Health secretary Sajid Javid’s decision last week to force through another ‘surge capacity’ deal with independent providers, to protect the health service from being overwhelmed by the Omicron variant, has been questioned by many in the sector – not least by NHS England’s own chief executive – and suggests few, if any lessons have been learned from similar deals waved through by Javid’s predecessor earlier in the pandemic.

Although NHSE ceo Amanda Pritchard eventually signed off on the three-month contract, having covered her back by requesting ‘ministerial direction’ on the matter, she reportedly told Javid that it would leave the health service “exposed financially” and that it represented “a material risk that the NHS pays for activity that is not performed”, adding “On a per bed basis this is significantly more expensive than the equivalent costs of an NHS site with much less certainty on the potential staffed capacity.”

Under the terms of the new deal – which allows the independents to carry on treating private patients and choose which cases to take on – the private sector will receive at least £225m between now and 31 March simply to reserve elective capacity, despite only agreeing to staff just half of the 5,600 beds being made available.

If that capacity is then fully used, this windfall increases to £525m, a sum which nevertheless pales in comparison to the £10bn in state support already being made available to the independent sector over the next four years, to help the NHS clear its backlog of elective surgery.

Worryingly, these generous terms echo those of earlier deals agreed during the pandemic, and could end up representing similarly poor value for money.

Around £2bn of NHS cash was wasted on block-booking private hospital beds back in 2020, resulting in just seven beds a day being set aside for covid patients, according to the Centre for Health and the Public Interest, whose spokesperson Dr David McCoy later told the Covid People’s Inquiry there were many days during that period when no private beds at all were being used for covid patients, and that at no point did private hospitals treat more than 67 covid patients on any single day.

Two-thirds of the private sector’s capacity block-purchased by NHSE in 2020, at an alleged cost of £400m a month regardless of how much work was carried out, were left unused that summer, following which ten independent providers were removed from the national contract because of “poor utilisation”.

The HSJ news site, a few months later, memorably quoted an unnamed source who thought the independent sector – and the doctors working in it – were at that time simply “taking the piss and walking off with the money”.

The Omicron deal has already prompted similar levels of concern. Colin Hutchinson, chair of the campaign group Doctors for the NHS, told the Guardian last week, when the deal was announced, “Do [the independents] have the staff to do this or is this deal again bailing them out at a time when they can’t maintain their cashflow from their normal activities? The independent sector… is acting as a parasite, absorbing public funding that could be used to address the workforce crisis within the NHS. It’s being portrayed as being the cavalry riding to the rescue of the NHS, but it is more like a tapeworm.”

And CHPI researcher Sid Ryan, also talking to the Guardian, said, “It’s not clear what help the private sector can really provide when it relies so heavily on NHS consultants working privately outside their core NHS hours. The private sector may have beds, but their workforce is vanishingly small, and just as challenged by Omicron as the NHS, so it seems unlikely their support will be the key difference-maker.”

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