Safety issues in private work

My principal objection to dual practice ¹ is that it creates an unsafe environment for patients because, in the words of a spokesperson from the Royal College of Surgeons, ‘patients may be being put at risk by the failure of private hospitals to report serious incidents’. ² According to a BBC Panorama investigation, private hospitals were not reporting enough on patient outcomes. This meant that the private sector ‘cannot be as robust or safe as the NHS’, Royal College of Surgeons president Derek Alderson said. ²

These issues were highlighted in the Ian Patterson case. According to Colin Leys (17 July 2017, BLOG), the starting point is ‘the need for private hospitals to be held accountable for the care that takes place in them, and the mechanisms they have in place for ensuring that patient safety is prioritised’.

The next issue is that of conflicts of interest and perverse incentives. The problem is that Medical Advisory Committees which advise hospital managements on the granting of privileges to consultants to practise privately have a built-in conflict of interest.

They are supposed to represent the interest of patients but, as they are composed of and elected by the clinicians who have practising privileges at the hospital, there is no clear incentive for them to put patient safety first and to highlight poor practice. ³

Some dual-practice surgeons combine a challenging commitment in the public health sector with the equally demanding private work. The combined hours probably breach the safety limits set by the European Union Time Directive.