Time to take our temperature again…

Back in September 2021, IHPN produced an Industry Barometer which provided a snapshot of how our members view their current business environment. The questions focussed around four areas:  the market; relationships with the NHS, commissioners and systems; the impact of the coronavirus pandemic; and safety, quality and the workforce. The responses captured a moment in time and told a fascinating story of what the key issues are facing independent healthcare who deliver both NHS and privately funded services.  This all took place before Omicron hit our shores, at the start of the Health and Care Bill’s journey through Parliament, and with a newly formed top team at NHS England. So, let’s remind ourselves of what the Barometer told us and what has changed if anything since then.

No 1. The impact of the pandemic continues to be profound but is receding. 50% of respondents felt that covid19 had had an extremely or very significant impact on their organisation, which has led to them making wholesale changes to their business. The impact on workforce has been considerable with particular concern around staff burnout and growing mental health issues.  And the “new normal” is just now normal – covid has changed attitudes to both homeworking and what a positive work/life balance looks like, and this is continuing to influence working practices.

No 2. Overall, the message to the NHS seems to be “help us, help you” to recover from the Pandemic.

NHS/independent sector partnerships were a key feature of the health system’s response to covid so not unsurprisingly providers broadly feel they have a key role in the recovery of local healthcare systems. And there is a strong appetite amongst independent providers to make an even greater contribution to the covid recovery and play a key part in emerging Integrated Care Systems.

No 3. Locally, relationships with the NHS have continued to improve but there are real concerns about not feeling part of broader “systems”. When it comes to relationships between individual providers and their commissioners – a third of members feel that relationships have seen a marked improvement in the past year, with almost no-one saying relationships had deteriorated. And that is an improvement on top of last year – where there had been a substantial improvement in relationships – so an increase on an increase.

But when we come to engagement and involvement in larger systems (notably new Integrated Care Systems) – over half of respondents don’t feel part of their local system and with significant concerns around the future of commissioning and uncertainty over how the Health and Care Bill will play out in practice. These issues around lack of engagement are generally felt by all non-NHS providers and it is not surprising with NHS leaders focussed on ICS formation and covid recovery – but still a cause for concern. And the uncertainty continues with the timings around ICS implementation being pushed back to July 22.

No 4. Strong growth is expected across all its key markets, and most notably with regards domestic self-pay where 89% of respondents are feeling very positive and positive. This is followed by PMI funded services at 67%, NHS funded services at 44% and finally international self-pay market down at 11%. This reflects growing demand for private healthcare, with recent IHPN polling showing around a third of people are more likely to consider paying for treatment compared to pre-pandemic.

Relationships have also continued to strengthen between the independent sector and both the NHS and government, but there is significant uncertainty about how these relationships will further develop. This stems from a number of places – impact of the move towards Integrated Care Systems, changes set out in the Health and Care Bill, as well as still (relatively) early days of what the appointment of the new chief executive at NHS England will mean for the sector.

No 5. Workforce, workforce, workforce – the big concern for 2021 and is it the “perfect storm”? 84% of respondents view workforce challenges as the top priority for their organisation with issues around sustainably recruiting and retaining staff, changing employee views on work/life balance and working patterns; as well as pressures associated with staff burnout and growing mental health issues. Although this was an issue in 2020, the combination of the pandemic and the impacts of Brexit has seen this issue balloon. This is a problem that providers across the whole health and care system share – whether NHS or independent – and hence requires collaborative, whole-system solutions.

Finally, independent providers were asked if they could change one thing what would it be? And four clear themes emerged: a clear strategy and policy direction for all areas of the healthcare system; independent providers to be involved in new Integrated Care Systems at all levels so that they can play their part and bring their experience to the fore; high quality, consistent and effective commissioning which ensures the best outcomes for patients and great value for the public purse; and collaborative, system-wide solutions to the healthcare workforce shortage

None of these things are rocket science and represent a practical and pragmatic way forward for a health system that is both recovering from the pandemic and faces a huge challenge in tackling the backlog of care. The elective recovery plan, published last week, makes clear that using the independent sector will be essential in bringing the elective backlog under control through providing efficiency and innovation as well as additional capacity.  Independent health care providers are already a key part of the health care sector, as was seen during the pandemic.  They are ready to continue to play their part and more involvement and engagement will lead to the holy grail – the best outcomes for patients at the best value for the public purse.

Danielle Henry, Head of Primary and Community Care Policy, Independent Healthcare Providers Network