Independent providers ‘prioritising private patients over NHS’

Several sources indicated to HSJ that, with limited staffing, including of doctors who normally also work in the NHS, the private sector was in some areas already prioritising insured or self-pay patients, and would soon do so elsewhere. 

Dorset Clinical Commissioning Group told HSJ the health system was aiming to increase its use of the independent sector to help reduce waiting lists, as are others, but that independents were facing staffing limitations, reducing the amount of capacity they could provide to the NHS.

Its July board papers state: “Regarding the ongoing utilisation of theatre capacity within the independent sector, there had been some reticence from the independent sector hospitals based within the Dorset footprint to deliver the acute trust requirements.

“This was in part due to the complexity of some patients and the need to deliver the private waiting lists.”

A spokesman for the CCG added: “Amongst a range of initiatives, the Dorset healthcare system is increasing the use of independent providers to help reduce waiting lists, however in common with other providers they are facing their own limitations in terms of capacity and staffing.”

Meanwhile a University College London Hospitals July paper states that the trust plans to access “as much independent sector capacity as possible”, but said it was inevitable that “as their referral base recovers they will have less capacity to offer the NHS”.

Ed Jones, a former government special adviser who was involved in negotiating IS contracts during the pandemic, and is now a senior partner at consultancy Newmarket Strategy, said: “Given the mounting backlog it will be frustrating for patients and policy makers that there is staffed capacity available in private hospitals right now which could be caring for NHS patients.

“System funding needs to be properly secure. The NHS then must be willing to pay fairly and at the going rate for the services it needs, and referral processes must be slicker in getting patients to whoever it is that can properly care for them quickly.”

However, David Hare, chief executive of the Independent Healthcare Providers Network, said: “Independent sector providers are fully committed to supporting the NHS with elective recovery and have the capacity to treat many more NHS patients if the NHS locally can get patients from A to B.

”So far this year we have seen a number of operational and financial blockers to achieving that including widespread block contracts; uncertainty over the application of the e-referral system; just a six-month financial envelope; and a new contracting regime with the independent sector which sees most contracts conclude on 30 September 2021.

“None of this is conducive to driving the long-term levels of activity which everyone wants to see to ensure that access to NHS care is improved.”

Meanwhile, HSJ analysis of hospital episode statistics indicates that as of May, the latest figures available, independent sector activity was still a little below pre-pandemic levels, with no growth above normal to begin elective catch-up (see charts below). That is despite national and local NHS officials saying they want to make the best use of IS capacity. NHS activity also remained a little below normal season levels in May, the analysis showed.

In May 2018 the independent sector carried out 43,145 NHS day case electives; in May 2021 it was 40,700. A further 7,720 overnight elective procedures (“ordinary elective”) were carried out in the independent sector in May 2018, compared to 6,715 in May 2021.

Meanwhile, the NHS waiting list at independent providers has also rapidly increased since before the pandemic — up 39 per cent, from 224,304 in May 2019 to 310,849 in the most recent figures.

The waiting list for NHS providers increased by 21 per cent over the same period, according to analysis of referral to treatment data.

10 August 2021 9.10am: Updated to include IHPN quote