As the summer hots up, hospital trusts are busy making plans for how they are going to cope with the coming winter.

A regular feature of these plans is buying bed capacity in the private sector – once purchased on an ad-hoc basis, it now seems that such private sector involvement is becoming more permanent.

This week, the HSJ reported on Royal Surrey County Hospital Foundation Trust’s winter plans; according to board papers seen by HSJ, the trust plans to switch from impromtu booking of private beds in busy periods to block-booking private beds in advance to ensure that entire surgical lists can be outsourced at peak times.

The likely candidate lists are urology, orthopaedics and benign gynaecology.

Hospital trusts have been told by NHS England to reduce elective work over the busy periods. However, Royal Surrey found that cancellations due to bed shortages increased and its A&E performance suffered.

So this coming winter the trust is considering ways to reduce its elective work earlier in the year and plans to outsource entire surgical lists to private companies.

National bed shortage

All trusts are experiencing a shortage of beds.  In 2010/11 the number of general and acute beds in the English NHS was 110,000 and this had fallen to 103,000 in March 2019, and in late 2018 was at 100,500.

A fall of around 7,000 beds across a period of rising activity has resulted in increased waiting times, including the number of people facing a wait of over a year.

NHS trusts are under immense pressure to reduce waiting lists. The target is to treat 92% of patients within an 18 months maximum waiting time.

In response hospitals have been forced to seek capacity in the private sector. Figures for hip and knee replacements show how the role of the private sector has grown – in 2012/13 20.1% of knee and 13.7% of hip replacements were carried out in the private sector, but this had risen to 29.4% and 19.7% by 2016/17.

In 2017/18 concerns over pressures on A&E prompted NHS England to advise hospitals to put in place a blanket ban on elective surgery to help cope with emergencies.

 


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Urged to ‘go private’

As result waiting lists rose to the highest level in a decade at 4.35 million in mid-2018 and local NHS leaders received more guidance, urging them to use private providers to reduce treatment delays.

More targets on waiting arrived in 2018 along with the revelation that a list of NHS trusts under extreme pressure to reduce their waiting lists had been drawn up by regulators and circulated to private providers including; Spire Healthcare, Care UK and Nuffield Health. A policy of using private providers to reduce waiting lists was firmly back in favour.

After several years of high pressures, it is now clear that trusts are struggling to cope with the level of activity all year round. What were ad hoc arrangements with private providers primarily in the winter months, are now expanding to cover all year round and are becoming more permanent fixtures.

University Hospitals Plymouth Trust’s 18 month partnership with Care UK will move 75% of its elective orthopaedic work to Care UK’s neighbouring facility. The unit will be staffed by NHS staff but managed jointly by Care UK. By adding bed capacity, the trust hoped to improve its waiting times for elective orthopaedic surgery.

And in June 2019, Northumbria Healthcare Foundation Trust announced the signing of a contract with the private Rutherford Cancer Centre’s facility in the North East for chemotherapy patients.

The trust noted that the partnership, which will initially treat around 120-150 breast cancer patients per year, is designed to help the trust ensure treatments for cancer patients are not delayed due to lack of capacity in the trust.

Despite the arrangements with private companies, at the end of March 2019,  the waiting list was almost 6% higher than in March 2018. The only bright spot was a reduction in the number of patients waiting over a year for treatment, down 58% compared to March 2018.

Recognition from the top

Finally, in June 2019, Simon Stevens acknowledged at the NHS Confederation’s conference in Manchester that the numbers of acute beds will have to increase over the next five years. Something that many people in the NHS have been saying for some time. Back in March 2018, NHS Providers chief executive Chris Hopson told HSJ it was estimated the beds shortage could be as high as 15,000 beds, 12% of the system’s total bed base. Since this time, bed numbers have continued to fall.

Now a rise in bed capacity has received a seal of approval from the top, where will these beds come from? Will NHS trusts have the money and staff to open new beds or are the trusts going to be encouraged to seek additional capacity in the private sector?

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Block booking

Will we see more block-booking of bed capacity in the private sector, as in Surrey, or the type of arrangement with Care UK in Plymouth?

In many cases the physical beds are there, just staff and/or money is needed to open them – the Guardian reported back in April 2018 that trusts had reported 82 “ghost wards” containing 1,429 empty beds that had been closed due to lack of staff and/or lack of money.

Of course, the private sector will be very keen on plans to increase bed capacity; the UK private sector is heavily reliant on the NHS and will have suffered a reduction in revenue due to the ban on elective surgery in the winter of 2017/18.

According to NHS Partners network, which represents non-NHS health organisations 515,000 non-urgent operations and surgical procedures were carried out by private clinicians for the NHS in 2017, about 6% of the total and the number will have risen over the last year.

Spire is one of the major private providers and NHS work contributed 29.2% of its total revenue at £272.2 million. According to its strategy outlined in its most recent annual report, “NHS waiting lists are getting longer and Spire Healthcare is part of the solution.”

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