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Sir Keir Starmer has vowed to make “better use” of the private health sector to help clear a massive backlog of patients waiting for treatment in England.
The UK prime minister on Monday announced a “new agreement” to expand the existing relationship between the NHS and private groups, designed to encourage the independent sector to take on more complex patients and utilise excess capacity.
Using private sector capacity to reduce waiting lists is not a new idea and over the years there has been a steady shift towards the NHS paying private providers for medical treatment.
The private sector currently delivers about 10 per cent of all NHS elective care in England, up from 7 per cent five years ago, according to analysis by the Financial Times. Last year alone, the sector treated more than 1mn NHS patients.
But policy experts say that while the private sector has a role to play, it is relatively limited in terms of the patients it is able to treat. The majority of private hospitals are not equipped with intensive or emergency care facilities, leading many to lean towards taking on simpler cases. Capacity is also limited by the fact that the majority of the private health sector workforce are also NHS staff, for example doctors taking extra shifts in private hospitals.
“The NHS has had a long-standing relationship with the private sector throughout its history,” said Tim Gardner, assistant director of policy at the Health Foundation, adding that the government’s announcement was “more ‘evolution than revolution’”.
The private sector already helps reduce waiting lists for routine operations, such as hip and knee replacements and cataract removal, and is paid per procedure by the NHS. Government officials said they would only be rewarded under the new plan if they took on more NHS patients.
NHS England spent 6.8 per cent of its day-to-day budget on private services during the last financial year, in line with the average over the past decade, according to the Department of Health and Social Care annual accounts.
One government official insisted the new deal with the private sector would definitively shift the dial on waiting lists. Under the new partnership, the sector will be expected to carry out an extra 1mn appointments per year using its existing capacity, they said.
Under the terms of the agreement, providers have also been told they must review their “clinical exclusion criteria” to ensure as “broad a cohort of patients as possible” are treated.
The government official emphasised that providers would be required to offer more appointments to NHS patients in “working class” areas of the country, as well as start treating more specialities, including gynaecology, where 600,000 women are on waiting lists.
Private providers delivered more than 25 per cent of NHS trauma and orthopaedic care and 22 per cent of ophthalmology elective treatment at the end of last year, according to FT analysis of NHS England data.
“The government has updated their agreement with private providers, but they haven’t said what they are going to spend on buying up additional capacity in the independent sector,” said Siva Anandaciva, chief analyst at the King’s Fund. “This is nothing like what we saw during the pandemic.”
In 2020, the NHS poured in millions of pounds of taxpayers’ money to buy up virtually the entire capacity of the private sector, to ensure the health service was not overwhelmed as the Covid-19 pandemic swept the UK.
Anandaciva added that the new push was “largely about signalling that the private sector has a role to play” and was valued as a partner. “But we need a bit more detail to know what impact this will really have on bringing down waiting times.”
David Hare, chief executive of the Independent Healthcare Providers Network, said private groups already treated millions of NHS patients every year.
He said the latest agreement “builds on these strong foundations by making full use of existing capacity in the sector, ensuring that patients are offered proper choice of provider as well as supporting the sector to invest in, and deliver, an even wider choice of high quality services to NHS patients to bring waiting times down”.
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