Boon of co-operation
A long-awaited Government report from its ‘elective recovery taskforce’ has set the ball rolling on new partnerships between the private healthcare sector and NHS. Taskforce member David Hare reports.
Independent Practitioner Today readers will know that establishing co-operation between the NHS and the private sector has been a rather long-running project, but let’s recap how we got here and then talk about some of the implications.
The ‘elective recovery taskforce’ first convened at the end of last year and I, along with colleagues from the independent sector, the NHS, Government and a large range of other stakeholders including patient groups were involved as members.
Our objective was to try and establish a programme of shared ambitions and alight on ways we could do more to harness the capital, capacity and capability of the independent sector to tackle the growing NHS waiting lists.
Some content of the taskforce report and its recommendations will undoubtedly be familiar to those blessed with a longer memory going back to the Blair reforms of the 2000s and some of the announcements and commitments made earlier this year.
An interesting point about how this work has unfolded over the past few months has been that rather than save all the big announcements to the end, the process has been more iterative – for example, the Prime Minister’s announcement on patient choice at the end of May, of which more below.
When we first embarked on this process, there were four strategic issues we saw as key priorities. They either needed to be further embedded, firmed up or highlighted for attention, both inside and outside the taskforce process:
1, Payment by results. We felt there needed to be a return to a method of payment by elective activity – both for NHS and independent providers – to ensure the NHS and independent sector were being incentivised appropriately to treat as many patients as possible, as quickly as possible.
2. Patient choice. We and patient groups knew that patients were simply not aware of their rights to choose how and where they could receive their NHS care and there were concerns that signposting to the independent sector was not effective or not happening.
3. Procurement/the marketplace. How could the procurement landscape be improved to ensure that the playing field is level, that independent providers can access the market and that decision-making is transparent and fair?
4. Diagnostic capability and capacity. How could we boost utilisation of the significant opportunities presented by the private sector to deliver additional diagnostic capacity?
The taskforce had its last formal meeting in March and, with a draft report and recommendations in place, it was clear on a number of key areas. In the intervening months, we have seen some encouraging progress.
So how are we progressing in those key areas?
1. Payment by results
Following conversations we held along with NHS England (NHSE) and the Department of Health and Social Care, the NHS Payment Scheme for 2023-24 saw the re-introduction of payment by results for elective activity for both the independent sector and NHS providers.
We feel this is definite progress in terms of reducing financial blockers to the movement of elective activity between providers – including independent providers.
2. Patient choice
At the end of May, Prime Minister Rishi Sunak personally fronted a significant announcement saying he wanted to make it much easier for patients to choose where they receive their NHS care and that improvements to the NHS app would be made, along with a public awareness campaign.
This in itself is significant – to have the Premier’s personal commitment in such a clear and explicit way was, I think, both welcome and unusual.
He was clear in his support, saying: ‘Currently, just one-in-ten patients make a choice about where they receive care. We want to change that by helping the NHS to offer patients a real choice while also giving patients the information they need to decide.’
The PM added: ‘Our aim is to create an NHS built around patients, where everyone has more control over the care they receive, wherever they live or whatever their health needs are.’
The idea is that patients should, either via the NHS or via their referring clinician – usually the GP – be receiving a minimum of five choices of options where they can receive their care, including those in the independent sector.
3. Procurement/Provider Selection Regime
A few weeks ago, following a consultation we responded to, the Government announced the Provider Selection Regime.This is an important set of rules to support fair play.
It now sets out an approach we think is positive for all concerned and certainly much better than the initial consultative proposals.
One of the most significant changes we believe is the move to establish independent oversight to resolve complaints, which will help bring transparency and consistency to decision-making.
There will be two independent panels – one relating to choice issues and one for procurement issues – but operating as one. This is a positive step because, by ensuring transparency and consistency in decision-making, it will help give patients and taxpayers maximum confidence about the decisions made on their behalf.
There is more for us to do to ensure guidance is issued and that providers are well equipped to work constructively with the NHS under the new rules, and that there is a good wider understanding of how this will all work in practice. But, again, we see this as a very positive step.
4. Diagnostic capability and capacity
As part of the announcement around the report, we were pleased to see the commitment to opening further independent sector-led community diagnostic centres (CDCs). However, we believe this really can and should be dialled up significantly.
CDCs are undoubtedly a key piece of the jigsaw. We know millions of people await diagnostic appointments, tests and scans. The principle of providing easily accessible capacity, in convenient locations and, crucially, away from hospital sites to shield this activity from the urgent and emergency pathway, seems spot-on.
We feel this is still an area of huge untapped potential and makes big financial sense. Why would we not want to lever in private sector capital to actually build the facilities, rather than fund them from NHS budgets?
It is also really important that we are seeing CDCs as the route to additional capacity, not just moving around activity which would already have been undertaken.
We have made some great progress. The idea of a taskforce, set up directly by the Prime Minister with the explicit purpose of finding ways to maximise the contribution of the independent sector in tackling NHS backlogs, would have seemed out of the question not too long ago.
Lots of the work done in the past few months has definitely been steps in the right direction. It is always easy to say we could do more, go further, move faster.
But reflecting on the historically polarised and often hysterical debate that usually surrounds private healthcare’s role in the NHS, it is no mean feat to be in a place where both Conservatives and Labour leaderships can see the value of the independent sector.
From a private healthcare perspective, the more that patients get exposure, familiarity and experience of the independent sector, it can only be a good thing.
Our research at the Independent Healthcare Providers Network shows that many patients, once they have experienced the quality and safety of independent sector care, feel favourably about it. This may lead to longer-term choices about going private in the future.
People feel that the independent sector can help them and we could be seeing the beginning of a significant behavioural shift, with people feeling it is perfectly normal and sensible to use private healthcare when they need it in addition to, or separate from, their NHS care.
David Hare (right) is chief executive of the Independent Healthcare Providers Network (IHPN)
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