Select Committee on Health Minutes of Evidence

Memorandum by Independent Healthcare Association



Outline Contents

Summary of main conclusions
Section 1: Overview of the evidence
Section 2: Acute medical/surgical hospitals
Section 3: Mental health and substance misuse providers
Section 4: Unregulated providers
Section 5: Options for regulatory reform
Detailed Contents


Outline Contents
Detailed Contents
List of Exhibits
List of Annexes
Summary of main conclusions
Section 1: Overview of the evidence
What is the Independent Healthcare Association?
Who are the IHA's members?
The scope of the Health Committee inquiry
Section 2: Acute medical/surgical hospitals
Overview of sector and providers
Consultant staff
Quality drivers
Quality Assurance and Clinical Governance
Patient Complaints
Registered Homes Act 1984
The content of regulation
The process of regulation
Summary: Acute Hospitals
Section 3: Mental health and substance misuse providers
Acute and Non-acute Care
Overview of the sector and providers
Employed Consultant Staff
Registration and Inspection
Mental Health Act 1983 and Commission
Regulation by purchasers
The Government's Mental Health Strategy
Patient Complaints
Summary: Mental Health
Section 4: Unregulated providers
NHS Private Patient facilities
Cosmetic Surgery
Surgery in consulting rooms and GP premises
Isolated professional practice
Substance misuse clinics registered only as care homes
Private ambulances
Section 5: Options for regulatory reform
Principles for new regulations
Practical regulatory options
Next Steps


The Health Committee inquiry

  The Independent Healthcare Association (IHA) and its members welcome the Health Committee's inquiry. The Association hopes that this inquiry will stimulate legislative reforms to give UK healthcare a coherent and effective system of regulation.

  The Association's members believe in the quality of care and quality of service they deliver. The right new regulatory system could help providers to ensure that patient's can be confident in independent healthcare providers.

  The independent sector is a major provider of healthcare in the UK, a large employer, and a vital part of the UK's strategic healthcare cluster.

  The evidence covers acute medical/surgical hospitals, mental health hospitals, and gaps in the regulation provided by the Registered Homes Act 1984.

Acute medical/surgical hospitals

  There are nearly 11,000 independent acute medical/surgical beds in the UK. Of the 850,000 patients operated on per year, 70 per cent is funded by medical insurance, 20 per cent is privately self-paid and 5 per cent is NHS funded.

  Typically, independent hospitals grant practising privileges to self-employed consultants. There are some exceptions where a hospital directly employs consultants.

  The Independent Healthcare Association has a raft of initiatives to build a coherent system of clinical governance for the independent sector. This includes quality assurance, clinical governance and audit frameworks, and complaints handling and independent review.

  The vast majority of Independent Healthcare Association member hospitals already have independently certified quality assurance schemes. The remainder will have by the end of 1999. More independent hospitals have achieved King's Fund Health Quality Service Full Accreditation than NHS hospitals.

  The revised and strengthened Independent Healthcare Association Code of Practice on Patient Complaints is currently out for consultation with consumer and patient groups. IHA is implementing a mechanism for the independent review of unresolved complaints.

  There are many influences on independent hospitals that encourage them to deliver a high standard of care, of which regulation is but one. At present the Registered Homes Act 1984 is not making a significant positive contribution to quality of care. There are serious flaws with the structure and operation of the regulatory system of the Act.

Mental health hospitals

  There are nearly 2,500 independent acute psychiatric and substance misuse beds in the UK. A substantial proportion of their services are supplied under contract to the public sector as "ECRs" or longer-term arrangements. These units often directly employ consultant psychiatrists.

  Psychiatric and substance misuse providers are registered under the Registered Homes Act 1984, and also may come under the Mental Health Act 1983. The Mental Health Act system is integrated across the NHS and the independent sector and appears to work well.

  Medical insurers and NHS purchasers also exercise oversight. Mental health members of the Independent Healthcare Association are committed to independent quality assurance systems and are signed up to a Code of Practice.

Services outside direct regulation

  The current healthcare regulatory system has gaps, which include NHS private patient facilities, some cosmetic surgery, other minor surgery in unregulated premises, isolated professional practice (including complementary medicine), some substance misuse clinics registered as residential homes, and private ambulances.

  The regulatory system should cover all independent healthcare providers, unless there are clear and defined reasons to the contrary.

New regulations—principles and options

  Some of the principles for a new regulatory system should include:

    —  Full coverage of the healthcare sector

    —  Outcome focused

    —  Culturally oriented towards healthcare

    —  Light of touch

    —  Regulate organisations and people

    —  Integration for quality standards and good practice

    —  Differentiation of management and finance

  The Independent Healthcare Association supports the extension of the Health Service Commissioner's remit to cover not just NHS commissioned independent care but all independent healthcare. There are some technical difficulties with such a proposal but they could be overcome. This would provide an extra layer of review over the independent sector's own complaints handling and independent review systems.

  The Independent Healthcare Association's preferred option would be NICE and CHI being implemented for both the NHS and the independent sector. Alternatively, there should be a new national regulatory or self-regulatory body for independent healthcare.

  Independent healthcare providers are demonstrably committed to delivering the highest quality of care, and would welcome moves to create a regulatory system that did more to support that goal. IHA very much hopes this Inquiry will help that to come about.

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© Parliamentary copyright 1999
Prepared 14 May 1999