Private Sector Health Providers and local accountability – Quality Accounts and local Healthwatch
In an earlier blog I mentioned some of the good practice being developed by local Healthwatch with regard to engaging with and influencing Quality Accounts.
The NHS Choices website states that there is a statutory responsibility for all healthcare providers over a certain size to produce a Quality Account and to seek the views of local Healthwatch who if they wish may send a written response. This is affirmed in the Healthwatch England Guidance.
The logic is clear – a bit of local voice based on the experience of the public can provide a reality check, foster engagement and bring a bit of informed challenge to this annual statement.
This mechanism could become more important as we move to more devolution, integrated care and co-production with the public as local health and care systems respond to the ambitions set out in the Five Year Forward View.
Whats the problem?
When we compare the approach taken by NHS Trusts to the private sector in particular there is a striking contrast. While the private sector does produce Quality Accounts their quality is more variable and they often do not appear to seek the views of local Healthwatch or the local Overview and Scrutiny Committee.
A quick scan of a couple of private hospitals in Sheffield shows that only one mentions engagement with their local Healthwatch.
- Thornbury Hospital Quality Account – no mention
- Claremont Hospital Quality Account – asked for comments
The problem gets worse when you look at some of the big players in this field who operate across the country.
For example Partnerships in Care have around 60 sites across the country and specialise in providing services to some of the most vulnerable people (people with a learning disability, people with a head injury and people with a mental health problem). They produce one Quality Account for the whole service and it has no comment from a Healthwatch – although it does have a comment from one ex service user who now works for Rethink he also commented in the previous Quality Account.
Service user comments are very important – and a number of private sector Quality Accounts have these – however, I think the views of an organisation such as a local Healthwatch are qualitatively different – they have a duty to consider a Quality Account when asked and are accountable for the views they express in a way that individuals are not, in the case above I don’t think that the comment reflects the views of Rethink.
I could not find many examples of where a private sector provider has sought the views of a local Healthwatch and that Healthwatch has responded – but there are some.
Care UK in their 2014/15 Quality Account include comments from Healthwatch in South Gloucestershire and in Bristol. Also since writing the blog Sian Balsom from Healthwatch York has said that the Ramsay Clifton Park Hospital in York have asked them to comment on their Quality Account for the last two years. However, Ramsay have a network of 22 acute hospitals and their practice does vary – for example there is no mention of Healthwatch in the Ramsay Berkshire Independent Hospital Quality Account.
I could find no mention of local Healthwatch in the Quality Accounts that I looked at from:
Circle Group – for example see Bath and Nottingham
BMI General Healthcare – see for example the Priory Hospital Birmingham and Clementine Hospital
Spire Healthcare produce a national Quality Account – again no mention of Healthwatch in their Quality Accounts
Priory Group who are an acute mental health provider – who also produce one Quality Account
This national issue does not just apply to private sector providers – have a look at the one produced by Marie Stopes – again no mention of local Healthwatch.
Where this leaves us
Advice from NHS Choices is as follows
There is considerable variation with regard to how independent providers use Quality Accounts and what they expect from them. It does seem as though many independent providers are working in a parallel world where they have a much narrower view of the purpose of Quality Accounts and their relationship with local Healthwatch than NHS Trusts.
- Some big national independents produce one Quality Account for all their sites.
- Others produce a quality account for each site.
- A minority seek the views of local Healthwatch – most don’t appear to.
- There is a wide variation in the quality and accessibility of the Quality Accounts produced.
What should be done?
- Local Healthwatch with the support of Healthwatch England should develop an explicit strategy for engaging with the Quality Accounts of the big national providers.
- Clinical Commissioning Groups should take a more robust approach to challenging private sector providers on the content and quality of their Quality Accounts – some of the ones I looked at above are inaccessible and uninspired.
- Finally, I think that NHS Improvement need to produce some clear guidance for non NHS providers stating clearly why producing accessible and engaging Quality Accounts is important and why local Healthwatch must be involved in commenting on them.
What do you think?