Supplement: Enhancing the independent sector's role can ease pressure

Few would deny that last winter was one of the toughest the NHS has been through, with warnings of more problems to come.

Lengthening waiting times, delayed discharge and well documented failures to meet accident and emergency targets added up to headaches for providers and commissioners alike – not to mention for the patient whose operation has been cancelled.

So perhaps that is why the NHS is increasingly working in partnership with the independent sector, in new and innovative ways.

The scale of the current challenge is not in doubt: in March, the Nuffield Trust published a report showing “marked deterioration” in NHS performance against a key set of measures, including waiting times for elective treatment and for diagnostics.

‘Problems in areas like access to planned treatment is a real concern’

Unusually, this decline has been seen not just in the worst performing, but pretty much across the board.

At the time, Holly Dorning, co-author of the report, said that worsening access to services was starting to affect patients attending even the best performing hospitals. “We’ve known that hospitals have been struggling to meet the four hour A&E target for a while,” she says.

“But the fact that we are starting to see problems in other areas, like access to planned treatment, is a real concern.”

Enter independent sector

So what can be done? Traditionally, the independent sector has been seen as a valuable resource for the NHS, particularly in high throughput areas like hip and knee replacements.

But according to David Hare, chief executive of the NHS Partners Network, which represents independent providers of NHS clinical services, this is being extended to other areas, including high acuity and care at home.

“The beauty of the independent sector is its sheer diversity,” he says. “The NHS benefits from the capital investment made by independent providers, patients have lower waiting times, and we know from the [patient reported outcome measures] data that outcomes are good: there are low infection rates and low cancellation rates.”

‘Patients have lower waiting times and outcomes are good’

He points out that rising numbers of patients are choosing independent providers for their NHS treatment; solid benefits include shorter waiting times.

Use of the independent sector by the NHS remains relatively small. Figures quoted by the Department of Health in March suggest that it is about 6 per cent of the total NHS budget, up 1.7 per cent since May 2010.

Both commissioners and providers are, however, turning to the sector to help them in times of need – making use of extra capacity on a flexible basis.

For example, BMI Healthcare’s London Independent Hospital has been making its six bed intensive care unit and state of the art cath lab available to NHS customers, helping them to meet waiting list targets while ensuring high quality care.

One customer is Plymouth University Hospitals Trust, which is sending patients to the hospital for cardiac surgery – performed by the trust’s own surgeons, which contributes to continuity of care. According to Ruth Hoadley, executive director of BMI Healthcare, patient feedback so far has been extremely positive.

“We were approached by Plymouth because they wanted to ensure that patients were treated in a timely manner, but also because they knew that we had good staff, and great facilities,” she says. “So far it’s going very well.

“We’re doing cardiac surgery here anyway, so we have the processes in place and the quality of care and outcomes are excellent.

‘These arrangements really benefit the NHS as it’s more cost effective’

“Patients seem to appreciate the care they get from being in a smaller hospital, and also appreciate the personal communication that they have with staff, even before they get here.”

The majority of procedures are valve replacements and coronary artery bypass grafts, and patients tend to spend 5-8 days in hospital. The major difference from having the surgery nearer to home is that they are admitted the night before to take account of travelling.

“These arrangements really benefit the NHS because they can use our facilities – it’s more cost effective for them than building a whole new unit,” says Ms Hoadley. “And it also benefits us: we have excellent intensive therapy unit staff and intensivists and where we have spare capacity we want it to be used.”

Enhancing patient experience

Most importantly, says Annie Ollivierre-Smith, cath lab manager and a former nurse of the year award winner, the patients get a great experience with excellent outcomes. “We pay particular attention to communication, both with patients and with specialists in Plymouth, and make every effort to ensure the smoothest journey possible for all cardiac patients,” she says.

The relationship between the Plymouth surgeons and BMI Healthcare has been helpful in setting up the arrangement, adds Ms Hoadley.

This is something that rings true for Mr Hare. “Relationships are critical - both the relationship with the patient, and with the commissioner,” he says. “It’s also important to work collaboratively with other providers in a locality. Of course there are challenges – for example, there’s a way to go until the patient record transfers seamlessly.”

What to look for

So what should commissioners look for in an independent provider?

“It’s important for any patient considering using the private sector to look at things like waiting times and Care Quality Commission reports so that they can feel confident in the provider they choose. It’s the same for commissioners, who also want to feel confident that they are making the right decisions.”

Mr Hare points to other trends, including increasing involvement of the independent sector in out of hospital care, such as critical care in people’s own homes. “We expect to see continued growth across both [acute and community] sectors,” he says.

‘It is important that patients do not experience any fragmentation of care’

“Of course the NHS Five Year Forward View calls for more care closer to home. That’s the direction of travel, but there’s still a lot of pressure on acute provision. All providers – independent and public – will have to look at the services they deliver.”

Meanwhile, new relationships and ways of working are helping to take the strain off the NHS. “I think that what we’re seeing is a gradual broadening out from routine [elective] surgery to areas like high acuity,” he says, adding that it is important to ensure that patients do not experience any fragmentation of care if they are moving between different providers.

“Patients don’t have one interaction. You have to do things that benefit the whole person, and make sure people feel supported all the way. I’m very optimistic about the future; the independent sector has long helped the NHS to respond to challenges and will continue to do so.”