Daily Insight: Road to recovery goes via independent sector

The NHS’s efforts to bring down elective waiting lists are becoming increasingly reliant on the independent sector, figures seen by HSJ have revealed.

The share of elective recovery cash going to private hospitals has surged by more than a fifth, compared to pre-pandemic levels, as NHS provider activity grew by just 3 per cent.

In another mark of their outsize importance, private providers delivered 40 per cent of the extra activity during the first quarter of this year.

For patients who get to be seen and treated quicker, this trend is undoubtedly positive.

But experts say the data raises questions about the foundations of NHS recovery efforts – and warn the money leaving the service could be better spent boosting the health service’s efforts.

Waiting list analyst Rob Findlay said independent sector outsourcing was “not genuine backlog clearance, but a way of plugging some of the recurring shortfall in core NHS capacity”.

Sally Gainsbury, from the Nuffield Trust, said: “This approach risks hard wiring a larger reliance on the independent sector into our healthcare system than we had before the pandemic, and with it very real equity concerns over which patients can receive timely elective care.”

The PSR is (almost) here

Ready the white smoke to billow forth from Wellington House, the provider selection regime is almost here. After much delay, the government has laid before Parliament its new commissioning rules that will underpin the bright new world of integration that we now live in.

The centre has long promised the PSR. It will, we are told, turn the competitive, transactional, confrontational process of commissioning of yesteryear into a collegiate, congenial, collaborative endeavour undertaken by providers and commissioners together.

We must wait another few months – until January 2024 – before they actually come into force. But the draft regulations as presented to lawmakers show us what the rules will be from then on.

The big change remains the long-planned move away from the Public Contracts Regulations, which had governed commissioning and obliged NHS bodies to go through onerous public procurement exercises that critics said were time-consuming, expensive, and detrimental to service continuity.

There are still some instances when competitive processes must be used but they are far fewer in number and narrower in scope than before, and come into play only when they cannot use the new process whereby commissioners select an entity they deem the “most suitable provider”.