Why turning to the private sector won’t save the NHS backlog

As the NHS battles soaring waiting lists for care, both NHS England and the government have made repeated nods towards greater use of private hospitals to tackle the backlog.

Just in the past week reports surfaced over Rishi Sunak’s plans to encourage more patients to use the NHS app to book a private hospital appointment.

Meanwhile, NHS England wrote to healthcare leaders saying the private sector had “stepped up” to help the NHS work through long waiting times and said private healthcare must be included in its recovery plans.

But how much impact will the private sector really have on reducing that 7.3 million backlog in patients waiting for care?

A leaked cache of documents from the pandemic, obtained by The Independent, and briefings with insiders, cast real doubt over the NHS ability to manage and incentivise the private sector in this respect.

Two years later, more people are paying for private healthcare and the increase in demand could mean private hospitals are less reliant on the NHS as an income source.

In April 2020, the NHS signed an unprecedented £2bn contract, to take over 200 private hospitals for exclusive NHS use during the pandemic. Under the contract, the NHS covered all running costs on the condition they would get exclusive access to facilities and staff.

But internal briefings seen by The Independent reveal that the NHS was forced to change its contract just months later as private hospitals failed to see enough NHS patients. Though the reasons are disputed on both sides, one issue was that staff, such as consultants, typically work for both the NHS and private hospitals and they couldn’t do both.

While the contract was costing £200m a month, the NHS was getting less than £100m worth of surgeries and procedures in return, a leaked briefing by the most senior members of NHS England showed.

The report warned the NHS would continue to lose money on the contract and later changed the rules to allow private hospitals to again treat paying patients and keep up to 40 per cent of profits.

According to a letter in August 2020, multiple private hospital providers were kicked off the NHS contract due to “a plateauing of NHS activity in July”. 

The letter said the predicted “cost-value gap” between what they paid and the work carried out could be too great and several hospital sites which were seeing the lowest number of patients had their contracts terminated.

Clearly, there was an underestimation from NHS leaders of the ability of the private sector to provide care for NHS patients and the appetite for them to do so.

Reflecting on discussions with the private sector in the wake of the first pandemic wave, one NHS trust executive said: “They had us [hospitals] over a barrel [in charging to treat NHS patients].”

It was also reported that there was further conflict over NHS consultants appearing to prioritise private patients who didn’t need urgent surgery over more pressing NHS patients. That prompted NHS medical directors in London to write to private hospitals in January 2021 asking them to stop the practice.

One source said private hospitals gave “excuse after excuse” for not treating NHS patients adding: “The only people that suffered that will get cancelled, were NHS patients.”

Emails from 2020 also showed some trusts raising concerns over private hospitals “limiting” NHS patient bookings and cancelling NHS operations at the last minute.

One insider with knowledge of the contracts said: “NHS executives protected [private hospitals] ... At no point did the contract become a lever for them to accept [NHS] patients, it was always used as a way of not seeing NHS patients … to me that shows private patients were prioritised. It was written in a way that disadvantaged NHS patients that betrayed NHS patients and NHS hospitals.”

In a statement to The Independent, NHS England denied private patients were prioritised over NHS and said: “Any suggestion that NHS England has not complied with its duties of transparency under the Freedom of Information Act is wholly unfounded, as has been upheld by the Information Commissioner.”

David Hare, chief executive of the Independent Health Provider Network, said: “At the start of the pandemic, the NHS in England and the private hospital sector mobilised in less than a week to make all private hospital capacity available to the NHS ‘at cost’.

“In hugely demanding circumstances the NHS and the independent sector worked hand-in-glove to keep vital NHS care going. Whilst still daunting, the challenge of NHS recovery would now be even harder had this arrangement not been struck.”

This week the Private Healthcare Information Network revealed the number of people paying for private healthcare reached the highest levels since its records began and was 5 per cent higher than pre-pandemic levels.

Meanwhile, data released by NHS England for 2022 shows 40 per cent more operations and procedures were sent to the private sector compared to pre-pandemic levels, in a bid to clear the backlog.

David Rowland, director of the Center for Health and the Public Interest, told The Independent: “The expectation that the private hospital sector will be there to support the NHS as it seeks to reduce the waiting list backlog was not [reflected] by experience during the pandemic.

“Even though the NHS had paid the private sector over £2bn for the use of its facilities during the first year of Covid, when the NHS was at its hour of greatest need, the private companies – quite rightly from their perspective – put the generation of income from private patients over the needs of seriously ill NHS patients who were struggling to access care.”

“Partly because of this, the NHS backlog means that there is now growing demand for private care from those patients who are willing to pay.”

He added: “If the NHS is going to get the private sector to do more work – using the NHS’s own consultants – it is likely that the private sector will charge a high price for this, as its fundamental concern is revenue generation and the bottom line, not helping the NHS to get out of its current crisis.”