Why don’t we expand PPUs?

Investment made by the NHS in staff ends up benefiting the private sector – so why don’t NHS trusts at last try to get some return on that investment? Andrew Robertson argues the case for change.

When I was working for some of the major private healthcare companies, it was always said that the biggest threat to the business was if the NHS got its act together in delivering private patient services. 

At the time, I was grateful that most trusts made little or no attempt to step into the private patient arena. 

But having been director of private care at Moorfields Eye Hospital NHS Foundation Trust for the last almost five years, I cannot understand the reluctance of many trusts to grasp what is surely a significant opportunity to generate much-needed money for the benefit of all patients.

There are some excellent examples of private patient units (PPUs), mainly in London: The Royal Marsden Hospital, Great Ormond Street Hospital, Royal National Orthopaedic Hospital and Moorfields Eye Hospital being some of the larger ones. 

These PPUs contribute millions of pounds towards the treatment of NHS patients, as well as to education and research. But the development of PPUs outside London is variable and, in many cases, non-existent. 

With little or no central directive or guidance, it is left to local management of trusts as to whether they treat private patients. 

And as experience of private healthcare is limited within NHS senior management, there is either no appetite for private patient services or little understanding as to how to capitalise on the opportunity. The latter is reflected in the variable investment in staffing and facilities.

No choice

In an era when ‘choice’ has been the watchword of the NHS, it is confusing why patients who wish to follow a private patient pathway are not given that choice in many NHS trusts. 

The choice they have is to find their local private hospital or be treated on the NHS. It is ironic that, over the last 25 years, the private hospitals have made much money by treating patients funded by the NHS, yet in many parts of the country trusts are reluctant to treat private patients. 

In a number of private hospitals, over 50% of their patients will be NHS-funded and around half of all NHS patient hip and knee replacements are carried out in private hospitals.

We have choice in most walks of life. We can choose to stay in a five-star hotel or pay less and stay in a three-star hotel; we can pay for Sky TV or settle for the choice of terrestrial channels. 

But when it comes to healthcare, the NHS seems nervous about offering that choice as though differentiating in healthcare is wrong. 

But let’s be clear, we are not talking about differentiating treatment; we are talking about the experience. 

It’s a bit like getting on an aeroplane. One can choose to pay more and turn left or pay the standard price and turn right. All passengers achieve the same objective of arriving at their chosen destination, but they enjoy a different experience along the way.

About 12% of the population choose to be treated privately. If they didn’t, there would be an increased burden on an already strained NHS. 

Slice of the cake

The results of not offering private patient services in NHS trusts is that the money generated by private patients ends up in the private sector. 

While it is important that private companies flourish in order to support the healthcare economy, it feels almost irresponsible not to take at least a slice of the cake. 

After all, who trains the doctors, nurses and other healthcare professionals who end up working in the private sector – the NHS does. The investment made by the NHS in staff ends up benefiting the private sector, so why not try to get some return on that investment?

So why is it that many NHS trusts do not include private patient services as part of their strategy or are so cautious in their investment in them to capitalise on the opportunity? 

One reason already mentioned is unfamiliarity with how private patient services work and need to be set up. But that can and is addressed by many by buying in expertise. But the main reasons appear to be more to do with how it looks.

At a time when elective care waiting lists are at record highs and the NHS is struggling to cope with the backlog, trusts are understandably worried about what it looks like if they turn attention to providing private patient services that many will think will compromise NHS patient care. 

If private patients are to be accommodated, surely that will take up valuable capacity needed for NHS patients? I can see the argument, but it really doesn’t have to be that way.

The trusts that do have successful PPUs perform no less well against their NHS targets than other trusts. They separate NHS and private patient care by either investing in separate facilities or they use NHS facilities at times when they are not being used, mainly in the evenings and at weekends. 

More attractive

I have heard it said that NHS facilities should not be used for private patients. But private patients treated in NHS trusts are trust patients, they just happen to choose to pay for a different experience. 

The quality and range of equipment actually makes being treated in the NHS as a private patient more attractive to both patient and consultant, as the equipment is often more up to date and technically advanced than in many private hospitals.

I have heard it said many times that trust management are concerned about ‘the Daily Mail test’; that is, what would journalists say about the NHS treating private patients when there are such long NHS waiting lists. 

In my five years at Moorfields, I never heard any adverse press about our private patient services and I am sure other successful PPUs have not either. 

However, it is important to be clear and transparent about private patient services and not treat them like some kind of dirty secret. If challenged, it should be straightforward to defend having a comprehensive private patient service. I would have no hesitation in stating that:

 Treating private patients in NHS trusts does not compromise NHS patient care; 

 Private patients are seen and treated outside of NHS clinic and operating times or in separate facilities;

 Consultants treat private patients outside their NHS job plans ;

 Providing private patient services encourages consultants to generate private patient income for the trust rather than for other private providers;

 Income from private patients contributes to staffing, training, equipment, education and research for the benefit of all patients;

 Treating private patients helps to reduce NHS waiting lists.

NHS PPUs are not only an important and acceptable source of income but also play their part in the overall healthcare provision. Trusts should not ignore the opportunity to pick this low-hanging fruit.

Andrew Robertson (right) has spent his career managing private hospitals. For the last five years, he was director of private care at Moorfields Eye Hospital. He is now looking to support the development of other private patient units. He can be contacted at andrew@pripatconsulting.co.uk.