Quality, safety and clinical governance in NHS and independent hospitals: lessons from the interface

The overall aim of this research is to provide evidence on the quality and safety of patient care in NHS and independent hospitals and the effectiveness and impact of shared arrangements for clinical governance. There have been concerns about these arrangements among policymakers and leaders in both the NHS and independent healthcare sectors, and reports such as the Paterson inquiry, the medicines and medical devices safety review, a recent Healthcare Safety Investigation Board report and the Care Quality Commission state of care report have highlighted opportunities for improvement.

In the past, empirical evidence on the quality and safety of care has been limited by the lack of comparable routine data across both NHS and independent hospitals, but that is now changing with reforms led by both NHS Digital and the Private Hospital Information Network which will create a single dataset for all admitted patient care across all acute hospitals.  The importance of clinical governance has been recognised and we know that some important reforms have been initiated but not how well they are working, particularly to address the way clinical governance works across the interface and between organisations. 

In this study, we will address four main research questions:

1. What are the characteristics of the patient population and the care provision in NHS and independent hospitals in England, and what differences are observed by funding type (NHS or private), care setting (NHS or independent), specialty, procedure, geography and over time?
2. Can we map and measure the overall scope of practice of doctors providing care in both NHS and independent hospitals, and explore how well those organisations understand and oversee that scope of practice through the separate and shared arrangements for clinical governance that they have in place?
3. How does the quality and safety of care provided in NHS and independent hospitals differ, and what hospital, consultant, or other characteristics are associated with such variations?
4. How have the practice and working arrangements between NHS and independent hospitals changed during and after the COVID-19 pandemic, and what effects have those changes had on clinical governance and the quality and safety of care?

This is a mixed methods study, combining the use of a survey of clinical governance leads in NHS and independent hospitals; in-depth qualitative research in some case study “clusters” of linked NHS and independent hospitals; quantitative analysis of existing and newly available routine data sets on inpatient care; and qualitative work with patients with experience of both NHS and independent hospital care. 

The project also benefits from a public contributor co-applicant (Michael Molete) and a dedicated patient and public forum, consisting of 8 public contributors with varied backgrounds and experiences.  This group are involved in all aspects of the research.

You may find it useful to read our project summary and you will find more information on the National Institute for Health Research website.

• We will put all our project updates reports and other materials here as they are published.  Some useful background resources are also listed below.
• The Kings Fund has produced a very useful briefing on independent healthcare and the NHS which provides some history and context and facts and figures.  It outlines some of the trends in public and private spending on independent sector health care providers.
• The Independent Healthcare Providers Network (IHPN) is a membership network for independent healthcare providers, and it has produced a Medical Practitioners Assurance Framework which improve the safety and quality of care independent providers deliver to patients.
• The General Medical Council has published a useful handbook for all employers on effective clinical governance.
• In 2018, the Care Quality Commission published a specific state of care report on independent acute hospitals and it also covers both the NHS and independent sector in its regular annual state of care reports.
• In 2020, the Paterson Inquiry reviewed the circumstances surrounding Ian Paterson’s malpractice and considered other past and current practices in the NHS and the independent sector with the aim of learning lessons from these and to make recommendations to improve the safety and quality of care provided to all patients.  The full report is available as is the response from the Department of Health and Social Care
• The Health Foundation has published an analysis on the role of the independent sector in delivering orthopaedic and ophthalmic care.

The project advisory group exists to provide advice and oversight of the project team, and is independent of the project team. Its chair and members are appointed by the National Institute for Health Research and are listed below.

• Dr Andrew Vallance-Owen (Chair), Formerly chair Private Healthcare Information Network and chief medical officer, BUPA
• Mr Richard Steele, Programme Head, ADAPt, NHS Digital
• Dr Howard Freeman, Clinical Director, Independent Healthcare Providers Network
• Ms Dawn Hodgkins, Director of Regulation, Independent Healthcare Providers Network
• Dr Ian Gargan, Chief Executive Officer, Private Healthcare Information Network
• Mr David Darton, Head of intelligence and insight, General Medical Council
• Ms Ailsa Donnelly, Vice-chair of project PPI forum
• Dr Sally Pearson, Responsible Officer and HPAN Lead, NHS Resolution
• Dr Sarah Scobie, External academic advisor, Nuffield Trust
• Dr Elaine Kelly, External academic advisor, Institute for Fiscal Studies/The Health Foundation
• Prof Sara Shaw, External academic advisor, University of Oxford
• Ms Samina Malik, Programme Implementation Lead, National Consultant Information Programme
• Mr David Gosling, Policy lead, Department of Health and Social Care
• Ms Claire Land, Policy Manager, Care Quality Commission
• Ms Carolyn Jenkinson, Deputy Director of Regulatory Leadership Secondary and Specialist Healthcare, Care Quality Commission