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With London’s NHS looking to spend £20m a month with the private hospitals up to the end of 2020 to burn through swollen waiting lists, a few questions remain unanswered.
Is this even much money considering what has been spent so far? The £400m a month nationally reported earlier in the pandemic would seem to be considerably more, even if you assumed London’s proportion was one tenth (like with the old strategic health authorities) of it, rather than one seventh (the new regions) or five forty-seconds (STPs).
Maybe the thinking is that the rest of the capital flexed ICU capacity upwards successfully last time, and a lot of bought-and-paid-for IS facility sat idle; certainly parts of the NHS did.
But if a second peak hits as hard or harder is there going to be the capacity to block book the independent sector like before?
It appears not. Spire Healthcare, one of the big private hospital groups (although small in London) said in a note to investors that the new NHSE contract had set different companies different proportions of privately funded work they could do, so they could start to get some of their private patients through the door again.
What the contract provisions say about paying customers if the NHS is once again faced with overwhelming covid surge, alongside a winter surge from people whose fear of the virus has abated, is not known.
NHS England and Improvement London operated a system at the peak of the outbreak where private hospitals had to apply to them for permission to treat private patients ahead of NHS ones.
The phase three letter and its follow up stressed that resources would be targeted disproportionately at those most in need, aimed squarely at health inequalities – ability to pay is a key health inequality and one that will hopefully not come to the fore in a second wave.