Private healthcare companies have received millions as the Scottish Government advised NHS boards to block-book all available space in private hospitals in an attempt to bring down waiting times, healthandcare.scot can reveal.

The £18m programme of paying to have NHS patients treated privately was paused due to the covid-19 outbreak.

Now senior doctors are questioning how the NHS will be able to deal with “the biggest waiting list for elective surgery for a generation” without relying heavily on the private sector.

Trade union Unison says the figures “blow apart” Scottish Government claims they had ceased privatisation within NHS Scotland, describing the practice as bad for patients and taxpayers.

Ministers have been vocal in their opposition to the use of the private sector in the Scottish health service in the past.

The 2015-16 programme for government, which set out the Scottish Government’s plans for the year ahead, pledged to ‘effectively eliminate use of the private sector for planned care’ as part of a 20-year strategy.

In 2017 Nicola Sturgeon told SNP conference delegates that “as long as the SNP is in office, the NHS will always be in public hands.”

But a year later, faced with growing waiting lists, ministers drew up two national contracts with private sector health providers as part of the Waiting Times Improvement Plan – using private providers to deliver NHS services.

 

“A more efficient and strictly limited use of the independent sector’s contribution”

The Scottish Government says the use of the private sector in the NHS is on a “strictly limited” basis.

But letters from St Andrews House to NHS boards in June 2019 reveal the Scottish Government wanted boards to utilise “all the available private sector capacity in Scotland over the next few months.”

A total of £18.3m was set aside for private sector providers in letters seen by healthandcare.scot, which span May 2019 to January 2020, around 18% of the total funding allocated under the Waiting Times Improvement Plan over that year.

In some cases health boards were advised to keep using private providers, with NHS Ayrshire & Arran being told by the Scottish Government: “We expect the board to continue with this…with no cessation of activity.”

“We would also envisage that there would be the potential to increase the activity allocation, and discussions are presently ongoing with providers,” the letter states.

Amounts allocated to private providers vary across the country.

NHS Greater Glasgow & Clyde, the biggest health board in Scotland, received £5.28m for operations including hip and knee replacements, cataracts and ear, nose and throat procedures.

Meanwhile NHS Borders was given £231,000 to buy in services from private firm Medinet, as well as £350,000 to send patients to an independent hospital in Newcastle.

 

"The biggest waiting list for elective surgery in a generation"

The Scottish Government has told healthandcare.scot that no decision has been taken on whether private sector outsourcing will be restarted after it was paused due to covid-19.

But experts say the backlog of cases that has built up over the last few months because of the pandemic may leave ministers with little choice.

Mark Dayan, of the Nuffield Trust health think-tank, says he expects the government will have to restart the programme:

“If you want to maintain and improve the amount of activity, it’s hard to see how you could not contract with the private sector to some extent, given that is something that had been happening in the past.

“With coronavirus and its after-effects in terms of NHS productivity, that may mean it’s certainly not a good time to move away from using private providers if you want to keep waiting lists under control at all.”

Professor Michael Griffin OBE, President of the Royal College of Surgeons of Edinburgh, warns the NHS is facing unprecedented pressure.  

“We’re going to be facing the biggest waiting list for elective surgery in a generation, so as healthcare professionals, it’s vital that we adapt our ways of working going forward in order to tackle this,” he said.

“One of the ways this can be done is by negotiating with the private sector, in order to allow NHS staff to utilise their facilities over the next year at least, in order to increase the number of operations that can take place.

“I’m aware that this is already happening in certain areas, but further negotiations are required to enable this to continue in the longer term. It is likely to take some years to recover completely.”

Of the cash allocated in letters seen by healthandcare.scot, £10.7m is for sending patients to independent hospitals, known as outsourcing, mostly for orthopaedic operations, as part of a programme overseen by the NHS National Waiting Times Centre at the Golden Jubilee hospital.

The remaining £7.6m is for getting private companies in to do a range of procedures in NHS facilities, referred to as insourcing.

The Nuffield Trust’s Mark Dayan says there has “long been private provision” in the Scottish NHS, though the figures involved have been a lot smaller than elsewhere in the UK.

He adds the question of the private sector’s impact on the health service in England is “still very debated”.

 

"Not good for the taxpayer"

Tom Waterson, chair of Unison Scotland’s health committee, told healthandcare.scot the figures “blow apart the Scottish Government’s claim that they have ceased privatisation within NHS Scotland.”

“The continued use of these private companies is not good for the taxpayer or indeed patients,” he said.

“Scotland’s population would be better served by more localised services provided by in-house staff using in-house facilities and ensuring we fully utilise NHS capacity.

“The Scottish Government need to be more open with the public about the use and indeed the cost of using the private sector.”

Alison Smith, chair of the Independent Healthcare Providers Network Scotland, says the sector is “committed” to supporting the NHS response to rising waiting times:

“With a significant backlog of cancelled and delayed operations expected as a result of the pandemic, the sector is committed to supporting the NHS for as long as needed and look forward to working with colleagues in the Scottish Government to ensure patients can access the care they need.”

The Scottish Government announced last week that some NHS services would begin staggered restarts from the end of June.

In a statement, the government pointed to investment in NHS facilities for planned and elective treatment, including a £15m expansion of the ophthalmology unit at the Golden Jubilee Hospital in Glasgow and the £36m North of Scotland Elective Centre.

A spokesperson said: “While this NHS capacity is being increased, we have said that we will pursue use of the independent sector in a structured and prioritised manner.”

 

 

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