Managers wasted billions on buying capacity in private hospitals
There’s been a lot of media panic about the Omicron variant this week, but there were two damning reports that have been completely overlooked. Both show the disturbing state of cancer and elective care in this country.
The first, by the Macmillan Charity, reported that there were an estimated 50,000 missing cancer diagnoses due to shortcomings in cancer care over the last 2 years. The second, by the National Audit Office, made for equally grim reading: between 7.6 million and 9.1 million fewer referrals for treatment were made during the pandemic. And yet, there is still a shocking 5.9 million, or around 1/10th of the UK population on an NHS waiting list, with the potential for this to increase to 12 million by March 2025.
The causes are likely complex and multifactorial: chronic staffing shortages, a fall in diagnosis (due to people staying at home to “protect the NHS”, and perhaps due to reduced in-person GP appointments), less hospital capacity for appointments, diagnostic and therapeutic procedures have all contributed to a perfect storm. It’s no wonder that this has been labelled the “biggest cancer catastrophe ever to hit the NHS”.
One crucial area that has often been overlooked is the impact of poor management in the NHS. A report recently released by the Centre for Health and the Public Interest has outlined some worrying decisions made during the pandemic. In March 2020, NHS England entered into what would become a series of contracts with the private sector. These contracts were designed to have specific goals: to provide some Covid care, uphold urgent elective care and operations, maintain NHS diagnostic capacity, and to undertake non-elective care.
The aim was to relieve pressure on NHS hospitals and to ensure that diagnosis and treatment of illnesses continued, even while the NHS suspended much of its non-Covid work. Estimates vary as to the cost of these contracts, but costs are believed to be in the region of £2 billion to £5 billion. For this money, the NHS paid for 100% of the capacity of private providers and received an additional 8,000 beds, 680 operating theatres, 10,000 nurses and over 700 doctors.
Permission was given to private providers to gain further revenue by treating private patients if the capacity purchased by the NHS was not used. These contracts acted to give private hospitals a guaranteed revenue stream for periods during the pandemic. The contracts were subsequently renegotiated for the second wave, but the NHS still purchased at least 75% of private hospital capacity, under similar terms.
The results were poor: very few Covid patients were treated in private hospitals and rather than the number of operations increasing, the amount of NHS funded elective care in private hospitals fell by 45%, resulting in 235,000 fewer procedures compared to pre-pandemic levels.
Between April and July 2020, there was a 73% decrease in the NHS-funded total activity of private providers compared to pre-pandemic levels, from 1.2 million operations, procedures and appointments to a mere 336,000. Far from relieving the burden on the NHS, it appears these contracts instead meant that the NHS paid for empty operating theatres and wards.
The NHS cannot continue to throw yet more money into poor management decisions and inadequate contracts. Management needs to work not just harder, but smarter.
Amy Jones is an anonymous medical doctor with a background in philosophy and bioethics. You can find her on Twitter at @skepticalzebra.