Private hospital group Bupa, now owned by Spire Healthcare, has been collecting patient reported outcome (PROMS) data for the past decade. In this sense, they are ahead of the NHS, which has recently agreed to collect data in four areas: hip replacement, knee replacement, inguinal hernia, and varicose veins.
The initial motivation was to make systems more robust in the wake of the serious malpractice of NHS consultant gynaecologist Rodney Ledward, who also treated patients in the private sector. Andrew Vallance-Owen, Bupa group medical director, explains: “I went through [Ledward’s] details and there were no deaths, no readmissions, no complaints—there was nothing to tell us about him. There were patients who clearly had serious complications but we knew nothing about it. It made me determined to collect patient reported outcomes.” Bupa decided to use a “health status survey” to gain a generic look a patient’s health status. “We used Short Form 36 (SF 36) which we give routinely to patients before treatment so that we have a baseline health status. Three months after the treatment we send the SF 36 again.”
The complex form contains measures of physical wellbeing, such as those concerning mobility and pain, and indicators of psychological health, such as wellbeing and vitality. Dr Vallance-Owen acknowledges that there was initial resistance from doctors, but that the benefits of outcomes data were now broadly accepted. It helps that the SF 36 now gets a high patient response rate, of about 85%. “I suppose at first it was a ‘bad apple’ exercise but it is really a tool for continuous quality improvement. We feed back to hospitals every three months, benchmarking against all colleagues undertaking the same procedure,” he says.
Although you can compare data on, for example, hip replacements, between the different Spire hospitals carrying out orthopaedic work, individual consultant data only goes to the consultant concerned. “But once the response rate went up clinicians began to realise the data was valid and they started to share it with each other,” he said. Another positive is that it helps clinicians appreciate their strengths and weakness. “Occasionally, you may have a surgeon who always does knee replacements in the NHS, carrying out a different procedure in the private sector, for example, laminectomy, and then realising from the patient outcome scoring that they might not be quite as good as expected, and then deciding to stop doing that procedure,” said Dr Vallance-Owen.
The Spire Healthcare Hospital website contains some examples of improvement in outcomes, allowing patients to compare its different hospitals.
Not having any other organisation to benchmark against, such as the NHS or other private hospital groups, meant there was some initial nervousness says Dr Vallance-Owen. “But the NHS is now going down that route in four areas and it would be good for other private hospital groups to do the same.”
Critics might say that comparing patient outcomes data between the NHS and the private sector has limited usefulness because the public sector deals with higher risk patients in the first place. Dr Vallance-Owen agrees that a level playing field is important, although difficult to achieve. “We will all need to adjust our data for age, sex and risks,” he said.