Private sector ‘pushing back’ on NHS request to take more patients, says top trust

Manchester University Foundation Trust, one of the largest NHS providers, has reported difficulties in accessing capacity at its local Spire, BMI and Ramsay hospitals this month.

It comes as the NHS is facing “unthinkable” pressures from coronavirus patients, with dozens of hospitals on the brink of being overwhelmed.

Throughout most of 2020, the bulk of private providers in England were on a national block contract whereby the NHS could use as much capacity as it needed.

But a new contract, agreed with oversight from the Treasury last month, is now in place between January and April, and only offers trusts a minimum volume of activity which equates to activity provided in October and November.

Pressures on the NHS have since intensified to unprecedented levels, with many areas now in far greater need of the private capacity than they were two months ago.

And there appears to be a misunderstanding or lack of clarity in some areas about the extent to which they can now call on private capacity.

A report to the MUFT board yesterday, from chief operating officer Julia Bridgewater, said their “local interpretation” of the new contract was “not supported” in meetings with their independent sector providers. She said some of the providers were “pushing back on services they can provide from January and the volume of activity available to NHS trusts”.

The report added: “In addition, they have requested that management of lists and scheduling is delivered and managed by them rather than a continuation of the current model whereby [MUFT] support the management of this with the IS teams.

“Clarity is being sought with the national and regional teams, however this is still ongoing. Contingency plans are in development and discussion is ongoing with IS providers.”

Asked about its contingency plans, MUFT said in a statement it was continuing to “work constructively” with the independent hospitals.

It is understood there are “surge” arrangements within the new national contract which can only be triggered by NHS England nationally, although it is unclear what this involves or if they have been triggered.

HSJ asked NHSE about this, and why the new contract did not offer as much capacity as the NHS had access to in the spring, when the pressures now are far higher.

A spokeswoman said: “The most recent agreement with the sector is not comparable to the one made in March 2020, with more flexibility built in so that providers can adapt to the growing need.”

Low utilisation rates of the block booked capacity over the summer, as revealed by HSJ, were likely to have been one factor in the changes to the contract.

A senior source in the private hospital sector told HSJ: “The new arrangement was only set quite late in the day and a number of NHS systems persisted with the thought that they had access to 100 per cent of private capacity if they wanted it. There’s been some back and forth in some places about that and some misunderstanding.”

David Hare, chief executive of the Independent Healthcare Providers Network, said: “At the end of last year, NHS England contracted with 14 independent sector providers to deliver ongoing support for the NHS from January until March this year through activity-based arrangements.

“This represents a change from the previous ‘at cost’ capacity-based contracts which ended on 31 December and local systems needed to adjust to the new ways of working.

“Any local mobilisation issues have largely now been settled with NHS and independent providers working well together to deliver vital treatment to NHS patients.”

There have also been issues in London where NHS leaders, according to senior sources, have been seeking to “shame” private providers and their staff into helping the NHS.