The State of Healthcare report is the only place where we publish the national data for performance in the independent sector. In State of Healthcare 2006, we set out our findings based on inspection visits to all registered independent sector providers in England. Since then, we have developed our methods and now target for inspection those providers that we think are at risk of not meeting particular standards or not complying with particular regulations. On this basis, in 2006/2007 we inspected 78% of registered independent healthcare establishments. Table 12 shows the numbers and proportions of providers visited and ‘risked out’ (that is, not visited, because we had no reason to believe they were at risk of not meeting the standard).
Independent healthcare providers are assessed against the Government’s core national minimum standards. Given our move to a more risk-based approach this year, there can be no exact comparison with the results for 2005/2006. Nevertheless, we are able to draw some conclusions and identify emerging themes. Table 13 shows that overall levels of compliance with the core national minimum standards were good in 2006/2007 and appear to have improved compared to last year. The proportion that
failed five or more standards fell by half – from 10% in 2005/2006 to 5% in 2006/2007. The proportion of independent providers that met (including those that were almost met or ‘risked out’) all 32 standards increased from 50% in 2005/2006 to 63% in 2006/2007. If we break these results down further by sector, we can see that independent hospices have the highest proportion of core national minimum standards either met or almost met, while independent mental health providers have the lowest proportion (see table 14). The detailed table in the appendix shows how each sector performed against each core national minimum standard. On the basis of these assessments, we have some concerns about independent mental health services, although there has been improvement since 2005/2006. It is worth noting that around 85% of beds in independent mental health hospitals are funded by the NHS. 214
More than one in 10 mental health
providers did not meet the core standards on: monitoring and ensuring the quality of treatment and services (12.1%); the recruitment and training of qualifi ed staff (14.6%); and patients receiving treatment in premises that are safe and appropriate (14.8%). In the service-specifi c standards, similar proportions of independent mental health providers did not meet the standards
Table 14: Independent sector compliance with core national minimum standards, 2006/2007 by sector
Type of provider Met (including Met (including Failed five or more
‘risked out’ ‘risked out’
and almost and almost met)
met) all 32 29 or more
Acute hospitals 63.2% 93.4% 5.0%
Mental health providers 41.9% 80.8% 13.6%
Private doctors 74.2% 94.4% 2.8%
Lasers and lights 73.9% 93.6% 3.6%
Hospices 81.5% 98.3% 1.2%
Source: Healthcare Commission
Note: Categories are overarching. Each provider organisation features only once in this table. Percentage figures related to proportion of standards, not providers
on: risk assessment and management; the protection of patients from self-harm; and the management and restraint of patients displaying aggressive and violent behaviour. In independent acute services, only 0.8% of providers failed to meet the standard for ensuring that patients are treated in line with the relevant clinical guidelines. When it came to assuring that the quality of treatment and care is monitored, 3.5% of acute providers did not meet the standard. The core standard for infection control was not met by just over one in 20 acute hospital services. See chapter 4 for more information on how independent acute providers performed on decontamination and safety.
Independent sector treatment centres
Independent sector treatment centres (ISTCs) were created to help cut NHS
waiting times, provide choice and encourage innovation. They are registered with the Healthcare Commission. The centres
provide a range of planned, non-emergency surgery and diagnostic services. In our review of 23 of these centres we were able to offer some reassurance about the quality
of their services. Patients treated by ISTCs gave them a high rating in our survey (see chapter 1 for more details on the experience of patients in ISTCs). We have not carried out any in-depth reviews for other
independent acute sector providers. Our inspections and visits found that, in general, the systems that ISTCs use to identify and address problems and to monitor care, function well. We found some problems when patients move from ISTCs to NHS organisations, and vice versa, including arrangements for follow-up after discharge and the transfer of information about their care. Expert observation by experienced NHS consultants suggests that procedures in the centres broadly match those in the NHS, and that clinical practice during surgery was of a good quality. However, in some places we found evidence of poor relationships between ISTCs and local NHS organisations, with some ISTC contracts inflexible and not reflecting local needs. Because of gaps in the information routinely collected by ISTCs, we were unable to
compare their quality of care with that of the NHS. As far as we were able to tell, ISTCs have fewer emergency readmissions and shorter lengths of stay in hospital than NHS
Table 15: 2006/2007 annual health check targets relating to heart health
Waiting times for Patients waiting Thrombolysis: Thrombolysis:
rapid access longer than three 60-minute call 60-minute call
chest pain clinic months for to needle time to needle time
(acute trusts) revascularisation (acute trusts) (ambulance
(acute trusts) trusts)
Achieved 88% (79%) 94% (95%) 62% (47%) 55% (34%)
Underachieved 7% (18% 6% (2%) 36% (44%) 45% (66%)
Failed 5% (3%) 0% (2%) 3% (9%) 0%
Source: Healthcare Commission annual health check 2006/2007 Note: Figures are rounded. 2005/2006 figures in brackets
establishments. This is consistent with their mix of patients, which excludes those with the most complex health needs.
A particular problem was the submission of poor quality and incomplete data to Hospital Episode Statistics, the national database of hospital activity that provides information on the care provided by NHS hospitals and NHS patients treated in ISTCs. There were major gaps in details of patient diagnoses and procedures undergone, and also in the recording of data on the ethnicity of patients. We have made detailed recommendations for improvements to the information collected and submitted by ISTCs. We are currently working with the Department of Health, the NHS Information Centre and independent providers on the development of new datasets to be collected to common standards across the NHS and independent sector.