No Turning Back –Transforming Co-existence into Collaboration for the Long Haul

Andrew Vaux, Head of Independent Healthcare at Practicus, looks at how the partnership between the independent sector and the NHS that evolved during the pandemic can be sustained.

The NHS has long turned to the independent sector when it needs additional capacity to manage waiting times and avoid penalties for missed targets. But the pandemic that was unleashed over the last year changed this relationship, at least for a while. As the impact of the rapid rise in Covid hospital admissions became clear, the NHS struck a deal in March 2020 to free up virtually all independent hospital capacity and absorb it into its own operations. This arrangement enabled essential treatments for cancer, stroke and heart patients to continue.

Never has healthcare been so much in the spotlight and rarely has the interaction between the NHS and the independent sector been so constructive. At the time of greatest need, the willingness to work together broke down barriers. The IHPN website cites numerous case studies where whole departments were relocated in independent sector facilities, giving patients the treatment they needed.

And despite enduring years of funding squeezes, severe staff shortages and the usual seasonal winter pressures, the NHS successfully rose to its greatest challenge in its 72-year history. The resilience, agility and professionalism of its staff and willingness to go the extra mile must be recognised. At the same time raising the capacity headroom helped to prevent the NHS becoming overwhelmed.

While the pandemic engendered unprecedented and swift adaptation of systems and processes from across the entire healthcare ecosystem, it also exposed some of the fundamental flaws in current healthcare policies. Some of these undoubtedly lie behind the recent Government White Paper announcement to accelerate the streamlining of Integrated Care Systems (ICS) and local health economy structures.

The private sector is often held up as a beacon of efficiency by policy makers. For the last 20 years, successive Governments have used competition and outsourcing as the levers to improve quality of care and value for money for the taxpayer. But this began to change in 2016. In response to the recent Government White Paper, The NHS Confederation recognises that “the existing legislative framework created in 2012 has largely failed and that changes are needed in favour of collaboration and partnership working”. The Health Minister’s new policies and the reformed structures are designed to build a new NHS landscape founded on collaboration rather than on competition.

In the same way that the NHS structures are reforming to ‘build back better’ after the pandemic so too should the independent versus public health care delivery debate be reframed. The crisis undoubtedly triggered some overdue and welcome changes in perceptions. Now is the time for a grown-up conversation about where the collaboration potential goes next.

As the NHS moves into the recovery phase, it needs to find ways to address the backlog of procedures, outpatients’ appointments and unmet needs that have built up over the past year. To do this successfully, the service needs to take on board what worked well. How do health officials from all sides lock in the beneficial changes that have been collectively brought about during 2020?

With an aging population and an enormous Covid backlog, the NHS needs to invest in capacity to meet demand, including using the independent sector to take on a proportion of the elective workload. Even before Covid, bed occupancy rates in NHS hospitals were too high. A key question for policy makers and health executives going forward is how to make the independent providers a real part of integrated care systems so that their capacity and expertise can be used to best effect. This means matching the right private expertise and resources with the NHS demand that can be best served by these, taking cost effectiveness into account. Indeed, Practicus recently partnered with IHPN to host a roundtable to discuss some of these issues – a summary of which can be read here.

The scale of the backlog is unprecedented and could reach 6m by April 2021. According to a statement from the Royal College of Surgeons (RCS) in December 2020 the figure was 4.5m, of which over 200,000 had been waiting over 12 months for operations such as hip replacements. Compare that to 1,500 a year earlier. This massive increase drives home the devasting impact Covid has had on the wider NHS. New ways of working will need to become the new normal.

Medical experts warn there will be a long-term need for infectious diseases management and to be ready for recurring Covid outbreaks impacting capacity and performance. There is a clear demand for more capacity in the public health system and the independent sector has the expertise and skills to efficiently provide many of the services and procedures.

The Government recognises this in contracting with 90 independent providers, in a four-year national deal to help clear the backlog. Although a national arrangement, it is hoped that allocation can be determined by local health authorities to meet the most critical local needs.

Every day normal NHS activity lags demand, the backlog continues to grow. The impact of postponing elective care for millions of people, the extent of the backlog the NHS will face and the new measures needed to address it, should all be considered when making decisions about future NHS funding. There needs to be a sustainable foundation to the independent sector and NHS arrangement that provides some predictability and certainty for both.