NHS Manager

Private hospitals profit in crisis

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The NHS has done a deal with private hospitals to use almost all their capacity during the coronavirus epidemic.

Despite NHS England’s claim that there will be no profiteering, it seems likely the taxpayer will be hit for the full cost of all private sector beds used. This means a very expensive bailout for private hospitals whose usual business would otherwise be badly affected by Covid-19.

Private health facilities should belong to the NHS in the first place. Most private hospitals, in my experience, contribute nothing whatsoever to training medical and dental staff or any other essential members of healthcare teams.

Their consultant medical staff are generally not salaried by the private hospital. Instead they either bring private patients with them from the NHS or have private patients allocated to them by the hospital, which pays a fixed fee for the elective—planned, non-urgent—procedure.

Private hospitals contribute nothing to out of hours or emergency care, to treating trauma, acute strokes, heart attacks, pneumonias, psychoses and so on. Private hospitals do not offer emergency diagnostics or emergency in-patient treatment.

Even where a well insured person demands to be taken to a private hospital, the ambulance will always take them to an NHS hospital.

Most private hospitals do not offer critical care. They may have ventilators and high dependency beds, especially so if they offer elective cardiothoracic surgery, but if someone suffers complications and requires critical care then almost universally the patient’s consultant will want them transferred to an NHS critical care bed.

Private hospitals are almost all only in the business of providing elective care. Given the government’s Covid-19 advice and guidance, all elective care should by now be cancelled, so private hospitals shouldn’t currently be earning any money and will have significant spare capacity.

The NHS will most likely use private sector beds for recovery and recuperation and to look after rehab patients (who might not get any rehab). It will try and move so called “bed blockers” from front line hospitals. That is patients awaiting community care assessments, packages of care or placements in rehab, continuing care or nursing home care accommodation.

This will help to reduce pressures when NHS capacity is reached—as was already happening in most hospitals several times a week as evidenced by the long trolley waits in A&E departments for emergency inpatient care.

In other words the private sector will provide care and maintenance for a group of very low-cost patients.

The government has been very coy about the cost per inpatient bed day that they have agreed with the private sector. It will, in all likelihood, match the average cost of an acute NHS hospital inpatient bed day.

But costs in the private sector are far lower than those of the NHS. Private sector hospitals directly employ fewer staff—wages in the private sector are about 20 percent of turnover, in the NHS they are 70 percent.

The private sector specialises in uncomplicated surgical procedures with short recovery periods. It will provide only a staff grade non specialist doctor, no consultant led care, no specialty or sub-specialty care, no diagnostics, no rehab and no out-of-hours specialist care.

If things don’t work out, they will simply call an ambulance and return the patient to the NHS. Anyway, it will probably have recruited its staff from the NHS which trained them.

A small number of private hospitals might agree to take Covid-19 patients, but it is very unlikely that they will take critically ill patients.

Government funding will, I suspect, be used to diagnose and treat urgent but straightforward NHS cases during the crisis, or to catch up with waiting lists after the crisis rather than investing in NHS capacity.

I don’t generally comment about the private health care sector. It is used by the super-rich, people whose employers buy health insurance for staff, rather than pay corporation tax to fund the NHS, and by individuals driven to despair by the failings of a grossly underfunded health service to deliver them the treatment they need.

I have no confidence in private health care management or its standards of care.

It is parasitic on the NHS and should be brought into public ownership now.

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