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Utilising private healthcare as a method to tackle the NHS backlog is “not a panacea” for bringing down waiting lists, according to a new report by The Health Foundation.
This idea has been proposed by both Conservative ministers and the Labour party, and is a key policy of the elective recovery plan.
However, the report states that while the private sector has an important role to play, it is “no substitute” for addressing wider issues such as staff shortages, social care and underfunding.
Do private healthcare providers have adequate capacity to reduce the backlog?
The report’s authors analysed the use of independent sector providers (ISPs) in the delivery of NHS-funded ophthalmic and orthopaedic care, two areas where the independent sector’s share of care has grown most.
There are approximately 630,000 on the waiting list for 630,000 for ophthalmology procedures and 800,000 for orthopaedics, including trauma.
Previous analysis found that the share of NHS-funded operations carried out by ISPs increased every year from the early 2000s up until 2020/21 (when the pandemic struck). However, the number of NHS-funded treatments has only just recovered to pre-pandemic levels, with IPSs carrying out around 9% of ophthalmic and orthopaedic care, up from 7.7% pre-pandemic.
This raises questions about whether the independent sector can provide genuine additional capacity given the finite pool of staff the NHS and independent sector draw on.
Regional and ethnic disparities causing inequalities in healthcare access
The number of ophthalmic care procedures carried out by private providers has grown significantly in recent years, with 38.6% of procedures now carried out by ISPs compared to 23.3% pre-pandemic. Much of this growth comes from cataract procedures, which account for around 60–70% of all inpatient ophthalmic care.
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However, there has been a much smaller increase in the number of orthopaedic procedures being carried out by private providers, with 31.2% of procedures carried out by ISPs in February 2022, compared with 26.8% during the same period pre-pandemic.
This means the number of people receiving private healthcare is relatively high, with four in 10 people receiving private treatment for eye disorders and a third receiving private care for orthopaedic issues, yet the NHS waiting list still stands at 7.2 million.
The report also found that people living in the most deprived areas struggled to access NHS-funded private treatment, with treatment volumes in the most deprived areas 1% lower than before the pandemic, while they were 5% higher in the most affluent areas. The authors say this is likely due to the fact there are more private care providers in the most affluent areas.
There were also ethnic disparities, with white patients consistently more likely to receive private NHS-funded treatment compared to patients from other ethnic groups.
Workforce planning and investment are key to addressing the backlog
Charles Tallack, Director of Data Analytics at the Health Foundation, says the government must now turn its attention to addressing the workforce crisis and providing adequate funding for the NHS and social care.
“Patients are facing unacceptable waits, and the NHS has a huge challenge to increase activity to the levels needed to bring down waiting lists. Our study shows that, while it has an important role to play, the independent sector is not a panacea for bringing down waiting lists, despite it being at the heart of the elective recovery plan.
“To truly increase activity and bring down waiting lists, the government must address the major problems facing the NHS – from the lack of an adequate workforce plan to historic under-investment, as well as pressures in social care,” he said.