Private hospital spend varies widely, study shows

The data, from consultancy BDO, shows PCTs’ spend with the private sector for secondary care ranged between zero and 18 per cent of their total secondary care expenditure.

The information covers the financial years 2007-08 to 2009-10 and shows the net spend increasing only marginally from 3.21 per cent to 3.47 per cent over this period.

Most strategic health authorities’ figures show PCTs spent roughly three per cent with the independent sector but NHS South East Coast is an outlier with an average spend of 5.64 per cent, the data shows.

These figures do not include money spent with councils, charities and non-secondary parts of the independent sector.

Although the number of accredited providers under the extended choice network increased significantly over the period, this coincided with the end of the first wave of independent sector treatment centre contracts.

Large ISTCs in some areas explain some of the variation.

NHS Partners, the part of the NHS Confederation that represents independent sector providers, said the indications for 2010-11 were that ISTC and ECN use had continued to grow slowly.

Director David Worskett said: “The interesting thing about this is that it comes ahead of the lengthening of waiting times which we are now seeing, and results vary largely from patients exercising choice.

“While the earlier figures probably do reflect that some areas - e.g. the South West and North West - have been strongly proactive in promoting choice, the most recent figures are very much patient rather than PCT or SHA driven.”

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NHS Plymouth spent an average of 13 per cent with independent sector providers over the three years.

Assistant director of commissioning Fiona Phelps told HSJ the geography of the area meant the PCT wanted to ensure there was choice for patients, and that two independent sector providers currently competed with Plymouth Hospitals Trust.

A wave-one ISTC contract expired last year and a UK Specialist Hospitals facility has taken its place.

NHS Portsmouth, which reported 10.2 per cent average independent sector spend, said it had just renegotiated a three-year treatment centre contract to reduce pressure on its acute trust.

Healthcare Financial Management Association spokesman Chris Calkin said London, the West Midlands and Yorkshire and Humber had the lowest use of the independent sector.

“There is no doubt the independent sector will continue to play an important role in providing healthcare across all care sectors as patient choice develops further,” he added.

The figures do not include NHS trusts sending patients for treatment in the independent sector when their own lists are full and paying them at tariff for the work.

Some PCTs acted as lead commissioner for a group of PCTs and said this had given them a disproportionately high percentage of independent sector spend.

A spokeswoman for NHS South East Coast the data had been affected by some of its PCTs taking a more inclusive view of what should be labelled as being provided by the independent sector than PCTs elsewhere.

But she added: “In the SEC region we have a high concentration of independent sector providers, and a population that has traditionally accessed the independent sector through choice.”

Top Spending PCTs on Independent Care

PCT independent sector spend as percentage of secondary care spend, average from 2007-08 to 2009-10