Quality, safety and clinical governance in NHS and independent hospitals: lessons from the interface

Every patient has the right to expect safe, high quality care whether they are treated in an NHS hospital or an independent hospital. We propose new research to help understand and improve the quality and safety of patient care in NHS and independent hospitals. Independent hospitals are private sector organisations which provide health care to patients who pay, directly or through private insurance, and which are often also contracted to provide care for some patients funded by the NHS. We will learn about the systems which oversee the quality and safety of patient care, which are often termed 'Äúclinical governance'Äù. Good clinical governance is the foundation of good patient care. The need for this research was demonstrated by the public inquiry into the case of Ian Paterson, a surgeon who worked across both NHS and independent hospitals. He carried out inappropriate and unnecessary operations over many years, finally being suspended from practice, and eventually imprisoned. The inquiry report found he could have been stopped from harming patients eight years earlier and it recommended national changes to improve clinical governance. In 2018 a report from the health regulator also criticised the way independent hospitals monitored and reported on clinical performance, and in response a new framework for clinical governance for independent hospitals was introduced. For the first time, in 2022, information about all patients treated in both NHS and independent hospitals will be brought together in one dataset, and we plan to use this to compare quality and performance and provide information for better clinical governance. The main aim of our research is to understand how quality and safety is monitored across both NHS and independent hospitals and how newly available data can be used to provide information to support this. Our research has four main aims. Firstly, we will describe and compare the care provided in NHS and independent hospitals and how that has changed over time. Secondly, we will observe and assess doctors'Äô work in both NHS and independent hospitals and how clinical governance works. Thirdly, we will examine how the quality and safety of care varies across NHS and independent hospitals (measuring things like readmissions, deaths and patients transferred from independent to NHS hospitals). Fourthly, we will explore how the working arrangements between NHS and independent hospitals have changed during (and after) the COVID-19 pandemic. To do this, we will analyse the new national dataset covering all patients in NHS and independent hospitals. We will also send questionnaires to the staff who lead clinical governance in NHS and independent hospitals, and researchers will visit hospitals to conduct interviews and focus groups with patients who have experience of care in both settings, and to observe and interview doctors and other professionals who work across both NHS and independent hospitals. We have already worked closely with a patient and public involvement group in developing this proposal and incorporated their views into the research plan. We have a PPI co-applicant on our research team, we will have a PPI Forum for the project and will involve PPI collaborators in interviewing patients in our research as well as in the oversight of the project through our project advisory group.