Peter O’Donnell

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| Department

| of Health |
Your reference: MJL/YD/104-18 Ze
Our reference: PFD 1125666

Mr Simon R Nelson ~
HM Coroner’s Court
Paderborn House
Howell Croft North
Bolton
BLI 10Y

[May 2018

Thank you for your letter of 20 March to the Secretary of State for Health and
Social Care about the death of Mr Peter O’Donnell. 1 am responding as
Minister with responsibility for hospital care quality and patient safety.

I was very saddened to read of the circumstances surrounding Mr O’Donnell’s
death. Please pass my condolences to his family and loved ones. I appreciate
this must be a difficult time for them. /

Your Report raises several matters of concern and my officials have made
enquiries with the Care Quality Commission (CQC) and the Nursing and
Midwifery Council (NMC) in preparation of this reply.

Firstly, I would like to make clear that independent hospitals are expected to
meet the same Fundamental Standards for quality and safety of care just as any
other registered provider. Indeed, you may be aware that the Secretary of State
wrote to independent sector hospital provider chief executives on 7 May

seeking their co-operation on a number of safety and quality issues’. Patient
safety must be paramount in all healthcare settings which is why all NHS and
independent hospitals are rated by the CQC. |

‘ pas gov ul/government/oublications/pasient-safety-letter-to-independent-healtheare-pravisers
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Independent hospitals are required to submit the
monitoring data for NHS patients as expected by

never events are reported to the stra

and surgical outcomes are reported to the Natio
would then be monitored as part of the contrac

NHS.

This is not mandatory for non-NHS
monitoring system in place for i
part of CQC’s inspection process
their own robust internal system
monitor quality of service provisi

it
to

i
Tam advised that the CQC carri
Healthcare, Beaumont Hospital
unannounced visit on 17 Septe
patients were cared for out of
part of its comprehensive ins
hospitals.

Overall, BMI Beaumont Hospital was rated as ‘Good’. The CQC’s

of this service included a review df
assessment and monitoring of pati
processes in case of emergency) a

same quality and safety

NHS trusts. For example,

ve information system (STEIS)
nal Joint Registry. Outcomes
tual monitoring process with the

tegic executi

patients and there is no other mandatory

dependent healthcare services. However, as

would expect providers to have developed
identify, monitor and mitigate risks and

On.

ed out an announced inspection of BMI
on 2 and 3 September 2015, and an
mber between 6 and 7.30pm to check how
hours.
pection programme of independent healthcare

The CQC carried out this inspection as

inspection

training and appraisal rates, staffing levels,

ent risk (including escalation and transfer
d monitoring of patient outcomes. A copy of

the report can be found at Wwww.cd¢.org uk/location/1-128758526.
i

Registered providers must notify the C

incidents that affect their service o;

injury and death of a person using |the
required can be found at www.caclor

acute-hospitals.

[am advised that BMI Beaumont EH
regarding the death of Mr O’Donn
responsible for this service contact’
incident and the enquiry was closed
internal investigation. Information
will now be used as part of the CQ
the next inspection.

I can provide assurance that the C

IC
and protocols as part of its inspeetin

QC about certain changes, events and
€ people who use it. This includes serious
service. A full list of the notifications
-uk/guidance-providers/independent-

th

ospital submitted a statutory notification

ll on 27 January 2017. The CQC inspector

d the registered manager to discuss the
pending the outcome of the inquest and

from both the investigation and the inquest

"s monitoring intelligence in the planning of

reviews escalation and transfer procedures
N process under Regulation 12: Safe care

|
|
|

“— :

Department
of Health |

and Treatment, Health and Social Care Act 2008 (Regulated Activities)
Regulations 2014. In accordance with Regulation | 12 (2) (i) CQC would expect
that where responsibility for the care and treatment of service users is shared
with, or transferred to, other persons, there are systems in place for working
with such other persons to ensure that timely care planning takes place to ensure
the health, safety and welfare of service users.

The independent health care sector is diverse and many independent providers
deliver a wide range of services for both adults and children, including
specialist and enhanced healthcare in an array of settings and in a number of
ways. However, we recognise that the sector delivers many of the same types
of services as acute NHS providers, and is increasingly being commissioned to
deliver services on behalf of the NHS.

While the CQC’s regulatory model is tailored to each sector and type of service,
it does also take into account the need to ensure providers are treated equally
when delivering similar types of services and that all providers are regulated in
an appropriate and proportionate way. This is critical to providing assurance
about the quality and safety of these services. CQC has therefore, where
possible, aligned its regulatory model for the independent health sector with
other sectors including the NHS acute and primary medical services.

The CQC published its analysis of the quality and safety of care provided by
independent acute hospitals across England on 11 April. The report, ‘The state
of care in independent hospitals’ is available at
www.cqc.org.uk/publications/major-report/state- care-independent- acute-
hospitals, and provides for the first time a comprehensive picture of the quality
of care provided.

While the report found that the majority of independent acute hospitals are
providing high quality care for patients, 41 per cent of hospitals were rated as
requiring improvement and | per cent, inadequate, for safety. Relevant to the
concerns of your Report, the CQC identified a lack of formalised governance
procedures, meaning that hospitals were not effectively monitoring the work of
consultants, and a failure to monitor clinical outcomes and to prepare for the
possibility of clinical deterioration in a patient’s condition.

As outlined above, the CQC is working with providers through its inspections
and enforcement powers to help independent hospitals understand where

improvements are needed and t to hold ther to account for delivering those
improvements.

Also of importance to the matters of concern you raise is the Paterson Inquiry,
set up following the conviction of the surgeon Jan Paterson, to learn lessons
from Ian Paterson’s malpractice and other past and current practices to enhance
the safety and quality of care both in the independent sector and the NHS.

The Paterson Inquiry will address issues relating to the conditions under which
doctors provide services within independent hospitals, including levels of
supervision, The Terms of Reference include:

‘A comparison of the accountability and responsibility for the safety and quality
of care received between the independent sector and in the NHS; including the
roles of hospital providers and others in appraising, reporting, considering
concerns and monitoring as regards healthcare professionals’ activity levels,
conduct and performance, ..

And will consider, among other issues, the ‘...arrangements for assuring that
healthcare professionals maintain appropriate professional standards and
competence, including appraisal, revalidation, scope of practice, and the role of
hospital providers, professional and quality regulators, and other oversight
bodies’. i

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if

The full Terms of Reference ate available at

www. patersoninquiry.org.uk/terms-of-reference/ . We expect the Inquiry to
report and make its recommendations in the summer of 2019.

Given the relevance of the concerns you have raised, you may wish to share
these with the Paterson Inquiry. The contact details for the Inquiry are:

Email: enquiries@patersonin ui org.uk
Tel. no: 0207 972 1295
Or you can write to the Inquiry at PO Box 879, LS1 9RZ

i
Finally, with regard to your last area of concern, pertaining to the referral of
registered nurses to the NMC, I can confirm that the NMC’s guidance applies to
all employers of nurses and midwives, whether NHS or independent sector. It
is for the employer to decide whether to make a referral based on the
circumstances of the case. Referrals must always be made if the employer
believes the conduct competence, health or character of a nurse or midwife

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Department |
| of Health |

presents a risk to patient safety. Further details can be found at
www.nme.org.uk/concerns-nurses-midwives/dealing-concerns/services-

employers/

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I hope that you find this information helpful. Tha k you for bringing the
circumstances of Mr O’Donnell’s death to my attention.