NHS heading for ’massive’ endoscopy backlog if no private sector deal agreed

Ministers and NHS England are though to be still in discussions over the basis for a new contract between the NHS and independent sector providers, to make extensive use of the latter’s capacity in coming months. 

The current contract, agreed in March, under which NHSE has block-booked the hospitals for fixed fees based on costs, remains in place until it is terminated or replaced. It was previously expected to be replaced at the end of June, but no replacement deal — likely to move to more activity-based payment — has yet been announced.

One senior manager told HSJ that unless a deal was reached the “massive” elective backlog would not be dealt with, including endoscopy, which is already seeing bowel cancers go untreated.

Other sources said a deal was expected soon but could end up covering a period of a few months, rather than to the end of the financial year, as some had hoped.

The Treasury is reported to have balked at the £5bn proposed cost of extending the contract beyond June.

The NHS’s national diagnostic target is that 99 per cent of patients should wait no more than six weeks from referral to a diagnostic test. For endoscopies the share meeting this fell from 91.2 per cent in May last year to 33.6 per cent in May 2020.

More than 180,000 people were awaiting an endoscopy procedure at the end of May, data released this morning revealed, of whom 56,000 had waited more than 12 weeks.

At the end of May 977,000 people in England were awaiting any diagnostic procedure, more than a quarter had waited more than 12 weeks. London had the highest median wait time at nine weeks and the south east the lowest with 6.7.

Endoscopy services were already under significant pressure pre-covid, and the Royal College of Physicians’ joint advisory group on gastrointestinal endoscopy said it “recognises these pressures will be severely exacerbated and waiting time targets for accreditation will need adjustment and tolerance during the evolution and recovery from the pandemic”.

HSJ reported last year how failings in endoscopy services at one trust had led to at least three patient deaths.

The NHS has divided patients into four different priority levels for surgery, P1 where surgery is required with 24 hours or 72 hours, P2 in which surgery can be deferred for up to four weeks, P3 where it can be delayed for up to three months and P4 where it can be delayed for more than three months.

HSJ understands that while P1 and P2 patients have largely had their treatment, procedures for P3 patients were seeing substantial delays, in addition to the endoscopy problem.

The government this week said it had spent £5.5bn on ”Independent Sector Health facilities; enhancing NHS discharge process[es], delivering medicines to those who are vulnerable and shielding; keeping pharmacies and GP practices open during bank holidays and funding for domestic vaccines R&D and manufacturing”, but the Department of Health and Social Care declined to tell HSJ what share of this went on IS providers.