• Private provider capacity estimate revealed as NHS grapples with spiralling waiting list
  • Private sector lobby group says they are not forecasting huge glut of work
  • News follows widespread fears NHS cannot hit flagship 2018-19 elective target

Private providers could carry out around 100,000 additional inpatient procedures by the end of the 2018-19 year, senior industry sources told HSJ, as the NHS grapples with its growing waiting list.

There was, however, widespread scepticism about how much of the estimated spare capacity the NHS would seek to use in its fresh drive to tackle a list which now has more than half a million patients on it waiting longer than the statutory 18 week target.

HSJ exclusively revealed last week that NHS bosses were making a last ditch attempt to hit the flagship elective target of ensuring the waiting list was no higher in March 2019 than in March 2018.

The waiting list in March 2018 stood at 3.84 million but it has increased in every one of the four months since then, rising surprisingly sharply by 270,667 to hit 4.11m in June, the latest official data confirmed.

Senior NHS sources told HSJ that some system leaders had privately already all but written off meeting the target while NHS Providers said if large amounts of work were sent to private centres, it would destabalise trust finances.

But letters sent out by system leaders ordered trusts to draw up plans for how capacity in private and neighbouring NHS facilities could be utilised to get them back on track.

Senior independent sector sources told HSJ industry estimates suggested there was capacity for around 100,000 additional inpatient procedures on top of outpatient and diagnostic capacity in the last six months of 2018-19.

The NHS Confederation Partners Network, which represents independent providers, however, said that while the estimate sounded “in the right ballpark”, private providers were not yet forecasting a significant amount of extra work as a result of system bosses’ plans.

Partner’s Network chief executive David Hare said: “I was not surprised that forecasts from independent acute providers have not publicly changed that much because we have not got a clear view yet of what the NHS’s firm plan is to recover the referral to treatment position.

“The last thing any private operator wants to indicate to investors is that there will be a significant uptick in their NHS activity when the NHS’s messaging is around contingency planning at this stage rather than an actual plan for delivery.

“It’s far too early to say whether recent signalling from NHS England will lead to this changing up or down over the coming months.”

Waiting list expert and HSJ contributor Rob Findlay of Gooroo said if around 100,000 inpatient operations were carried out by the independent sector this year, “it would go a long way to helping the NHS get back on track towards its targets”.

But he warned: “The NHS has traditionally struggled to transfer large volumes of work to the independent sector, partly because patients are understandably reluctant to move once they have been seen in an NHS clinic and built a rapport with their local surgeon.

“So scepticism around how many operations will actually be moved over is understandable.”

The Royal College of Surgeons said using independent sector capacity was “necessary in the short term to benefit patients, although it is likely to come at a premium price at such short notice”.

RCS president Derek Alderson, however, warned the indication that 100,000 patients could be seen privately against a list of four million, with over half a million breaching 18 weeks, meant that it was “unlikely to be a panacea”.

He added: “Sending patients to the private sector may [also] harm younger surgeons’ training. Last winter the RCS had to issue advice to trainees who were at risk of not undertaking sufficient numbers of operations to fulfil their training… This proposal may make things worse as more patients are diverted from NHS hospitals.”

The amount of elective work going to the independent sector has remained broadly stable for the last 18 months, standing at around 6 per cent of total NHS caseload, according to the Partner’s Network.

The service has already long abandoned the target included in the government’s mandate to the NHS that: “at least 92 per cent of patients on incomplete non-emergency pathways to have been waiting no more than 18 weeks from referral”.

The service’s 2018-19 planning guidance stated commissioners and providers should ensure their waiting lists are “no higher in March 2019 than in March 2018 and where possible, they should aim for it to be reduced”.