Waiting list plans could see 250k patients referred to private care

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Quarter of a million patients could be referred to private sector under changes to waiting time rules, HSJ analysis reveals
Waiting time target could be scrapped under proposals and patients offered alternative provider at 26 weeks
Independent hospitals have capacity for extra work, says trade body

An estimated extra quarter of a million patients a year could be referred to the private sector under new waiting list rules, HSJ analysis has revealed.

If plans announced last week had been in place over the past 12 months, then 250,497 patients on an elective waiting list would have been offered the choice of an alternative provider, which could be one of the private hospital groups.

National waiting times data shows between 10,000 and 25,000 people move past the 26-week mark each month and would have to be offered an alternate provider.

The size of the elective waiting list and the average waiting time have steadily worsened over the past five years, with the average wait now 22.7 weeks.

NHS patients already have a choice of provider for their elective care but, under the new rules, NHS providers would be obliged to offer the alternative at an extra point. This could be to another NHS provider or a private one.

Not all of the 250,497 patients passing the 26-week threshold over the course of a year would need an operation but a significant number are orthopaedics procedures, which are high-cost under the tariff.

In January, of the 25,057 people waiting 26 weeks, 3,602 of them were trauma and orthopaedics patients. T&O patients were 34.3 per cent of the NHS-funded caseload for the independent sector in January.

The Independent Healthcare Providers Network said the sector had spare capacity to take on extra NHS-funded work.

IHPN chief executive David Hare said: “We welcome NHS England’s commitment to proactively support patients to choose an alternative provider if they are going to wait over six months for elective care. The 18-week target should still be the default, however, and it is important to note that a wait of over six months is still far too long for the vast majority of patients.

“What needs to happen for this new right to be effective is a proper national approach to identifying spare capacity and making patients aware of their options well before they hit 26 weeks. Patients may then choose to remain with their existing hospital, go to another NHS trust, or go to an independent sector provider – this isn’t about simply moving patients into the independent sector.”

Modelling work is currently underway, with the NHS calculating which service lines and areas would need support.

Other proposals in the waiting times review would replace the current waiting times target – that 92 per cent of patients wait no more than 18 weeks – with an average wait time target.

The 92 per cent target was introduced in 2012 but has not been hit since March 2016.

A report to investors from Ramsay Health Care UK, one of the largest private providers of NHS-funded care, said the NHS was on track to miss its target of the waiting list being no bigger in March 2019 than it was in March 2018.

The report, released last week, said the NHS was on track to miss this target by 293,000.

The company runs 31 hospitals in England, and 79 per cent of its admissions are NHS-funded.

The presentation to investors from chief executive Andrew Jones said “positive signs [were] emerging” after a “challenging” first quarter of 2019 but that the “UK government has renewed commitment to patient choice and use of independent providers to cut waiting times”.