Private hospitals are doing one in 10 of all planned NHS operations amid patients’ frustration at long delays in NHS care and political pressure to cut waiting times.
New figures seen by the Guardian prompted campaigners to warn that the NHS is “allowing the private sector to make a killing” and is seeing more and more of its services “cannibalised” because years of underinvestment mean it can no longer provide care quickly.
The NHS in England outsourced 10% of all elective procedures such as hip and knee replacements to private operators for the first time during 2023, new figures showed. That proportion has shot up by almost 50% since before Covid, the Independent Healthcare Providers Network (IHPN) said.
Staffing problems and pressure to reduce the 7.6m-strong care backlog are increasingly forcing health service trusts to send patients on their waiting lists for private treatment.
The rise in NHS work done by private operators has prompted fears that more and more of the health service is being left weakened and patients’ access to vital care is increasingly a “two-tier system” dictated by their wealth.
The unprecedented transfer of NHS patients is happening at the same time as a dramatic increase in patients using either their own savings or private medical insurance to pay for treatment in the independent sector that the NHS cannot provide fast enough.
Private operators carried out 1.67m procedures on NHS patients in 2023 – the most ever – which the health service paid for as part of its “referral to treatment” (RTT) scheme. That was 29% more than the 1.3m they did during 2019, the IHPN’s latest internal briefing on activity levels showed.
Private hospitals performed 442,925 trauma and orthopaedic operations, 440,776 eye surgeries, mainly cataract removals, and 165,270 dermatology procedures – all far more than in 2019. And they undertook the largest number of NHS procedures ever in a single month last November – 85,460.
“It’s alarming to see that private hospitals now do 10% of all planned NHS operations. This is turning the clock back to before the NHS was founded in 1948,” said Dr John Puntis, a retired paediatrician and co-chair of campaign group Keep Our NHS Public.
“Moving work into the relatively small and parasitic private sector is a policy decision aimed at undermining the NHS and growing a two-tier system. The NHS is being increasingly cannibalised by the private health industry.”
But the IHPN hit back and stressed that its expansion was helping NHS patients get speedier care. It made clear that, with the demand for care rising and long waits likely to continue for the foreseeable future, it hopes private operators will diagnose and treat even more NHS patients in the next few years, and thus relieve the pressure on an NHS many doctors and experts say is overwhelmed.
“There is much more that the independent sector could do, which would enable timely access to treatment and tests, and give NHS patients more choice over when and where they are treated,” said David Hare, the IHPN’s chief executive.
The IHPN’s analysis shows that January 2023 was the first month in which private hospitals undertook more than a tenth of all the NHS’s elective – non-urgent – activity on its behalf. It was also at least 10% in February, March, September, October and November. Although it fell to 9.8% last December, that was a sharp increase on the 6.5% in December 2019.
In some parts of England, local NHS integrated care boards – regional groupings of trusts – find it so hard to get to grips with their waiting lists that they are outsourcing as many as one in five of all elective procedures to private firms, the Health Service Journal revealed last month.
Between last September and November, the figure was 20% in both the Bristol, North Somerset and South Gloucestershire ICB, and the Bath and North East Somerset, and Swindon and Wiltshire ICB; it was 18% in the Sussex ICB and 17% in both the West Yorkshire and Mid and South Essex ICBs.
The cost of building new hospitals and the NHS’s lack of capital funding mean some trusts are now building new facilities in collaboration with private firms to treat both NHS and private patients, said Tim Read, the director of research at the specialist private care data firm Laing Buisson.
He pointed to the opening in January of the Harborne hospital in Birmingham, a partnership between healthcare giant HCA and the University Hospitals Birmingham (UHB) NHS trust. Under the deal, UHB has been allocated two of the eight floors, giving it 72 extra beds, and some of its top specialist doctors provide much of the private care in HCA’s larger share of the new hospital.
Similarly, the Royal Surrey NHS trust plans to open a new cancer centre in Guildford in conjunction with Genesis Cancer Care, which already operates 14 diagnostic and treatment centres
David Rowland, director of the Centre for Health and the Public Interest thinktank, said he was concerned by the growing outsourcing of NHS because of the “systemic patient safety risks” in the private sector. About 6,000 patients a year have to be transferred from a private to an NHS hospital when complications occur, he said, citing government figures.
But the IHPN pointed out that private hospitals receive positive feedback. The Care Quality Commission, England’s health and care watchdog, rates 92% of private hospitals as “good” or “outstanding” compared with just 52% of NHS hospitals.
The government is encouraging the NHS to make as much use as possible of private healthcare capacity, and Labour’s shadow health secretary, Wes Streeting, has made clear that he sees outsourcing as benefiting both patients and the NHS.
NHS England defended its increasingly close relationship with private hospitals. A spokesperson cited its efforts to tackle the backlog, especially of people waiting unusually long times for their care.
The spokesperson added: “As part of this recovery, services are working closely with private providers to maximise use of all available capacity for patients, increasing usage of the independent sector by more than 50% since 2021 – from 65,000 appointments and procedures a week to more than 100,000 currently.”
