. Here doctors have the opportunity to present and defend their practice and to expose themselves to the scrutiny of their peers. My personal experience, after having been involved with dozens of inspections of private hospitals is that little more than lip service is paid to mutual clinical scrutiny. There is little insistence upon attendance and the minutes of such groups are usually either absent or scanty in the extreme. Meetings, if they happen, are poorly attended and the completion of the audit circle usually incomplete.
If doctors and surgeons fail to set and maintain their own standards then it is inevitable that outside agencies such as the GMC, and the CQC will move in to fill the vacuum, encouraged by politicians and public pressure. Then the profession will become ever more enmeshed by the very rules and regulations it already complains of. Moreover, the Royal Colleges, putative clinical standard setters, may make recommendations but who is aware of these institutions enforcing good practice rules on their Fellows and taking punitive action where they ought to? The lamentable fact is that doctors largely have only themselves to blame for the Paterson outrage and for what will follow.
Yours sincerely,
Peter Mahaffey
Competing interests: No competing interests
Re: Improving transparency and performance of private hospitals
Dear Editor
Anderson et al (BMJ 2020;368:m577) referred to a worrying lack of transparency in the private healthcare sector. The suggestion that all private healthcare should be judged on the basis of the Spire Hospital (Solihull) experience would be similar to suggesting that the National Health Service should be judged by the worst examples of its failing hospitals. None of the authors are clinicians. If they were clinicians, working in either sector, they may have a different view. Whilst the National Health Service proclaim that whistleblowing is encouraged, and safe, many clinicians including myself are aware the converse is true.
At a recent medicolegal meeting, a colleague of Ian Paterson’s stood up and told the large audience that he had repeatedly tried to alert the National Health Service hospital where they both worked as to his colleague’s aberrant practice. His words fell on the deaf ears of the NHS management.
The BMJ should avoid politicising healthcare.
Yours sincerely
Robert Marston BSc FRCS FRCS(Orth)
Consultant Orthopaedic Surgeon
London NW8
Competing interests: No competing interests