Published: 14/07/2005, Volume II5, No. 115 Page 18 19

As the new executive director of the Independent Healthcare Forum, Tim Elsigood's mission is to help independent healthcare providers win the business available to them in the new NHS Tim Elsigood, the newly appointed executive director of the Independent Healthcare Forum, has no doubt about his number one task.

He intends to lead the IHF into negotiations with the Department of Health to ensure the private sector successfully makes deep inroads into the much-coveted and often impenetrable world of publicly funded provision of healthcare.

The IHF was established last year from the ashes of the Independent Healthcare Association, which was wound up after internal member wrangling about its direction and focus.

The IHF has done well so far to build itself back up. It now represents 75 per cent of independent healthcare providers in the UK and many of those entering the market from overseas.

Mr Elsigood says the main aim of the IHF is not only to represent 'the very traditional major companies', but also 'the smaller independent hospitals and the new independent treatment centre providers like Mercury and Care UK'.

He is keen to hold the government to its promise to open up 15 per cent of the NHS market to the private sector and to make sure the opportunities for work are 'available for all our members'.

This is particularly important for the smaller independent providers, 'who do not have the same infrastructure as the bigger companies, ' he says - adding that he is currently in talks with the DoH to help the government find a more efficient way to involve these businesses in providing care for NHS patients.

Mr Elsigood appears well placed to lead the increased use of private sector providers by the NHS. For the four years immediately before taking the top job at the IHF, he was chief executive of Capio UK which had considerable success in securing work in the first wave of independent treatment centres procured by the DoH. This success included the national spine chain providing independent elective and general surgery across the country.

One of Mr Elsigood's first jobs as IHF director is to grow the membership, and he is particularly keen to 'pick up on new streams of activity, of which diagnostics is a good example'.

The DoH announced the second wave of independent sector procurement back in March and set out a clear target to expand diagnostic capacity.

So far, use of the private sector in this field has been limited. The most well-known company is Alliance Medical, which provides diagnostic services to NHS trusts through specialists based in Barcelona.

Although he concedes that Alliance Medical is not yet a member of the IHF, it is this type of companies that Mr Elsigood is keen to bring into the IHF fold.

So does he intend to set off round the world attracting new members to the IHF when they show an interest in UK healthcare? He laughs and says that for the time being he will be recruiting from those businesses operating or setting up in the UK.

Another important area of development for the IHF is forging links with both the Healthcare Commission and the NHS Confederation.

Mr Elsigood is keen to ensure that the Healthcare Commission does not expand any further on the amount of information it demands from providers when regulating the private sector.

'My aim is to ensure that the burden of inspection is reduced, and obviously we are watching carefully the number of unannounced visits they intend to carry out, ' he says.

Mr Elsigood claims he is 'encouraged' by the commission's approach, which looks 'at the risk analysis of the location they are going into rather than trying to say 'here is the plethora of regulation, make sure you have got a file of paper relating to each'. It has recently been far more pragmatic in its approach.' The IHF has also forged a relationship with the NHS Confederation and established a programme of work to 'explore the so-called level playing field' for public and private providers.

The independent sector has been vocal in questioning whether they are being given a fair base to compete with local NHS organisations, and Mr Elsigood sees the work with the NHS Confederation as a chance to 'let both sides of the healthcare delivery platform explore what it feels is the unevenness of that playing field'.

He welcomes health secretary Patricia Hewitt's announcement that the clause which meant independent providers who won first-wave ITC contracts were barred from employing NHS staff will be largely dropped in the second wave of contracts (news, page 7, 30 June).

The IHF director thinks both the government and the independent sector have learned from the firstwave ITCs that the insistence on using non-NHS staff created 'difficulties with relationships at local level'.

He says there were tensions between clinical staff who were part of the local community and those who were not.

He adds that private providers also found it 'a challenge' to recruit potential staff from abroad and then to get them registered, approved and properly processed within the tight timescales set out by the contracts.

Future tests for the private sector, he claims, include the move away from guaranteed volumes of NHS work and the way it will measure outcomes to ensure it is 'delivering to an agreed standard with a set of key performance indicators'.

Mr Elsigood acknowledges that independent healthcare companies have been slow to provide the information patients may require on their performance. However, he is keen that they are able to compare like with like in the NHS and the private sector.

One of the most controversial areas in which this is likely to happen is information concerning healthcare-acquired infections.

The private sector typically performs better than the NHS on HAIs because of its case mix.

Mr Elsigood sees no reason why private sector providers should be shrinking violets when it comes to advertising this advantage to patients making a choice on where they should choose to receive their NHS-funded elective care.

He says it would be 'better for us to get out there and tell people rather than just being quiet about it...this is an area [where] we feel we should stand up and be counted'.

Should this happen it will no doubt put a number of NHS noses out of joint. But despite this and other tensions Mr Elsigood believes the cultural and historic barriers between the NHS and the private sector are coming down.

'The traditional relationships are changing, but even before this [current set of policies saw greater use of the private sector] there has always been a spectrum of opinion [in the NHS] which ranges between encouragement and partnership, to 'not on your life'.' He adds that one important lesson from the first wave of ITC procurement is that 'communication lines are kept open so that people do not think there is something going on behind their back'.

Mr Elsigood says the private sector is clamouring to expand in all areas of public healthcare provision.

He highlights primary care as the next big growth sector.

'There is an expertise out there and a willingness to get involved, ' he claims, adding that there is particular interest in chronic-disease management.

However, the IHF director, tempers his enthusiasm by saying the private sector would only be interested if there was a 'critical mass to justify commercial interest'.

Mr Elsigood adds that independent providers are also eager to forge links with foundation trusts. He believes partnerships, joint ventures, and even mergers with foundation trusts are 'inevitable'.

Crystal-ball gazing, he says he can see 'a complete blurring of the lines [in future] between public and independent sector provision, so that there is a true plurality of provision'.

'People will not ask if it is public or independent; they will ask whether it delivers the quality and gives me the access I need.'

The CV

Pre-1993: NHS manager in various hospital trusts in the East Midlands

1993-2001: senior director of private Swedish-owned healthcare providers Capio

2001-2005: chief executive of Capio UK

2005: executive director, Independent Healthcare Forum