Independent healthcare: get your governance in order

Kieran Seale Verita Consultancy Ltd

Kieran Seale

Published 26 June 2018 More about Kieran

Independent healthcare

Practicing privileges, complaints handling and duty of candour were three major areas of concern flagged by private healthcare providers facing scrutiny from the ongoing independent inquiry into the malpractice of convicted surgeon Ian Paterson. The Inquiry aims to learn lessons in how this case can improve care locally and by the independent healthcare sector across the country.

The concerns over the implications of this inquiry were aired at a roundtable discussion hosted by Verita, who carried out the initial Paterson investigation into his actions at Spire in 2014, and Hill Dickinson, one of the leading firms providing legal advice and support to independent healthcare organisations. The seminar, attended by independent healthcare leaders, revealed the gap between current governance standards and what will change post-Paterson.

Practicing privileges

The governance surrounding practicing privileges was a sensitive but well-discussed topic. It became evident that concerns surrounded the issues of appraisals, reviews, and awareness of the practicing privileges of the doctors currently on the payroll. Questions such as:

  • Can you find your agreement?
  • What does the agreement say?
  • Does the Medical director have the knowledge of their role and identify their responsibilities to audit these agreements?

were all raised and the overall conclusion was that there needs to be a thorough review of this information, and quickly. Knowing that consultants engage in a wider scope of practice in independent hospitals, compared to that of their NHS duties, comes greater responsibility. The responsibility that private providers need to step up and face to protect their patients and their professional indemnity.

Additionally, independent hospitals can rely on the NHS to teach and train their own staff before they move over to the independent provider which is seldom audited. Consultants can be working under outdated practicing privilege agreements, but also outdated training. Appropriate change and review is a must.

The Inquiry surrounding the surgeon Ian Paterson aims to learn lessons in how this case can improve care locally and by the independent healthcare sector across the country.


Duty of candour

When we explored Duty of Candour within the seminar there was confusion on where the liability should lie when responding to families, whether it be the hospital or the consultant in question.

When reporting an incident, it is the consultants’ responsibility to disclose information, however, the communication between the hospital and the consultant is sometimes unclear, leaving both the family and the hospital confused about the route in which to deliver sensitive information.

The conversation naturally moved on to serious incident investigations. Similarly to the consultants in the NHS, the capacity to investigate incidents is low. Datix and The National Reporting and Learning System is welcomed however the root cause of the incident is left unidentified through these recording facilities. Liability in independent hospitals and the speculation of the impact of indemnity is still just that – speculation.


Complaints is a topic well tackled at Verita and we have multiple blogs and presentations on complaint handling and how to see complaints as positive feedback. Read more here. In summary, complaints act as a free resource to hear the faults and ‘holes’ in any organisation. Listening to and dealing with complaints in a strategic manner will help to improve your services.

In an independent hospital, having strong governance processes surrounding complaint handling is no doubt the best practice to be in. Anything that goes out on your letterhead is your responsibility, so check it.

Future actions

Moving forward, our message to independent healthcare providers is to question your own governance, take responsibility for your consultants and be prepared in case you are asked to give evidence to the public inquiry that lies ahead of us. We recommend that you start by reading the executive summary report of our 2014 investigation into Paterson and check your organisation against the fifteen recommendations.


If you would like to learn more about Independent Healthcare then please contact Kieran Seale on 020 7494 5670 or [email protected].

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