Probe into NHS use of private hospitals during Covid pandemic launched after cancer patient's death

An investigation has been launched into NHS surgical services carried out in private hospitals during the coronavirus pandemic after a 58-year-old cancer patient died.

Concerns were raised that some private hospitals took on more complex surgery than they were used to while NHS hospitals were overwhelmed with Covid-19 cases.

The Health and Safety Investigation Branch (HSIB) launched an inquiry after a man, only known as Rodney, died following NHS care in a private hospital.

He was listed for keyhole surgery to remove part of his bowel due to cancer.

However, his operation at an NHS hospital was cancelled and re-booked at a private one nearby after cancer services were transferred to local independent care providers.

Rodney was asked to sign a consent form to undergo open bowel surgery - rather than the less invasive keyhole procedure - due to guidance at the time around a “potentially increased risk of Covid-19 transmission with laparoscopic surgery”, the HSIB said.

The cancerous part of the his bowel was removed but eight days later his condition deteriorated rapidly. He was then transferred to the local hospital so he could receive intensive care – which was not available at the private hospital.

When he arrived at the local NHS hospital, a scan and more surgery showed a leak in his bowel which led to sepsis and organ failure. He died later that day.Following the man's death, the HSIB launched an investigation into NHS surgical services being carried out in independent hospitals as a result of “dynamic situations” such as the pandemic.

The HSIB's investigation conclusions included:

• The capability and capacity of independent hospitals for the provision of surgical care was found to “vary” across the country.

• National and local NHS organisations had “limited understanding” of independent hospitals’ capabilities. This resulted in variation in how independent hospitals were used during Covid-19.

• Investigators suggested there were "safety risks" when organisations take joint responsibility for a patient's care.

• This included “unclear roles and responsibilities; limited integration of information and communication systems; and variation in what surgery was deemed suitable for an independent hospital”.

• The investigation also identified safety risks associated with the assessment of patients prior to surgery, but the HSIB said these could be reduced with “successful collaboration between the NHS and the independent sector”.

Its report highlighted that, during the pandemic, a national agreement was put in place to secure extra support for the NHS from the private sector, including certain types of surgery.

NHS patients have previously been cared for by private health providers and will continue to do so for many years to come, the HSIB added.It made six recommendations to “improve surgical pathways” - the processes that are administered before a surgery in order to prepare a patient.

Kathryn Whitehill, principal national investigator at HSIB, said: “NHS patients are being cared for in the independent health sector now more than ever before."

She said that their findings show if there are any "gaps" in the surgical care pathway, "the impact can be devastating on patients, families and healthcare staff".

“Covid-19 demonstrated that the capability and capacity of independent hospitals could be used as part of an integrated system, and we have designed our recommendations to support the safe delivery of NHS-funded care so that it could be used to respond to future challenges,” she added.

David Hare, chief executive of the Independent Healthcare Providers Network (IHPN), said: “This unprecedented agreement, put in place in March 2020 during a period of significant upheaval and uncertainty in the healthcare system, resulted in the delivery of over 3.2 million NHS procedures, including over 160,000 life-saving cancer and cardiology treatments.

“With independent healthcare providers continuing to play a key role in supporting the NHS to clear the elective care backlog, it is vital that the NHS and independent sector can continue to work seamlessly together to deliver the safest possible care for patients.

“We therefore welcome HSIB’s recommendation for new NHS Integrated Care Systems (ICSs) to fully understand local independent healthcare provision and ensure the sector is a key part of this new system working.

“This is something IHPN have long been calling for and which will ensure the NHS and independent sector can work together to improve patient access to high-quality care in the months and years to come.”