Should more be done to stop rogue surgeons in private hospitals?

I was heartened to see in the Guardian that the leader of the Royal College of Surgeons of England, Prof Derek Alderson, is calling for private hospitals to publish their safety information. The aim is to prevent another scandal like that which involved Ian Paterson, a “rogue surgeon” who was found guilty of intentionally wounding patients by carrying out unnecessary breast procedures. In the case of Mr Paterson, because there were confused lines of communication between the private hospital where he worked and the NHS, it was very difficult to be sure whether there was a problem and if so, how big it was. According to the Guardian’s report, even now standards of governance between the public and private sectors are “highly variable”.

What more could they do to find these rogue surgeons?

Surgeons in many disciplines now submit individual figures for operative outcomes to central bodies, so that overall risks for particular procedures can be established. This promotes better standards of clinical research as well as care.

It should not be too much to ask for private hospitals to provide this data – particularly not when they are working under contract to the NHS (as is frequently the case). Reportedly this would facilitate better and clearer statistical analyses, essential to assessing the efficacy of care and for identifying any statistical outliers. It would therefore identify particular problem areas early, and ensure remedial steps are taken, giving “rogue surgeons” fewer places to hide.

Where operations are performed in the private sector under contract to the NHS, it is not unreasonable to expect some degree of quality control to be in place. If you contract for any service, you are entitled to expect it is performed to a reasonable standard – whether you are an individual or a government body. However, the NHS has more reason than most to insist upon a good quality service when it enters into contracts with providers.

If any surgical procedure goes wrong, or surgery is performed inappropriately, then there will likely be adverse consequences to the patient; surgery is invasive, and rarely produces a neutral result. Whether or not that patient sues, it is almost certain that they will require further treatment, and the costs both of the additional treatment and any litigation will accrue to the public purse. There is therefore a very clear financial reason for ensuring that this step is taken, in addition to the primary concern of patient safety.

I sincerely hope that the Secretary of State for Health endorses this important and potentially costs-saving initiative.