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32LEGAL MEDICOMAGAZINESponsored by:LIABILITY AND ACCOUNTABILITY IN PRIVATE HOSPITALS – A PRECONDITION FOR PATIENT SAFETYBy Colin Leys, Emeritus Professor, Queen’s UniversityBackgroundIn 2014 the Centre for Health and the Public Interest carried out a major study of the operation of the private hospital model and the associated patient safety risks. We identified a number of weaknesses with the hospitals’ operating model and the governance and assurance regimes which are supposed to keep patients safe.The first concern we identified was that very few of the current private hospitals have intensive care beds to deal with situations where things go wrong during surgery. In theory, there should be a limited risk of operative and post-operative complications in private hospitals because these hospitals should only admit patients deemed to be low risk.1 But despite this there are over 3000 emergency transfers of patients from private hospitals to NHS hospitals every year.2 As Sir Bruce Keogh has pointed out, the NHS operates as a Colin Leys is an emeritus professor at Queen’s University, Canada, and an honorary professor at Goldsmiths, University of London. Since 2000 he has written extensively on health policy.The Centre for Health and the Public Interest is an independent health policy think tank funded solely by research grants and individual donations and contributions. To receive newsletters and new reports from the Centre sign up to the mailing list on our website (www.chpi.org.uk).The recent conviction of the consultant surgeon Ian Paterson for unlawfully wounding ten patients in two private hospitals seems bound to force a final resolution of the longstanding issue of the safety of patients in the private hospital sector, and of the respective liabilities of surgeons and the hospitals in which they operate.free safety net for private hospitals for when things go wrong – without it, it is unlikely that any private hospital carrying out surgery without intensive care beds would be deemed to be safe for patients.The second concern was that most private hospitals rely heavily on a single junior doctor (a Resident Medical Officer, or RMO) for post-operative care. Following an operation the surgical team (including the anaesthetist) hand over responsibility to the hospital whose RMO monitors the patient and deals with any complications. Unlike NHS hospitals there is no specialist team on the site to provide back-up and the RMO – who is usually contracted from an outside agency – has responsibility for a large number of patients, with most of whom he or she will have no previous acquaintance. In terms of governance and oversight, the private hospital model is also very different from the NHS model. Unlike the NHS, where surgeons are directly employed by their hospital trust, in a private hospital the consultant is granted ‘practising privileges’ by the hospital to treat patients in the hospital’s facilities. These privileges are granted by the hospital on the advice of a Medical Advisory Committee, a non-statutory body drawn from among the consultants practising at the hospital. Private patients in private hospitals have separate contracts with the consultant to undertake the surgery and the hospital as the provider of facilities. As the victims of Ian Paterson are currently discovering, whereas the NHS has already paid out £9.5m in compensation to patients he injured in the NHS hospital where he worked, the private hospital provider has refused to pay any compensation, except in a small number of cases, because they argue that Paterson was not technically their employee and so they are not responsible for his actions.3