Doubts raised over independence of new system which allows institutions to assess each other

PUBLISHED : Tuesday, 13 March, 2001, 12:00am
UPDATED : Tuesday, 13 March, 2001, 12:00am

Fears were voiced yesterday that a new system under which private hospitals assess each other could lack independence.

The new system was questioned in a statement last night from Matilda Hospital, one of the 12 private hospitals being accredited under Britain's Trent Accreditation Scheme.

The statement said: 'We believe that public confidence in the clinical audit system is critical to its success and that it is fundamental that the auditing institution, be it local or international, is independent from those hospitals wishing to become accredited.

'We consider that it is the essence of all auditing procedures that, first, they are technically and ethically first-rate and secondly, that they are completely independent of the institutions being assessed - this applies to hospital audits equally as to financial audits and other similar types of assessment.'

Under the Trent Accreditation Scheme, the assessment is carried out mainly by surveyors who are also employees of the 12 private hospitals.

A report based on the surveys will be considered by a special board of the scheme in Britain to determine whether the standards have been achieved. Full accreditation is given to a hospital for only two years at a time.

All 12 private hospitals were yesterday given accreditation based upon initial inspections last year by experts from Britain and Hong Kong hospital staff.

The scheme started in Britain about seven years ago and was brought to Hong Kong on the initiative of private hospitals in 1999.

However, its introduction will not necessarily exempt Hong Kong's private hospitals from any separate monitoring system. The Department of Health may decide to introduce a system to check standards.

Martin Taylor, chairman of the Board of Directors of the Trent Accreditation Scheme, claimed the system would not produce any conflict of interest because the surveyors would not assess their own hospitals.

'The heart of the Trent scheme is that people who understand the services from the inside and also deliver the services themselves are much more vigorous when they look at a similar service run by a different organisation. Put simply, they know what they look for.'

Speaking of the concern that hospitals would protect each other's interests, he said: 'I have found the opposite to be the case. We have never found an example [in Britain] where one hospital gave an easy ride to another.

'In fact, we have found the opposite, the complaints we have are that the surveyors are accused of being too vigorous.'

Colin Clews, lead surveyor of the scheme, did not detail the criteria of the standards which, he said, are set by local private hospitals.

Dr Walton Li Wai-tat, president of the Hong Kong Private Hospitals' Association, said the reasons for seeking accreditation came from the Harvard Report on medical reforms which criticised private hospitals for having no set standard on their provision of health care.

However, some private doctors pointed out only public hospitals had been accredited under the scheme in Britain so far.

One of the doctors, who asked not to be named, said: 'We question the independence of the system as one private hospital is allowed to accredit the other. The problem in Hong Kong is private hospitals have to be concerned about their economic success.'

Both Ho Hei-wah, spokesman for the Patients' Rights Association, and Iris Chan Sui-ching, chairwoman of the Alliance for Patients' Mutual Help Organisation, said the self-assessment practice could spark fear of 'hospitals protecting hospitals'.

Mrs Chan called on the hospitals to give details of the standards and criteria applying to the accreditation. 'It is the rights of patients who are also the consumers to know clearly the standard of those hospitals before they decide whether to use their services.'