Private hospitals look to NHS for elective operations as private medical insurance falls

BMJ 2012; 345 doi: (Published 06 November 2012) Cite this as: BMJ 2012;345:e7510
  1. Nigel Hawkes
  1. 1London

The number of NHS patients treated in privately run hospitals rose by nearly 11% in 2011-12, data from the NHS Health and Social Care Information Centre show. The admissions covered common elective procedures such as cataract, knee, and hernia operations, carpal tunnel surgery, endoscopy, and sigmoidoscopy.

In 2011-12 there were eight million non-emergency admissions in the NHS in England, with private providers accounting for 345 200 of them (4.3%), up from 312 324 (4%) in 2010-11. No reliable figures exist for earlier years because, the centre said, data from the independent sector had only recently reached a level sufficient to provide a meaningful comparison.

The rise reflects, among other changes, the increasing willingness of private providers to negotiate deals with the NHS at a time when income from patients with private medical insurance has been in decline. Across the private sector as whole NHS patients accounted in 2010-11 for a quarter of revenues: £1.1bn of a total of £4.1bn.

While NHS work is not very profitable for private providers, as it must be carried out within the same tariff as is paid to NHS hospitals, it has helped fill a gap left by declining numbers of patients with private medical insurance.

Figures from the consultants Laing & Buisson indicate that the number of people with medical insurance has fallen by 1.5 million (19%) since 2009 as the recession has bitten.

Of the total increase in non-emergency admissions between 2010-11 and 2011-12, 14.6% were to private sector facilities.

A detailed breakdown by commissioner and provider shows that the increase in use of the private sector has not occurred across the board. While many primary care trusts have made increasing use of the private sector, some have not, and while some private hospitals have expanded their NHS work, in others it has shrunk.

The primary care trust with the highest level of private provision, Southampton City, commissioned almost a third of its non-emergency admissions from the private sector, 10 130 of 32 120 admissions, a 31% rise from 2010-11. Many of these referrals were to the Southampton NHS Treatment Centre, based at Royal South Hants Hospital, which saw admissions rise from 9815 to 14 604.

However, the overall numbers treated at independent sector NHS treatment centres, a category of private providers set up under the Labour government to tackle waiting lists, fell as management contracts at several, including the Midlands and the Cheshire and Merseyside centres, came to an end during the year. They no longer count as private provision.

Primary care trusts in London are among the lowest users of the private sector, Camden PCT commissioning just 20 admissions in 2011-12, Hammersmith and Fulham 22, and Kensington and Chelsea 30. Relative to its population London has few private hospitals that undertake NHS work and an abundance of NHS hospitals.

Among primary care trusts where private admissions fell, South Staffordshire and West Kent stand out. Private sector admissions in South Staffordshire fell from 8948 to 3737, which can be accounted for by the change in status of the Midlands NHS Treatment Centre in Burton on Trent. The centre had been run by the private company Circle, but the five year contract ran out in July 2010, and it was taken over by Burton Hospitals NHS Foundation Trust. So the 2011-12 data cover the period up to July, and after that it was an NHS facility.

In West Kent private admissions fell from 10 564 in 2010-11 to 6889. (The trust failed to respond to a request to shed light on reasons for this change, but it may be due to the opening of a new NHS hospital at Pembury.)

In broad terms, falls in the use of admissions to private facilities tended to occur in primary care trusts where overall elective admissions were also falling, while rises occurred in trusts (the majority) where admissions were rising, indicating that the private sector is being used as a safety valve to ease pressures on NHS hospitals.

The patient choice policy is also having an effect. Since 2008 it has entitled patients to choose a private sector provider if they wish, a commitment now enshrined in the NHS Constitution. In Leeds, where the numbers of admissions to private providers rose from 6211 to 9008, the increase was attributed by local primary care trusts to the increased use of patient choice.

A spokesperson for NHS Airedale, Bradford and Leeds told the Yorkshire Evening Post: “Offering a variety of places where people can have their treatment is part of the NHS constitution. It’s something we are really committed to in Leeds and we work with our partner organisations locally to raise awareness of our patients’ right to choose.

“People choose where to have their care for all sorts of reasons. They may want to be closer to relatives, prefer the facilities available at one hospital more than another or be influenced by waiting times for treatment. In a small proportion of cases, patients waiting for treatment at an NHS hospital may also be offered an alternative provider to ensure they don’t wait too long for their care.”

In some cases, new private hospitals have attracted business. Circle Bath increased its referrals from the NHS from 575 in 2010-11 to 2732 in 2011-12, taking patients for hip, ankle, and knee operations from Royal United Hospitals Bath.

Earl Howe, the health minister, played down the notion of widespread privatisation and said that it was important to allow patients the chance to choose the best treatment.

“The crucial thing here is that patients have access to the highest quality services possible. Letting patients choose how and where they are treated is not new,” he told the Guardian.1 “We want to give patients more choice about where, when and how they can access their health services and these figures show that patients are making decisions about services that meet their needs.”


Cite this as: BMJ 2012;345:e7510