The independent may reveal that the NHS England will extend its national contract with private hospitals beyond June and until summer. Health leaders are in talks to find a longer-term agreement that will see private healthcare companies integrated into the NHS like never before and providing up to 2 million NHS procedures a year.
Health Secretary Matt Hancock has made it clear that he expects private hospitals to play a “critical role.”
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The persistent threat from Covid-19 means that hospitals across the country are forced to remove beds and reshape buildings to ensure patient safety when routine services are resumed. But infection precautions mean that only half the normal number of operations per day can be performed.
Experts and hospital leaders have warned that the impact of the coronavirus will lead to longer wait times for treatment, higher costs to the taxpayer, and the need to ration care to an extent normally seen only in countries the poorest.
A hospital chief said, “The outer circle of what we provide will shrink.”
More than a dozen health leaders have unanimously agreed that using the private sector will become the cornerstone of any planned recovery for the NHS and could last for years.
Nigel Edwards, managing director of the Nuffield Trust think tank, said it was likely that the NHS would experience an overall “relative decline” adding: “We are a country with high income standards and high income expectations, but we will be faced with a capacity for something much less than what we were used to. This will create very significant tensions.
“In 18 months people will be looking at the NHS and saying that it is not quite what we expect. “
“There is always pain”
For former police and army reservist Steve Cassidy, the issue of huge wait lists for NHS treatment is very personal.
Steve’s appointment to finalize plans for a hip replacement operation to treat osteoarthritis was canceled in March due to coronavirus.
Now, like millions of people, the 57-year-old man from Poole in Dorset is forced to wait in pain, to lose sleep and to worry about the end of his ordeal. The NHS told him that it could take three to six months before the surgery was restarted.
Steve, who is supported by the charity Versus Arthritis, takes about 16 tablets a day just to ease his constant pain. He said, “It’s like an elephant with a stiletto shoe and standing on my hip. It will only get worse. We have to cut the wait. It’s too painful to live with such a long time. ”
He said The independent: “There is always pain there. The bottom line is that if someone tells you, you have to be like this for the rest of your life, I would say what’s the point. It makes life a total misery. Last week, I was sitting with my wife crying because the pain was so strong. ”
A Midlands orthopedic surgeon said that leaving patients awaiting operations like hip replacements was known to have an impact on their results.
He said that some patients could be left in a situation where their quality of life deteriorates to a “worse than death” position, adding: “If we delay surgery and start from a worse situation, well as patients improve, they don’t improve as much as they would if it had been done earlier. ”
Delaying surgery also means more bone erosion and joint damage – which means more expensive and longer surgeries, he added.
Robert Francis QC, president of Healthwatch England, a statutory patient advocate, said the NHS should include patients like Mr. Cassidy in treatment decisions and planning. He said temporary support should be offered so that patients do not feel “forgotten”.
He said The independent: “As a nation, we are very proud of our health and care services, and we have come to expect high standards as the norm. But the sheer scale of the current backlog presents one of the greatest challenges in the history of the NHS and will no doubt have an impact on people’s experience with care.
“For those who struggle or suffer, longer waiting times cannot be considered inevitable. As a country, we need to explore all of the options for getting lists, including the continuous things that were introduced during the crisis, like a bigger seven-day job and thinking about how we could deploy the extra capacity provided by the hospitals. Longer term Nightingale. “
Up to 10 million people waiting
Since the Covid-19 crisis began, NHS hospitals have treated more than 95,000 patients with the deadly disease, but it has been very expensive. The release of thousands of hospital beds meant that almost all routine or elective surgery, outpatient referrals and referrals were stopped, many of which were for patients who may have cancer and other conditions that may change their condition. life.
It’s only in the past few weeks that health leaders have been given the green light to begin the recovery process, but no one thinks it will be quick.
As the crisis approached, the NHS was already struggling to keep up with the demand for surgery, with a waiting list of more than 4 million people. The goal of treating patients within 18 weeks was reached in March 2016.
About 1.6 million patients are added to the waiting lists every month, which means that an additional 3 million may have been added after April and May. Adding the 10 day lockout in late March and early June, the waiting list could already be 8 million.
As hospitals barely begin to recover, but still at reduced capacity, the waiting list will continue to grow in the coming months and may reach 10 million by fall.
Rob Findlay, director of demand and capacity planning company Gooroo, said he estimated the waiting list by the end of this month – only three months after the NHS had taken action to focus on the Covid-19 epidemic – is estimated to be between 6.2 and 8.4 million.
He said The independent: “It is clearly a very large number. In terms of wait times, it is reasonable to assume during shutdown that wait times increase by one week, every week; at the end of March, the waiting time for British nationals was 92% of the waiting list at 26.5 weeks. ”
He said he would estimate that it could take the NHS three or more years to recover, assuming it could create the additional capacity needed to perform this number of surgeries.
“Over a three-year period, the recovery would continue until 2024. There will also be significant variations in the country and some places will take longer.”
“We can’t run like we did in the past”
Without an effective vaccine or rapid test that works in less than an hour, many hospitals have to reconsider how they deliver health care in a post-Covid world. The threat of spread of the virus in hospitals is not only a theoretical risk.
As early as March, the Sage government committee identified clusters of transmission in hospitals which then worsened in April, according to a meeting report: “Transmission is important in hospitals. This may have masked the decline in cases in the community. ”
Sage was so concerned that local hospitals were becoming hot spots for the virus that he commissioned a study by health leaders and new guidelines to hospitals on infection control, including building design and the need to separate patients, especially for elective surgeries.
Patients about to be operated on are also particularly vulnerable to the virus. A study The Lancet examined 1,128 patients in 24 countries and found that more than half of the patients who underwent Covid-19 infection suffered from pulmonary complications, 38% of whom died later.
Hospital leaders said The independent the risks were serious and the “new standard” for the NHS to ensure patient safety meant removing beds and spending millions on physical construction to create separate areas and buildings without Covid.
A medical director in the north of England said, “We need to have biosecurity on our sites and biosecurity for our patients and therefore there will be a decrease in capacity as we have to have the distance appropriate between beds and zoning in hospitals. This will reduce our capacity. ”
Several hospital chief executives have said they are reducing the number of six-bed bays to four and removing at least one bed from each four-bed berry. The hardest hit were the NHS trusts in older buildings, with narrow corridors and a lack of single rooms to isolate patients.
A hospital chief said, “There is no doubt in anyone’s mind, the current capability will not be able to handle a post-Covid world. We cannot run like we have done in the past. The numbers we are looking at are about 50% theater efficiency, we plan to waste half of our operating time.
“We lose 15 to 20% of our box spring because of Covid-19. Overall, as a trust, we review 60% of our capacity before Covid. ”
Another hospital chief in the Midlands said his hospital created physical barriers between planned surgery areas and emergency rooms, but that meant that only four of eight operating rooms were used.
He added that delays caused by personnel putting on and taking off their protective clothing and additional cleaning would further slow down the work. He said, “This will limit the speed through these four rooms by an additional third, we think. ”
All of this must be done while hospitals try to maintain emergency preparedness for a second wave of the virus, which will result in large numbers of patients requiring intensive care.
Difficult choices ahead
The shrinking beds, surgical capacity and huge additional costs of the coronavirus mean that tough choices will have to be made about what the NHS will be able to offer in the future.
Nigel Edwards of the Nuffield Trust said the UK may have to get used to a standard of health care seen in less wealthy countries.
“If you are a middle-income country, you start to decide who has access and who does not have access to treatment. There will probably be difficult choices to make in terms of prioritization, where our money and resources will go. And it may well be that we need to seriously consider some of the thresholds we use for processing.
“In terms of the real resources coming in, there will be more, but in terms of what we get, I think there will be a significant impact on productivity and a very large backlog. The question will be: how sustainable is it? How will people feel about it? ”
An NHS chief said his region was already looking to move to a set budget for services.
He said, “It means we have a pot of money which is X, we determine what care we can provide is Y and that is what the public will get. You could call it rationing, you could call it a clearer definition of your true capacity, whatever it is, we were mentally starting to adapt to it anyway. ”
He added that he was “very worried” about the public reaction: “We have an obsession in Britain, especially in England, that the district general hospital is the answer to all our ills. People like to complain. But when you try to modify elements of a service, all hell breaks down on you.
“We are talking about longer waiting times for elective procedures and probably explicit rationing of certain jobs. It’ll go down like a rat sandwich. ”
Rising coronavirus treatment costs are also forcing NHS England to review the way it funds the service. Previously, hospitals were paid for their activities, each operation having a monetary value. But during the crisis, hospitals were moved to a block, or defined contract, which will end in July.
With most hospitals unable to provide the same levels of activity, many warn that they will not be financially viable.
It is understood that the NHS England plans to maintain a comprehensive contract approach, while ensuring that hospitals do not lose their grip on cost control. The health service is undergoing a sustained political review after receiving more than £ 20 billion in a five-year plan and billions of capital expenditures. There is nervousness at the NHS and at Whitehall that the NHS has to offer.
The government has repeatedly promised that the NHS will get what it needs to fight the coronavirus, but local hospital officials say less restrictive funding regulations would free up hospitals to better plan services at the regional level.
Critical role of the private sector
All these difficulties indicate a challenge for the health service which should last for years and risks going beyond the existing objectives set for the NHS as part of its long-term plan, which has been rejected as “irrelevant now” by many. high-level hospital sources.
Nigel Edwards said, “You are going down this list and all of these things are pointing in the wrong direction in terms of being able to return to normal anytime in the foreseeable future.
“There will always be a major capacity constraint for the years to come. We will have to increase the level of elective capacity, even to catch up. And I suspect it probably means using the independent sector for at least the rest of this exercise. Otherwise beyond. ”
A central London doctor said plans to “transfer bulk” all diagnoses to the private sector in his hospital, adding, “Colleagues have started to review all the patients we have delayed and try to call those we think are urgent now. We kicked the box on the road, and there is very little you can do. ”
Cliff Shearman, vice president of the Royal College of Surgeons, said there were “a huge number of people waiting” for surgery, adding, “I can’t see us coming back like before. But I wouldn’t say either, because what we were doing before didn’t work very well either. That’s why we had a waiting list.
“The college strongly believes that some form of collaboration with the independent sector is important, as long as standards are met.”
There are more than 270 private sector hospitals in England, providing around 1.5 million NHS operations each year. At the start of the coronavirus epidemic, the NHS block reserved the entire sector for use as peak capacity and for urgent operations that could not be delayed. It is believed that the sector could add nearly 500,000 additional NHS operations per year as health leaders try to stay ahead of the waiting lists.
The move was not only a lifeline for the NHS, but also for the private sector. A surgeon who works privately and in the NHS said The independent: “Without the three-month contract during the crisis, private hospitals would have gone bankrupt because they had no business during the closure.”
He said that part of the reason why there had been so little activity in recent months was due to the low rates the NHS paid compared to normal private practice. He said the increase in private work is now inevitable, adding: “The waiting lists are going to be difficult and they were scary enough. ”
This contract with private hospitals was to end on June 28, but The independent has learned that the NHS England will extend this until July, while continuing discussions with industry on moving to a longer-term volume-based agreement for NHS activity.
This could see the massive use of private hospitals for diagnostic work. And already, some hospitals are talking to private providers to change all of their hip, knee and joint replacement surgeries.
With an almost certain recession, the private sector is as eager as the NHS to sign an agreement with insiders, claiming that it offers a level of security to the industry but also cement its integration with health services.
Earlier this month, Health Secretary Matt Hancock told members of the House: “The backlog has of course built up because we had to protect the NHS in the heat of the crisis. The independent sector has played a vital role in helping us get through the crisis and will play a critical role in the future.
“This has put to bed all the persistent and obsolete arguments regarding a separation between public and private in health care. What matters is the health care people receive. We would not have been able to get through the crisis without the combined teamwork of the public and private sectors. “
However, this increased use of private hospitals could be a rallying call for anti-privatization activists opposed to the use of the private sector.
The hospital heads said The independent there was a risk that these feelings would destabilize local efforts to integrate services at the regional level. Anti-privatization calls may also affect the creation of new regional integrated health care systems which technically do not exist as legal bodies but play an increasingly powerful role in directing local health services.
A hospital chief said, “People who cry out for privatization when NHS commissions block private sector capacity are just silly. This speech must be challenged head on with fairly simple and easy to understand language. ”
David Hare, CEO of the Independent Health Providers Network, which represents private hospitals, said he expected more dependence on the sector to deal with the NHS treatment backlog as estimates from his organization also revealed that waiting lists would reach 10 million people later this year. He said The independent: “We ran the numbers and that’s what we think it would be. We must understand that, behind this terrible crisis, health services will need the public and private sectors to work together. If we don’t, the public will be at a disadvantage.
“Discussions are underway between industry and the NHS England on the future of the use of private hospitals. Arrangements for the next phase are likely to reflect the need to significantly increase capacity for routine activities rather than maintaining buffer capacity. ”
David Rowland of the Center for Health and the Public Interest warned that the NHS had effectively subsidized the private sector to keep hospitals empty during the crisis.
He said, “The potential solution to this is to rent the hospital to the private sector. At the moment, they are paying the operating costs of the hospital. If they use them to reduce wait times, the only way to do it is to transfer a large number of consultants and patients to the private sector and they will pay twice. ”
A spokesperson for NHS England said that the coronavirus had been “a pandemic once in a century,” adding: “Now that the NHS has managed the first wave of this virus, there is clearly important work to be done to help people whose routine elective operation has been postponed, which will imply a permanent increase in staff and bed capacity, as well as a permanent partnership with independent providers. ”
The Ministry of Health and Welfare said, “We have been clear that the NHS will get all the funding it needs to respond to the coronavirus epidemic. On top of that, we are already providing the NHS with a record boost in cash funding of an additional £ 33.9 billion by 2023-24.
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