Daily Insight: A not so private matter

The evidence has been slow to emerge, but the NHS’s increasing reliance on private providers is starting to become clear.

HSJ previously reported that activity purchased directly by commissioners, which represents the largest chunk of spending on private providers, was up 30 per cent on pre-covid levels, and new data now suggests activity outsourced by trusts has almost doubled in the same period.

According to figures released by NHS England, trusts’ spending on healthcare from “other providers” increased from £2.4bn in 2019-20 to £4.7bn in 2022-23.

In terms of their total budget, this represented an increase from 2.5 per cent of spending to 3.7 per cent.

Independent providers are likely to account for the bulk of the spend, although there is also likely to have been an increase in outsourcing to other NHS trusts as “mutual aid”.

Trusts have looked to outsource more activity in recent years in a bid to tackle the huge waiting list backlogs that built up during the pandemic.

There have been steep increases in the activity carried out in the independent sector in some specialties, particularly ophthalmology, sparking concerns in some quarters that reliance on private providers is being “hard-wired” into NHS operations.

The spend by trusts only represents a portion of total NHS spending on private providers, as it excludes activity purchased directly by commissioning boards. The total figures for 2022-23 are unavailable, as NHS England has not yet published its annual accounts.

A shift to the left

An integrated care board in the South West is planning a major shake-up of community health services in its system through a £1.8bn contract award – the largest such deal of its kind for an ICB.

Alongside the local authorities in the system, Bath, North East Somerset, Swindon and Wiltshire ICB is seeking to procure a “sole provider or consortium of providers” to deliver all adult and children’s community health services from March 2025, for a maximum of nine years.

Community health services within the integrated care system are currently split across five separate contracts, all of which are due to expire between 2024 and 2025.

The move is part of BSW’s plan to “shift left” and focus more resources on primary and preventative services and move focus away from secondary and tertiary services.

The new provider or consortium will be responsible for a budget of around £138m per year for an initial period of seven years, with the option to extend by a further two years.

According to ICB board papers, the re-organisation of community services in this way will address “known quality concerns and issues raised by local people and providers and the inequalities in the community offer across BSW”.