NHS England had no choice but turn to private hospitals during Covid surge | Health policy

Another day, another initiative to stop hospitals becoming overwhelmed by a combination of the Omicron surge and normal winter pressures. NHS England has struck a deal with private healthcare providers whereby their hospitals will be ready to start treating NHS patients who cannot get the Covid or non-Covid care they need because their local NHS hospital is too under the severe pressure.

This follows the recent news that “mini-Nightingale” field hospitals are being built in the grounds of eight hospitals, that gyms and education centres in hospitals could be turned into overflow wards and that thousands of Covid patients could be treated at home in “virtual wards”. Any or all of this could happen if the increase in Covid hospitalisations leads to a hospital trust or even entire region of the NHS deciding it needs “surge capacity”.

Announcing the latest tie-up with the private sector on Monday, NHS England’s chief operating officer, Sir David Sloman, who is also the service’s Covid incident director, said: “This deal … means as many people as possible can continue to get the care they need.

“It also places independent health providers on standby to provide further help should hospitals face unsustainable levels of hospitalisations or staff absences. Just like the Nightingale hubs being created across the country, we hope never to need their support. But it will be there if needed.”

Sloman said the the new arrangement was “struck under direction from the secretary of state”. It is easy to see why Sajid Javid would look to private hospitals to ease the NHS’s burden. First, the waiting list for non-urgent hospital care in England is already at a record 5.83m and may break through the 6m barrier when the latest monthly performance figures come out on Thursday. Downing Street is open about the fact that getting that big number down is a key priority.

Second, the number of hospitals that have been forced to cancel elective surgery in the face of intense pressure will increase the headline total when the same statistics come out next month.

Third, however one feels about privatisation of NHS care, it is unarguable that people who needed urgent surgery during the pandemic, for a range of serious conditions but especially for cancer, have been able to undergo a procedure in a private hospital that they would otherwise have had to wait an indeterminate length of time to receive on the NHS, because the pandemic disrupted so many non-Covid services, especially in the first wave. The health impact of that is still emerging.

Will any part of the NHS need to in effect commandeer their local private hospital(s)? The deal is “another NHS insurance policy”, one health service boss says. The fact that at least 24 trusts in England have had to declare a major alert since New Year’s Day, because they could not cope with the level of demand they were facing, especially with so many staff off sick because of Omicron, suggests the arrangement may have to be triggered, especially with Covid admissions rising in many regions – up 7% in 24 hours on Monday in both the north-west and south-west, for example.

But David Rowland, the director of the Centre for Health and the Public Interest thinktank, cautions that private hospitals’ reliance on NHS consultants means the plan “really doesn’t stack up as a way of adding capacity to the NHS”.

He also asks whether private hospitals will be paid just the NHS “tariff” rate for any treatment they do provide – the fee they receive when performing a hip or knee replacement on an NHS patient – or whether the health service’s almost desperate need for extra capacity means they will receive a markup as part of the deal. NHS England said only that details about the “pricing and funding of the arrangements” would follow in the next few days.

The deal confirms that the sheer scale of the healthcare backlog means the NHS will be looking to private hospitals to undertake as many operations as they can for the foreseeable future. NHS England was budgeting to spend £10bn on them for that purpose over the next four years even before Javid ordered this tie-up. A report by the Commons health select committee last week said the private sector would play a key role in the NHS’s chances of tackling the backlog and that reality was central to NHS England’s finished but still-unpublished “elective recovery plan”.

The many people offended by NHS billions being handed to private hospital groups will baulk at what is likely to be a long-term marriage of convenience. But a decade of successive governments underfunding, and ignoring or worsening its staff shortages has left the NHS no choice.

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