Private hospitals barely provided beds for Covid patients – but they still brought in millions of dollars in public cash.
John Lister is a journalist and activist against the privatization of the NHS.
NHS waiting lists have reached record levels, reaching nearly five million, while wait times also continue to rise, with more than 436,000 patients waiting over one year for treatment in March, up from 3,097 in March 2020, and up 43% since January.
More than a third of patients wait more than 18 weeks for treatment: the goal of 92% of patients to start treatment with 18 weeks of reference from their general practitioner has not been reached for five years.
So what is the cause, and what is the answer?
Although wait times and the waiting list worsened ahead of Covid, the pandemic has clearly been the key factor in worsening the situation over the past year, forcing trusts to push staff away, resources and elective care beds and forcing infection control measures that reduce capacity, including changes in services to increase the distance between beds.
NHS bed numbers fell by nearly 10,000 in the spring of 2020, when the number of occupied beds fell by 35%, which equates to almost 32,000 beds less used.
While some of the closed beds have now reopened, the latest figures still show nearly 6,000 primary and acute general and acute beds opened in January-March this year compared to 2020, and more than 10,000 fewer occupied.
In other words, the NHS is still operating at reduced capacity, just when it needs a big boost in activity to contain and start rolling back the increased number of treatment waits. But it is also lack of capital investment necessary to reorganize hospitals and regain its lost capacity.
NHS England’s response has been to invest money in contracts to block the reservation of private hospital beds, despite mounting evidence, only a fraction of beds reserved have been used for NHS patients Last year. Worse, the plan for the next four years is to hijack up to Â£ 10 billion NHS budgets by paying up to 90 private clinics and hospitals to treat NHS patients.
This will leave NHS trusts with squeezed budgets, complex staffing issues (with NHS doctors and nurses having to work away from NHS sites) and no money to reopen their own closed and underutilized beds.
There is also no answer: even if ALL 6,500 private beds that the NHS claimed to have booked en bloc last year have been opened, it remains well below the 10,000 NHS beds less used – and in four years the NHS will end up weakened and chronically dependent on private hospitals.
The policy is a boon to private hospitals – but a blow to the NHS hospitals we all depend on. Ministers and NHS England must be called on to change course and invest in our NHS, not in private hospitals.
Bad value of last year’s bulk booking
Spending up to Â£ 2bn of NHS Covid funds on the allegedly stranded reservation of private hospital beds in 2020 has only resulted in seven beds per day for Covid patients, according to research from the Public Interest Health Center (CHPI).
Dr David McCoy of CHPI told the Covid investigation that there were many days during the period when no private hospital beds were in use for Covid patients; more and more days a single bed was used: indeed, at no time of the year, private hospitals treated more than 67 Covid patients in just one day.
This contrasts with claims by the private sector that treated three million NHS patients under the contract with NHS England for the 12 months to March 2021 – allegations that confusingly lump together many activities, most of which do not require beds.
The Network of Independent Health Care Providers (IHPN) boasts of “providing operations, chemotherapy sessions, diagnostic tests and consultations” to NHS patients, including 160,000 “cancer and cardiology treatments”. At the same time, private hospitals, saved financially by block booking from the NHS, increasingly returning to treating large numbers of privately funded patients.
The small number of Covid patients being taken care of by private hospitals is not a big surprise, as they have always been poorly equipped to do so. They are mostly small (212 hospitals with 8,983 beds, with an average of only 42 beds per hospital) and most are exclusively dedicated to simple elective surgery for policyholders of working age or the elderly wealthy enough to pay out of pocket.
Few therefore have an intensive care unit: most rely on NHS resources when things go wrong as well as specialist NHS staff working part-time and per session.
Meanwhile, the right calls for more private “investment”
Amid widespread concern over the growing role of US health insurer Centene in the NHS – buying up profitable GP practices and seeking contracts from Health systems support framework to support back office functions in integrated care systems – the The telegraph of the day plugged in a call from Andrew Haldenby (co-founder of a right-wing “research organization”) for a equivalent of the Marshall plan to save the NHS.
For those unfamiliar with the Marshall Plan (which is a recurring analogy in the Telegraph, whose readership ideas seem locked into World War II and its aftermath), it was a post-war program of American financial aid to rebuild the ravaged economies of Western Europe and thus limit the influence of Stalin and Communism.
Haldenby’s “Marshall Plan” involves the use of US (and Indian) investment to help cut the large and growing NHS waiting list – and appears to reject any increase in UK government spending, arguing: “Such a plan does not need to be based on the extreme spending and tax increases that some are clamoring for.
This kind of statement is both a clear endorsement of private sector solutions over NHS expansion, but also reflects a lingering illusion of the neoliberal right that private money can be used to treat NHS patients without any cost.
It is precisely the same illusion that led Tony Blair’s government to sign contracts to build over 100 hospitals with the disastrously costly Private Funding Initiative, putting the NHS in debt reaching into the 2040s – debts that have to be paid off from NHS revenue budgetsâ¦ and of course ultimately the taxpayer.
In an earlier version of the same article for the Conservative Home website, Haldenby insisted that “the solution does not lie in a ‘bigger’ NHS”, before proposing the construction of at least 42 new units: “high volume centers on the model of the South West London Elective Orthopedic Centerâ¦ knee replacement center in the UK and one of the largest in Europe.
The wheezing is that rather than funding them with public money, âthe NHS should draw on all national and global resources. Some of the centers could be joint ventures with experienced providers such as the Cleveland Clinic and Apollo Healthcare in India. “
To limit NHS spending, Haldenby presents a whole catalog of old and discredited ideas about diverting patients from outpatient hospitals, reducing A&E demand and expanding community services. He claims without evidence that “community services will provide much faster diagnostic scans, often working in partnership with private companies.”
Nowhere does Haldenby address the cost of his proposals, or restoring reduced NHS capacity post-Covid, the huge backlog bill for maintenance that led to the near collapse of NHS hospitals, or how to fill the more than 100,000 NHS vacancies.
But of course his chosen audience or the aging Brexiteer Tories won’t bother him with awkward questions on such matters – as long as he talks about the war.
This article is kindly republished with permission from The truth, the publication of the NHS Support Federation.
Image credit: UMHealthSystem (CC)
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