Plenty of pizzas, but a paucity of private care

By Robin Stride

Now let private doctors get back to doing their work and treating patients!

That is the impassioned plea from their specialties’ national body as waiting lists mount and fears grow for the well-being of many thousands of patients whose diagnosis is delayed.

The Federation of Independent Practitioner Organisations (FIPO) said: ‘Take-aways are open. Supermarkets are open. DIY stores are open. Garden centres are open. Parks are open. People can even now go and play golf! 

‘However, private doctors are in danger of going out of business as routine medical and surgical care in the UK awaits enactment of the terms of the de-escalation.

‘With every week that passes, the damage, the levels of pain and suffering, the morbidity and the mortality rates will simply continue to rise.’ 

Mr Richard Packhard

In a statement given to Independent Practitioner Today, the body’s chairman Mr Richard Packard said: ‘It seems anomalous that highly trained specialist doctors have been left doing next to nothing and that theatres and hospital beds have been left to gather dust when we could actually be working.’

Private hospitals empty

According to a FIPO document, there is a gross underutilisation both within NHS and private hospitals. A&E departments throughputs are down to 50% of their norms and about half of NHS beds are empty. 

Meanwhile, most private hospitals are either completely empty or else hosting just a trickle of NHS patients. 

FIPO said: ‘Whilst it is right that the independent sector should, at this time, assist with the care of emergency and time-critical non-Covid patients, this has clearly been at the expense of all other medical and surgical care. 

‘One major London private hospital recently boasted about having treated 500 NHS patients so far. However, when looking at the number of days divided by the number of theatres available, this equates to less than one case per theatre per day! 

‘The NHS cannot afford to subsidise the private sector, and nor should it have to. Likewise, the UK simply cannot afford to allow medical and surgical capacity to sit idle while pathology and waiting lists build up to unprecedented levels and patients suffer accordingly.’

FIPO called for ‘some proper joined-up thinking’. While praising front-line healthcare workers for responding heroically to the national emergency, it reported that a significant proportion of purely private doctors had not been needed despite having volunteered their services. 

Doctors’ businesses in jeopardy

Highlighting the plight of many independent practitioners’ businesses, it went on: ‘The contractual relationship that the NHS entered into with the private hospitals related to use of their facilities. There are very few employed doctors in the independent sector and those facilities have, thankfully, been under-used. Private doctors are an essential component of this sector. 

‘They often operate as small business and as stated in The Times of 18 May, many of these businesses are not eligible for many of the Government reliefs. Without support, many of these businesses will cease to exist, as their expenses do not cease while they are not active.’ 

FIPO said some private consultants felt they had been pushed aside without warning, but they needed to be able to have access to the operating theatres, investigations and services hosted by the private hospital providers to ensure their highly skilled services remained available for  current and future patients.  

A more flexible approach to the terms of the contract would have allowed private doctors whose services were not needed for front-line Covid tasks to tackle both urgent private patients with other pathology as well as support the NHS to tackle growing waiting lists, FIPO added.

De-escalation period 

NHS England and NHS Improvement wrote to independent providers on Friday 15 May to trigger the start of the de-escalation period of the contract. 

FIPO reported that negotiations with independent healthcare providers about how they might help reduce the NHS elective waiting list had commenced. 

Independent sector providers now had permission to restart routine elective work funded by individuals or private medical insurers – but only when this had been expressly agreed in writing with the local NHS regional lead or a nominated system or local deputy. 

FIPO warned that the NHS simply could not afford to absorb the additional burden of healthcare that would normally be provided by the independent healthcare sector. 

In late March, the independent healthcare sector entered into its biggest ever collaboration with the NHS, with the vast majority of private hospitals signing a 13-week contract to hand over full control of their facilities and services to the NHS. This was in preparation for what was feared might be an overwhelming wave of hospital and ITU corona virus admissions.

FIPO observed that, thankfully, services were not overwhelmed. At the very peak of the crisis, UK ITU beds only saw a maximal occupancy rate of less than 60%. 

The Nightingale Hospitals were established rapidly, with the Excel Nightingale Hospital in London Docklands having a potential bed capacity of 4,000. At its peak, the maximum number of patients seen there was less than 50 or 1.25% occupancy.

‘It was undoubtedly right to prepare for the worst and the independent sector hospital providers, as a core component of the healthcare system of the nation, needed to be part of this. The tragic deaths which have occurred during the time of Covid-19 behove us to look at the figures and make appropriate decisions for the benefit of all in the future.’

Covid-19 not the major issue now

FIPO added: ‘As has already been highlighted by Prof Karol Sikora, the almost complete cessation of normal routine medical care during the lockdown period will itself have had a very major impact on the health of our nation. 

‘Cancers will be going undetected. Patients diagnosed with cancer are suffering significant delays in their treatment. As is well known, delay in cancer diagnosis and treatment significantly increases the risk of poorer outcomes and lower survival rates. 

‘Likewise, patients with cardiovascular disease are now receiving delayed or even no treatment, again increasing the likelihood of significantly poorer outcomes. This is replicated in virtually all medical and surgical specialties. 

‘The major issue now is no longer the direct threat of Covid-19 itself, but the damage caused by the accumulation of medical morbidity and mortality from non-COVID-related pathology caused by the actual lockdown itself. The UK urgently needs to see the start of the resumption of regular medical care.’

FIPO’s document, entitled Healthcare provision – FIPO makes a plea for joined up thinking, quoted a 14 May report in The Guardian that surgical waiting lists in the UK were now somewhere in the region of 7m to 8m cases and continuing to expand by one million per month.  

The doctors’ body said: ‘Waiting times had been creeping up as the NHS struggled to cope before Covid appeared on the scene. 

‘Even once routine elective medical and surgical care does resume, the necessary increased precautions will see operating times doubled and hence productivity halved. 

‘It is hard to see how the healthcare service will ever be able to catch up unless an effective vaccine or Covid treatment becomes available in the near future.’