• 54 hospital trusts identified for potential private sector support
  • Move comes in response to waiting lists for elective care continuing to grow
  • Reducing waiting list to March 2018 level could result in financial impact of £400m to £600m
  • Full list of trusts identified

A list of NHS trusts which may need to outsource operations to reduce their waiting lists has been drawn up by regulators and given to private providers, HSJ has learned.

The list of NHS trusts, leaked to HSJ, has been distributed among providers such as Spire Healthcare, Care UK and Nuffield Health, to make them aware of potential opportunities.

The move has come in response to deteriorating performance against the 18-week referral-to-treatment pathway for non-urgent procedures.

Planning guidance issued by NHS England and NHS Improvement in February said additional funding would enable the overall waiting list to be “no higher in March 2019 than in March 2018”. The number of patients waiting more than 52 weeks should be halved by March 2019, it said.

But according to the latest data, the waiting list has grown from around 4.1 million to 4.3 million in the six months from March, while the number of patients waiting more than 52 weeks has risen from 2,775 to 3,156.

If the planning guidance objectives are to be met, then many areas are likely to require support from private providers.

However, it is unclear to what extent local leaders will be pressured into outsourcing arrangements, because there have also been concerns about the cost to the NHS. There is already a high risk of the NHS overspending its revenue budget in 2018-19.

NHSE and NHSI did not answer HSJ’s questions about the cost impact, or say whether they were confident of the planning guidance objectives being met. A spokesman said: “The NHS has encouraged providers to deliver on their own plans to reduce waiting lists, which include seeking support from other hospitals or bringing in the independent sector so that fewer patients have to wait for their elective care.”

The estimates by waiting list experts at Gooroo Ltd that elective procedures cost on average between £2,000 and £3,000 suggests that reducing the backlog by 200,000 could cost around £400m to £600m.

In a quarterly update published last week, NHSI said it was working with the Independent Healthcare Providers Network to ensure that outsourcing is “done as efficiently as possible”.

David Hare, chief executive of the IHPN, told HSJ: “On the current trajectory the NHS is a very long way from achieving even these targets which, it is important to note, fall short of the NHS’ constitutional standards for planned care.

“The independent sector has long played a key role in delivering NHS elective care and it is important that the significant spare capacity in the sector is swiftly utilised to ensure the NHS can meet its planning guidance commitments and that patients are not forced to wait unnecessarily long for care.”

It is not clear how the list of 54 trusts has been compiled, because not all of them are performing badly against the 18 week target. Senior leaders at several of the trusts told HSJ they were unaware of it.

The list appears to be based on data returns submitted by trusts following a drive by NHS England to ensure plans were in place to meet the objectives. Some trusts in the list, such as University Hospitals of Leicester Trust, are already outsourcing significant levels of elective activity to private hospitals.

The last time there was a significant increase was in 2015-16, when spending increased by around £800m (9 per cent in cash terms). This led to high level concerns over the cost impact of outsourcing and a drive to keep elective procedures within the NHS, which has since had an adverse impact on the private sector providers. In 2016-17 spending on private provision increased roughly in line with the overall NHS England budget, and last year it dropped by 3 per cent.

Miriam Deakin, director of policy and strategy at NHS Providers, said: “These decisions should be taken locally rather than being directed from the top down. Trusts should have a clear say in the contracting process, or lead it, to identify and mitigate any financial risk, and to avoid potential pitfalls such as paying an unnecessary premium for trust staff to work for an independent provider nearby.

“We also need to be careful about assuming local commissioners consistently have funding available to boost elective work in this way. Many are having to use their elective underspend for other purposes.”

The trusts identified for potential RTT outsourcing 

Ashford and St Peters NHS Trust

Barking, Havering and Redbridge University Hospitals NHS Trust

Barts Health NHS Trust

Buckinghamshire Healthcare NHS Trust

Chelsea and Westminster Hospital NHS Foundation Trust

Croydon Health Services NHS Trust

Dorset County Hospital NHS Foundation Trust

Epsom and St Helier University Hospitals NHS Trust

Great Ormond Street Hospital for Children NHS Foundation Trust

Great Western Hospitals NHS Foundation Trust

Guy’s and St Thomas’ NHS Foundation Trust

Imperial College Healthcare NHS Trust

Isle of Wight NHS Trust

Kettering General Hospital NHS Foundation Trust

King’s College Hospital NHS Foundation Trust

Kingston Hospital NHS Foundation Trust

Lancashire Teaching Hospitals NHS Foundation Trust

Leeds Teaching Hospitals NHS Trust

Lewisham and Greenwich NHS Trust

Liverpool Women’s NHS Foundation Trust

London North West University Healthcare NHS Trust

Maidstone and Tunbridge Wells NHS Trust

Mid Cheshire Hospitals NHS Foundation Trust

Mid Essex Hospital Services NHS Trust

Milton Keynes University Hospital NHS Foundation Trust

Moorfields Eye Hospital NHS Foundation Trust

North Middlesex University Hospital NHS Trust

Northampton General Hospital NHS Trust

Northern Devon Healthcare NHS Trust

Northern Lincolnshire and Goole NHS Foundation Trust

Oxford University Hospitals NHS Foundation Trust

Pennine Acute Hospitals NHS Trust

Portsmouth Hospitals NHS Trust

Royal Devon and Exeter NHS Foundation Trust

Royal Free London NHS Foundation Trust

Sherwood Forest Hospitals NHS Foundation Trust

St George’s University Hospitals NHS Foundation Trust

Taunton and Somerset NHS Foundation Trust

The Hillingdon Hospitals NHS Foundation Trust

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Torbay and South Devon NHS Foundation Trust

University College London Hospitals NHS Foundation Trust

University Hospitals of Derby and Burton NHS Foundation Trust

University Hospitals of Leicester NHS Trust

University Hospitals of North Midlands NHS Trust

University Hospitals Plymouth NHS Trust

University Hospitals Southampton NHS Foundation Trust

Western Sussex Hospitals NHS Trust

Whittington Health NHS Trust

Worcestershire Acute Hospitals NHS Trust

York Teaching Hospital NHS Foundation Trust

The figures for spending in previous years have been amended. The figures previously stated were for spending on all non-NHS bodies, but now relate only to spending on “independent sector providers”, as stated in the Department of Health and Social Care accounts.