Private care is `less safe than NHS'

Health: Devastating MPs' report calls for full regulation of a sector where some hospitals put cash before patients

TRAGIC CASES in which patients have died in private hospitals provided "graphic and moving evidence" of the need to tighten regulation of the private sector, an all-party group of MPs said yesterday.

Many private hospitals were too small, had too few back up facilities and were forced to operate commercially in a way that could "jeopardise patient safety", the health select committee said. The lack of proper regulation left patients ignorant of the risks they were taking, in the hands of staff who might not be competent to look after them, and without the means to complain or seek redress when things went wrong.

In a devastating report, the MPs say patients deserve the same protection from poor practice in the private sector as in the NHS. About 850,000 patients have private operations each year, accounting for 20 per cent of all routine surgery. Almost a third of all hip replacements are carried out privately and almost half of all abortions.

At present the sector operates under the Registered Homes Act, 1984, which was designed for nursing homes and was described as "inadequate for the task of protecting the public". In its place, the select committee calls for an independent regulator for private hospitals and other non-NHS homes and clinics, and a system of licensing to ensure they only carry out treatment that they are competent to perform.

The Government welcomed the report which echoed its own proposals, hastily published last month, for reforming what it described yesterday as the "out of date" and "unsatisfactory" regulation of private hospitals. The select committee notes that ministers have performed a U-turn on the issue after claiming a year ago that regulation could be left to market forces.

The MPs decided to launch their own inquiry - the first mounted into the private sector - in February after hearing anecdotal reports of poor practice and "disturbing accounts" of doctors suspended from the NHS continuing to work in the private sector while investigations proceeded into their past practice. The report says that suspended doctors should be automatically notified by the General Medical Council to all NHS and private hospitals to protect patients.

The committee is particularly keen to tighten up regulation of the cosmetic surgery business. It lambasts the Advertising Standards Authority for failing to crack down on cosmetic surgery clinics which take out advertisements featuring overly-flattering descriptions of their surgeons as "top" or "highly-experienced".

"It is clear to us that the ASA is failing to protect the public against misleading advertisements," the report says, and calls for legislation to deal with them. It also recommends that a conspicuous health warning be placed on all cosmetic surgery advertisements "to the effect that all surgery carries an element of risk". The ASA responded that it was constantly upholding complaints against the clinics and complained it had had to shoulder an unfair burden.

The report, which includes recommendations for the protection of residents of mental nursing homes and children's homes, was broadly welcomed by medical organisations and the private sector. The Consumers' Association criticised the committee for failing to recommend an extension of the health ombudsman's remit to the private sector.

The British Medical Association called for reform of the system for suspending doctors. Peter Hawker, chairman of the BMA's consultants' committee, said: "If a doctor has been suspended from NHS practice because of serious concerns about patient safety, it would be clearly wrong for the doctor to be practising in the same area privately.

"That makes it all the more important to reform the suspension procedure so that it is genuinely used to protect patient safety and not for other, arbitrary reasons," he said.

case study 1

MEP to sue over death of husband

BARONESS Nicholson's husband, Sir Michael Caine, died after suffering a cardiac arrest following an operation at the King Edward VII Hospital for Officers last February.

Lady Nicholson has since pressed for tighter regulation of the private sector. She also plans to sue the hospital, alleging that a lack of trained staff contributed to her husband's death. The hospital strongly denies the charge.

Sir Michael, a director of publishers Booker McConnell, had a bowel cancer operation. Lady Nicholson alleges that when a ventilation tube was replaced it was wrongly inserted, triggering the cardiac arrest.

It emerged at Southwark Coroners Court that the only doctor on site at the time was a general practitioner. A consultant anaesthetist was summoned but by the time he arrived, 15 minutes later, Sir Michael had suffered irreversible brain damage. He never regained consciousness. The coroner recorded a verdict of misadventure.

Case Study 2

Clients have no redress

ANITA HILL was left permanently maimed after undergoing a dozen operations and surgical procedures by the disgraced gynaecologist Rodney Ledward at St Saviour's private hospital in Hythe, Kent.

She was left with a perforated bowel which required four corrective operations, the last in March. She is receiving counselling for post-traumatic stress. Mrs Hill, 54, appeared before the Commons Health Committee and was one of those whose "graphic and moving evidence" is described in its report. She said yesterday: "There was nobody there to help the private patients when things went wrong. There was no one to go to."

She said in her own case she had tried to get help but had been blocked by the hospital's refusal to let her see her notes. In the end she had been forced to appeal for help to the NHS.

"If it wasn't for the NHS I wouldn't have anyone to help me. They have told me who to turn to ... I thought there would be someone in the private sector to go to if you had problems but I learnt to my cost that there wasn't. My whole life has been ruined and I have had nobody to turn to."

Mrs Hill, whose ordeal began 12 years ago, believed she had simply been unlucky until the full extent of Mr Ledward's incompetence emerged last November, six weeks after he was struck off the medical register in September.

More than 400 women contacted the William Harvey Hospital in Ashford, Kent, where he was employed as an NHS consultant, and more than 120 are considering legal action. About half the women, including Mrs Hill, were private patients.

Frank Dobson, Secretary of State for Health, ordered an inquiry into the Ledward affair earlier this year.

Cae Study 3

Struck-off doctor given job

SHEILA Wright-Hogeland is coordinating a support group of 100 women who are seeking damages from Dr Richard Neale, a gynaecologist. Mr Neale was paid off by the Friarage NHS hospital in north Yorkshire in 1995 because it was dissatisfied with his performance, but he has since found work in other NHS and private hospitals where he injured more women.

Mrs Wright-Hogeland, who gave evidence to the select committee, suffered from a condition called endometriosis, which causes thickening of the lining of the womb. As a private patient, she was checked regularly by Mr Neale but he failed to notice the worsening of her condition and she eventually required an emergency hysterectomy which left her unable to have children.

Mr Neale operated on her at the St John of God private hospital in Richmond, North Yorkshire, but the wound became infected and she required further surgery six weeks later. She has lodged a claim in the High Court against Mr Neale and has complained to the General Medical Council.

"There is tremendous anger out there," she said. "Women are furious not just with him but with the system."

Mr Neale had earlier been struck off a medical register in Canada after a woman died in childbirth in 1981. After leaving the Friarage he worked at two other NHS hospitals and the private Portland hospital in London. An "alert" letter about him was circulated around the NHS in 1998 but he has since seen patients at a private clinic in Leeds.