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The NHS’ central management team has always been at pains to conceal the size of its spend on the private sector.
For a long time, trusts (and sometimes commissioners) have been using the private sector and/or waiting list initiatives (overtime) to work through waiting lists that have built to an ugly size.
There are still many unanswered questions about what has been spent so far to keep some services going during covid, and whether the NHS got good value, but this morning’s news about the potential cost is interesting for a couple of reasons.
That the framework deal anticipates a spend of up to £10bn over four years is a lot of money – not as much as the £15bn this financial year on personal protective equipment, or the £10bn this year on test and trace (also money going out to the private sector). That £2.5bn a year looks small compared to these other facts of covid life should worry everyone thinking about where the public sector might elsewhere be cut to pay for it.
It’s also that when asked how long it might take to get things back to normal in waiting list terms, someone had to admit it might take four years.
Worth remembering also, the elective waiting times position was bad before covid, and probably worse than even the grim official figures looked.
Presumably the eventual agreements struck between the NHS and private sector will cover knotty business ethics questions like whether an NHS patient and private patient of equivalent need will be treated first at the private hospitals.
An appointment with confusion
Unclear guidance on how GP practices should be recording appointments has meant staff workload is likely to have been under-reported, according to NHS England.
This has been exacerbated by the covid-19 pandemic, as the major shift in primary care working towards digital appears to have confused things further.
Previously, it was unclear what form of patient interaction should be classed as an appointment and therefore recorded in a practice’s appointment book. And with the rapid introduction of total triage and remote appointments, there wasn’t a universal reporting standard in place to ensure all practices were noting appointment data in the same way.
Last week, NHS England published fresh guidance on how appointments should be recorded, after the pandemic highlighted inconsistencies in the way this was done.