One of the scandals of the COVID 19 pandemic which the current public inquiry has yet to explore is the failure by the government to use the private hospital sector to help the NHS and to reduce the growing backlog of elective care for NHS patients.
Nowhere was this failure more obvious than in January 2021 at the peak of the second wave, when London’s NHS hospital services were collapsing under the weight of thousands of new COVID cases.
At this terrifying moment for the capital, the Medical Director of the NHS in London along with the Medical Directors of the major London hospitals issued a public plea to NHS consultants to immediately stop treating fee-paying private patients and to instead focus on seriously ill patients in the NHS.
But the need for senior NHS officials to issue such an extraordinary plea to doctors doing private work appeared to make no sense.
As far as the public had been told, the government had bought up all 8000 beds in the private hospital sector to help the pandemic response and all the resources in the sector had been put at the disposal of the NHS.
Moreover, the consultants who were doing the private work were NHS consultants and so were contractually obliged not to do private work if this caused difficulties for the NHS.
So how did this happen?
We have recently submitted to the COVID 19 Public Inquiry a detailed analysis of the contracts, hospital activity data and financial accounts which seeks to explain this overlooked part of the pandemic response.
In our submission, we set out clear evidence that during the pandemic the government and the leadership of NHS England ensured that the private hospital companies could continue, and indeed expand, their core business of treating fee paying patients enabling them to make large profits.
We have previously shown that the private hospital sector was paid an astonishing £2 billion over the course of one year by the taxpayer to cover its full operating costs so that its facilities and staff could be available to support the NHS and the wider pandemic response.
However, the contracts which NHS England signed with the sector actually limited the amount of capacity in the private sector which was available for the NHS to use, particularly in the London region.
In addition, the contracts also provided incentives for private hospitals to increase the amount of private fee paying patients they treated as the pandemic progressed.
The outcome of this for NHS patients waiting for care was stark.
Rather than private hospital companies choosing to support the NHS as many have claimed, they instead took the opportunity to exploit the backlog of care which had built up as a result of the pandemic.
Take for an example hip replacements or knee surgery two of the most common forms of orthopaedic surgery.
For many years prior to the pandemic the NHS has used the private hospital sector in England to deliver this type of care.
In fact, in the years prior to the pandemic much of the work that the private sector undertook was not on private fee paying patients but on NHS patients.
According to data from the National Joint Registry in 2019 private hospitals were reliant on the NHS for around 60% of its work in these areas.
However, once the government gave the private sector free reign to pursue its own business interests during the pandemic, it turned its face away from supporting the NHS to concentrate on more profitable fee paying patients.
By 2022 year the private hospital sector had increased the number of hip operations it was carrying out by around 14,000 compared to the period prior to the pandemic, in part because elective surgery in NHS hospitals had stopped in many places. But only around 2000 NHS patients benefitted from this increase in work, with the remainder paying privately.
In general, the proportion of NHS hip operations carried out in private hospitals fell from 60% in 2019 to 48% by 2022.
Likewise the percentage of all knee surgeries where patients had to pay increased from 13% to 23%.
It is shocking to think that if you needed of a hip replacement during the pandemic, you’re chances of getting one was highly dependent on whether you had private health insurance or could pay out of your own pocket. Between 2020 and 2022 on average one in four patients were required to pay in order to access treatment.
It is even more shocking because this outcome was not inevitable – the overall capacity to provide hip operations in both the NHS and the private hospital sector actually increased during the pandemic rising from 110,000 in 2019 to 112,000 in 2022.
However, both the private hospital companies and the NHS consultants working in them simply shifted their focus to treating those patients with the ability to pay rather than those funded by the NHS.
Importantly, the approach by the government to boost the private hospital sector during the pandemic has had longer term consequences.
Had all the private hospital capacity been dedicated to treating NHS patients rather than fee paying patients a rough calculation suggests that around 1 million additional NHS patients could have been treated over the period of the pandemic, significantly reducing the currently waiting list backlog.
Some may argue that it would not have been ethically right to prevent patients paying for their care during the pandemic, and even that it would have been wrong to stop consultants earning money through private practice.
But the COVID 19 pandemic was a public health emergency and all healthcare resources should have been dedicated to treating patients on the basis of need rather than ability to pay.
That a two-tier healthcare system has been developing in the UK since the pandemic is a major concern for anyone who cares about the founding principles of the NHS.
That it was allowed during the biggest public health emergency the UK has ever faced is a scandal which the COVID Inquiry urgently needs to get to the bottom of.
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