Overseas or in house? How best to “grow capacity” in the NHS

The government has two to three years in which to cut NHS waiting lists—a key measure of the impact of additional spending—before the next election. Success will depend on engaging key stakeholders in the redesign and reorganisation of services. The current policy to increase capacity in the NHS by employing overseas providers makes an interesting case study of the tension between achieving results and engaging professionals.

The policy aims to use overseas doctors to tackle long waiting times, focusing particularly on ophthalmology and orthopaedics.1 Services will be provided within a financial framework that is guided by the current cost of NHS procedures and will be governed by the same quality standards.

For policy makers the use of overseas doctors has the key advantage of avoiding the perverse incentive of “rewarding” consultants for undertaking private sector “initiative lists” on NHS patients with long waiting times. With the NHS as the core purchaser and raison d'etreof overseas services, cost and quality specifications can be tight. Furthermore, with workforce as a major constraint on …