A major hospital trust is seeking to buck the trend of outsourcing healthcare to the independent sector, following the lead of another trust’s success in re-establishing elective care during the covid pandemic.
In an effort to reduce its reliance on independent contractors, Maidstone and Tunbridge Wells NHS Trust last month submitted an outline business case to NHS England/Improvement to develop an in-house specialist orthopaedic surgical facility, according to a report in LaingBuissons’ Healthcare Markets magazine.
The trust’s plan revolves around the creation of a ‘barn theatre’ model that will include four laminar-flow theatres, along with a 20-bed inpatient ward and a 16-bed day-case unit, all located within its Maidstone Hospital site.
This will enable it to separate elective and emergency work, and also deliver cost savings by cutting the number of orthopaedic patient cases (ie around one in three operations) that are currently outsourced to independent contractors at an annual cost to the trust of £2.8m.
It also suggests that the new set-up would ultimately provide a capacity of 2,500 patients, allowing Maidstone Hospital to take on operations now performed at the trust’s Tunbridge Wells site – and potentially at hospitals run by other NHS trusts – as well as those presently undertaken by the private sector.
And the outline business case for the new orthopaedic surgical facility at Maidstone echoes a programme to boost capacity that is already in place at the Croydon Health Services NHS Trust.
The south London trust set up an elective centre for non-covid patients shortly after the first wave of the pandemic receded, in the summer of 2020. It did this by creating a ‘hospital within a hospital’ – similar in concept to the proposed ‘barn theatre’ model at Maidstone – based around a protected zone which allowed it to separate elective and emergency care. This allowed the trust to continue with clinically prioritised elective work during the second wave of the pandemic.
The project triggered the creation of an emergency surgical centre, and led to the redesigning of the trust’s day surgery complex to provide dedicated theatres for non-elective work. It also saw the transformation of the Purley War Memorial Community Hospital into a high-volume, low-acuity elective centre.
As well as benefiting patients within the Croydon area, the project has enabled the trust to become a net provider of mutual aid to other trusts, last summer taking up to 1,600 patients from other trusts within the South West London ICS for high-volume, low-acuity procedures including gynaecology, ENT, general surgery and urology.
Despite this evident success, however, the government seems determined to maintain its blinkered approach to solving capacity issues in the NHS. Consider the health service’s new ‘delivery plan’, which ignores the issue of reopening the 5,000 NHS beds that closed in March 2020 as part of the pandemic preparation. And consider health secretary Sajid Javid decision recently to force through another ‘surge capacity’ deal with independent providers – a move described by NHSE ceo Amanda Pritchard as being “on a per bed basis… significantly more expensive than the equivalent costs of an NHS site”.
But Croydon’s experience shows that bringing in the independent sector to clear elective surgery waiting lists – now approaching six million patients nationally – doesn’t have to be the default option, and hopefully Maidstone will get the chance to prove that point soon too.
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