• NHSE faces delaying or cancelling cancer surgery as covid pressure increases
  • No deal with private sector means less capacity than in the first wave 
  • HSJ understands NHS unwilling to pay prices asked by three London private hospital groups 

Cancer surgery in London is under threat as rising covid admissions put pressure on services that no longer have back-up capacity from the independent sector, HSJ has learned.

Research by HSJ has discovered that NHS England ended contracts with HCA, The London Clinic and the Cromwell Hospital at the end of August, after concerns about underutilisation.

Under the previous deal with the private sector, rules were in place to make sure low-priority private patients were not treated ahead of NHS patients who needed surgery urgently.

HCA and The Cromwell have confirmed the contracts were ended in August and were not renewed. The London Clinic did not respond to a request for comment.

HSJ understands NHSE, under pressure from the Treasury, was not willing to pay the prices asked by the three private providers.

Each of the five London integrated care systems has two designated cancer surgery centres, where work might have to be cancelled as covid hospitalisations increase.

As of 19 December, there were 2,909 covid inpatients being treated in London hospitals, a rise of 39 per cent over the previous seven days. Barts Health Trust and Barking, Havering and Redbridge University Trust in the east of the city are under particular pressure.

Should the number of covid patients reach a level that requires the capital to instigate surge protocols, theatre space set aside for cancer operations is likely to be commandeered.  

Under this scenario, the NHS in the capital would no longer have the option to transfer cancer patients to private facilities as it did during the first wave of the pandemic.

While pressure on systems may ease slightly over Christmas, as demand traditionally falls, there is real concern about cancellations in January.

A senior London-based source said: “This is a real and imminent threat to London’s ability to perform cancer surgery. The reality was that NHSE offered something and these private companies simply did not respond as they had better income streams”.

Research published last month found it was riskier than previously thought to delay some surgery. In colorectal cancer surgery, it estimates a 4 to 8 per cent increased chance of death for each four week delay in treatment. In the first wave, many of these cases were delayed for longer than four weeks.

HSJ asked NHSE if it had modelled the impact of doing less cancer surgery in the second wave than the first and how much it had offered the three private hospital groups to use their facilities. It chose not to answer the questions.

A HCA Healthcare UK spokeswoman said: “HCA Healthcare UK is proud to have supported the NHS in the national response to covid-19. Through this collaboration over 14,000 time-critical NHS patients were able to get the care they urgently needed, including complex cardiac and cancer surgeries and we continue to support local NHS partners”.

NHSE recently announced a national framework which the NHS can use to arrange local deals with the independent sector, although as HSJ reported last week Spire and BMI are negotiating an extension to their national block contract.

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