Volume 1

The regulation of private and other independent healthcare : fifth report / Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee.
Date:
1999
Catalogue details

Licence: Open Government Licence

Credit: The regulation of private and other independent healthcare : fifth report / Health Committee. Source: Wellcome Collection.

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    “person registered” and only if there is a departure from standards of “adequacy” in respect of these can the regulatory authority invoke sanctions. In the event of a person registered failing to comply with statutory or local requirements, health authorities have the power to impose certain conditions, to vary them or to propose refusal or cancellation of registration. Representation and appeal to a Registered Homes Tribunal may be made in these circumstances by the person registered and it is then for the health authority to satisfy the Tribunal (whose decision is legally binding) that its proposal is justified. The consequence of this is that the burden of proof lies on the regulatory authority, not the service provider (see below paragraph 108). 23. The responsibility for both the registration of persons to operate premises and for their subsequent inspection is delegated by the Secretary of State to health authorities who use local management arrangements to carry out these functions. Regulation and inspection units usually comprise a manager (often the senior nurse of the unit) with supporting inspectors and administrative and clerical staff. Specialist inspectors to examine mental health, surgical nursing, the purchasing, storage, administration and disposal of drugs, theatre provision, control of infection, works services and equipment maintenance are employed within the team or contracted to work with it as required. Inspections, which may be unannounced, result in written reports which are required to be made publicly available. Standard practice is that at least one visit should be unannounced but there is no statutory requirement. The Act provides for fees to be paid to health authorities by persons registered both on an annual basis and in relation to initial registration and subsequent major changes. The health authority has powers to investigate complaints in relation to the home concerned provided that it can be shown that the complaint relates to a regulatory matter within the terms of the Act or Regulations. We discuss difficulties health authorities encounter in investigating clinical complaints below at paragraph 135. Other mechanisms of quality control: Medical Advisory Committees, insurance companies and quality assurance schemes 24. Most independent acute hospitals do not employ consultants. Instead they grant practising privileges (“admitting rights”) to self-employed consultants, most of whom also work in the NHS. Consultants may well have practising privileges at more than one independent hospital.*° In larger hospitals the grant of these privileges is on the advice of the Medical Advisory Committee (MAC) of the hospital concerned, the arrangement creating no liability on the part of the hospital or MAC for the clinical activity of the consultant. Action for the Proper Regulation of Private Hospitals (APROP) accepts that each hospital should have a Medical Advisory Committee whose responsibilities include monitoring the clinical standards maintained by their fellow consultants, auditing the progress of patients who are not making the expected rate of recovery, and examining the need for new equipment. However, referring to much- publicised cases in Bristol and Kent, they considered that “not much credence can be given to such committees being an effective assurance that the highest clinical standards are being maintained”.*! The Hospital Consultants and Specialists Association commented that a MAC Chair does not have the power to institute proper auditing or monitoring systems.” The British Medical Association (BMA) noted that Medical Advisory Committees often have very informal constitutions and that not all of the relevant specialties are represented.” 25. Such considerations are important as we found that increasing reliance is now being placed on MACs in monitoring clinical activity in independent hospitals. We examined the evidence from, and questioned representatives of, the four largest independent hospital groups about their relationships with the MACs of their hospitals. In these hospitals committees are invariably chaired by an elected or appointed clinician with formal terms of reference. The Independent Healthcare Association (IHA) told us that its policy guidance to members was that the MAC and hospital management should grant admitting privileges only to doctors who are well accredited %° Bv., p92. Ev., p6l. *2 Ev., p426. 3 By., p246.