London market stalls

By Robin Stride

Consultants’ private practice in central London is likely to be quiet for the next three months due to patients becoming ‘jittery again’ in the third lockdown, analysts warn.

LaingBuisson’s 7th edition of its Private Acute Healthcare Central London Market Report finds the area’s private acute healthcare market in the year running up to Covid-19 was its strongest in revenue growth since 2014. 

But its author Ted Townsend admits: ‘What 2021 will hold for the central London independent hospital sector is anyone’s guess. 

‘While pent-up demand led to a noted rise in the number of patients through their doors in the later months of 2020, the third lockdown has made patients nervous and the first half of 2021 is expected to be quiet as a result.

‘Nevertheless, central London private hospitals should continue to benefit from the restrictions being placed on NHS PPUs as well as lack of private capacity in hospitals outside of London, not to mention the ongoing backlog of private patients and the potential for new self-pay patients.’

He said the pandemic had obscured Brexit’s potential impact. ‘Whether this emerges as an issue, either through a loss of those jobs which offer health insurance as a perk to other counties, or through difficulties in staff recruitment, remains to be seen.’

A return of international and embassy patients plus higher private medical insurance spending and oncology revenues drove growth of more than 7% during 2019. Hospitals are broadly expected to maintain 2019 revenues, but the report warns profits ‘may be a different story’. 

NHS contracts kept the sector going during the pandemic when they might have closed, but the analysis says it is hard to predict when overseas patients will return. 

The upside

On the upside, the financial, insurance and legal services sector, with many insured patients, seems to have survived well and the report sees benefits for central London from NHS PPU restrictions, lack of private capacity in hospitals elsewhere and a backlog of private patients and potential new self-payers.

LaingBuisson estimates private medical insurance revenues grew by 4.6% in 2019, from £922m to £964m, generating 56.4% of hospital revenue, following previous year falls. 

This was partially reflected in the zone’s strength in complex care areas like oncology. Insurers tried to manage costs in the face of ‘flat demand’ for their products and growing claims from oncology patients, who account for 4% of patient volumes but 25% of total spend. 

The most successful insurance cost management policies included:

 Call centres directing patients to cheaper hospitals and consultants;

 More pathway management, such as recommending physiotherapy and pain management before or instead of orthopaedic surgery; 

 Price negotiation, such as putting out tenders on a specialty basis and inviting hospitals to bid, plus offering patients cash payments for being treated by the NHS. 

Self-pay revenue estimates rose by only 1.4% in 2019 to £354m, or 20.7% of total revenues, and apparently fell for some hospitals and groups despite high marketing budgets, ‘suggesting there is some sort of impediment to growing revenue from this source beyond some initial “easy wins”’. 

Shoots of recovery visible

There is optimism of a rise in self-pay revenues as NHS waiting times encourage more people to go private. 

Some hospitals are improving marketing and targeting individual patients effectively rather than relying on private consultants to bring them the work

The study notes that established consultants in large practices often feel they do not need to attract work by offering lower prices through a hospital self-pay package, so deals are agreed with specialists who need the work, rather than those who can bring it in.

Revenues from embassy work grew by 20.3% to £374m in 2019. But travel and visa restrictions are predicted to slow patients’ return and home countries have their own economic and pandemic issues.