Private hospitals have no doctors

Colin Leys | June 1, 2021 | Blog, Featured

Photo of a person in scrubs slumped down at the end of an empty hospital corridor - licensed under Creative Commons

The idea that the private sector is helping the NHS to deal with the aftermath of the COVID pandemic is a myth

Over the past year a number of multi-billion pound contracts have been struck with the private hospital sector to provide services to NHS patients. Those involved in promoting these deals speak of the private sector ‘helping’ the NHS with ‘extra capacity’ to clear the huge post-Covid backlog of patients waiting for treatment. But this language – which is repeated across the media – conceals a crucial fact: the private hospitals can only do this work by using NHS consultants. They themselves have no doctors.

To treat patients at all, the great majority of private hospitals rely entirely on NHS staff working outside their NHS hours on a self-employed basis. In fact, the business model of almost all private hospitals in the UK depends on not having to employ surgeons or other clinicians themselves, a strategy which allows them to keep their labour costs low and their operating profit margins high.

Not only do private healthcare providers not have to pay the salaries of the NHS surgeons, anaesthetists and other clinicians who work in them, or provide for their training or assessment, or pay into their pension funds, or cover their insurance; they don’t even need to pay them per operation. In the case of private patients that cost is met by the patient, or the patient’s insurance company, and in the case of NHS patients, by the NHS.

Private providers don’t even employ the ‘Resident Medical Officers’ who look after patients when they are recovering from operations. These junior doctors, typically from abroad, are most often ‘agency’ staff, employed on short term contracts by recruiting agencies. The only staff directly employed by a typical private hospital are theatre and ward nurses and management and support staff.

So when the private hospital sector is said to be ‘helping’ the NHS by carrying out additional healthcare services, it is actually the other way round: the NHS is helping private hospitals. In effect, the NHS is paying private hospitals for the use of otherwise empty beds by NHS patients and paying NHS doctors to treat them, rather than pay the same doctors to do the work in NHS facilities.

The falsity of the ‘helping the NHS’ narrative is only too clear when we look at last year’s deal with the private sector. Under that deal the NHS paid £400m a month for the private sector’s entire capacity, covering not only its running costs, but also all the interest payments on its debt, saving some companies from a serious risk of failure after Covid wiped out demand from private patients.

But two-thirds of the private hospitals’ capacity remained unused – a key reason being that many consultants, like other NHS staff, were redeployed to cope with Covid patients, and so were not available to work in the private hospitals. The key resource is not hospitals, but consultants: and of these the private sector has none.

But is there nonetheless a legitimate reason for the NHS to have made a new deal with the private hospital sector? This time the deal is on a payment-per-case basis, not the wholesale purchase of all the private sector’s capacity; but it still means that NHS consultants will be treating NHS patients using private facilities and staff. NHS funds will be boosting the profits of private hospital companies instead of increasing the staff and facilities of the NHS. What is the logic of this? Why not spend the money on more NHS facilities and staff, rather than on private facilities and staff?

It will be argued that there is an urgent post-pandemic need and that expanding NHS staff and facilities would take too long. This would be persuasive if there was a clear long-run plan and intention to expand NHS facilities and staff – but no such plan exists.

Instead, the private sector expects the NHS’s lack of adequate funding to be permanent and to steadily drive more and more people to ‘go private’ – so much so, in fact, that not all of the private hospital companies are keen on the new deal and some are demanding more money if they do, since private patient demand is picking up again and private patients are much more profitable.

The reality is that instead of the private sector stepping in to lend the NHS a hand, this is a further lifeline extended to the private healthcare industry by providing a steady income stream via the NHS. This is simply the continuation of the trend of the NHS propping up the private healthcare industry, at the cost of long-term investment in core public services.

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About the author

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Colin Leys

Colin is an emeritus professor at Queen’s University, Canada, and an honorary professor at Goldsmiths, University of London. Since 2000 he has written extensively on health policy. He is co-author with Stewart Player of Confuse and Conceal: the NHS and Independent Sector Treatment Centres.See all posts by Colin Leys