Written evidence submitted by Spire Healthcare
Spire Healthcare has a long history of working effectively with the NHS across the UK. We are presently commissioned to provide services from all our hospitals in England, Scotland and Wales.
Spire Healthcare was proud to support the NHS during the peaks of the COVID pandemic, providing treatment and diagnosis for around 356,000 NHS patients whose care would otherwise have been delayed or cancelled.
Since the peaks have subsided, Spire Healthcare has not only returned to our pre-pandemic services but provided care for some of the longest waiting NHS patients. It has also built on relationships established during the pandemic to forge successful commissioning partnerships at a local level in certain places around the country.
However, despite cross-party political will and support from NHS England centrally for the independent sector to be closely involved in tackling waiting lists, Spire Healthcare is being utilised less than it could be, and commissioning is subdued, despite our ability to undertake more work for the NHS.
In order to enable Spire Healthcare and others to play the maximum possible role, we reiterate our call, expressed in our previous submission to the Committee, for contracts of at least 3-5 years, underpinned by ringfenced funding, which include the provision of high acuity care, and reward providers which deliver the highest quality care. This would enable us to plan and to invest to secure the best outcomes for patients.
Our ambition is for a can-do, long-term partnership between the NHS and independent sector, based on mutual trust, and we believe this is the only way to maximise the chances of making significant inroads into clearing the backlog.
- Spire Healthcare is pleased to submit evidence to the Inquiry on managing backlogs and waiting
- Spire Healthcare is the largest independent hospital group by turnover, operating in England, Wales and Scotland. We have 39 hospitals and eight clinics, which encompass five critical care units, 21 cancer centres, 15,100 staff (including over 500 apprentices), and we work in partnership with almost 8,150 consultants. In 2021 we provided care for almost 870,000 patients.
Contract between the NHS and the independent sector during the pandemic
- Between March 2020 and March 2021, Spire Healthcare, together with the rest of the independent sector, made its staff, facilities, services and equipment available to the NHS. During this period, we provided care for NHS patients in our hospitals, who would otherwise have seen their treatment or diagnosis delayed or cancelled, and many were people suffering from critical or even life-threatening conditions.
- Our support continued throughout 2021. Between March 2020 and December 2021, we provided care for around 356,000 NHS patients.
- We outlined some of the detail of our contribution in our submission to the Committee’s previous Inquiry on this subject (see https://committees.parliament.uk/writtenevidence/41419/html/ ). Our support contributed to ensuring that the healthcare system as a whole had sufficient capacity to cope with the surge of patients, helping to keep cancer services going and stopping the waiting list from rising even more than it did. We are very proud of our contribution.
Our contribution since the peaks of the pandemic
- As the peaks of the pandemic have subsided, we have returned to our traditional service provision of elective surgical services working under the Increasing Capacity Framework. We have additionally continued to support the NHS by providing diagnosis and treatment for some of those patients who have been waiting the longest, helping with the near-elimination of 104-week waiters and reduction in 78-week waiters. Orthopaedics has been the area, to date, where we have been able to play the most significant role in helping the NHS.
- We stand ready to do more to support the NHS, should the NHS wish it. We are particularly well-placed to help with a combination of High Volume Low Complexity (HVLC) activity across England and, in a number of locations, complex care for patients, such as those with cancer, cardiac or complex orthopaedic conditions, where our capabilities are strong, compared to others in the sector.
- We also provide support to the NHS and wider sector through our learning and development programmes. We believe our nurse apprenticeship programme is the largest in the sector, with around 200 nurses currently in training. We hope that many of those nurses who graduate from the programme will go onto a career in the NHS, helping, in small part, to address the workforce challenge across healthcare. Our goal is to be a net contributor to the NHS workforce.
High level support for independent sector involvement in cutting backlogs
- There is cross-party political support for the involvement of the independent sector in helping to cut backlogs. In one of his first speeches following his appointment, at the Independent Healthcare Providers Network summit on 1 November, Minister of State Will Quince MP spoke of his enthusiasm for the sector and the breadth of the work it could do. Shadow Secretary of State Wes Streeting MP has said that he would have no hesitation in using the independent sector to help reduce backlogs.
- The desire for the sector to be utilised is also present among NHS England’s leadership; various iterations of their elective recovery plans and letters to system leaders encourage them to optimise the use of the sector.
Areas of success
- The electronic referral system (eRS) is back up and running, following the peaks of the pandemic, and the flow of patients being referred to us through this route is returning to normal, particularly in orthopaedics. We receive around 12,000 referrals and complete around 6,000 procedures for NHS patients per month. To illustrate our impact in total we expect to do over 10,000 hip and knee replacements for NHS-funded patients this year.
- In certain localities, we are being well-utilised by NHS systems. There are many localities where our commissioning relationship with the NHS works well, this includes Blackpool, Bristol, Birmingham, Leicester, Liverpool, Norwich and Washington in the North East.
- We can also respond to local activity challenges:
- In Southampton, we carried out neuro-surgery and general surgery earlier this year for a range of NHS patients when operating theatres were closed for planned maintenance at the local trust. We also provided breast cancer care for NHS patients, at the request of the trust, when there was a surge in breast patients being referred, post pandemic.
- Our Nottingham hospital is also supporting local trusts with complex surgery for stroke preventon and cardiology.
- Spire St Anthony’s Hospital in Sooth London has a progressive long term arrangement to undertake complex heart surgery to support University Hospitals Plymouth NHS Trust.
- However, in contrast to the NAO’s findings about the use of the sector, our experience is that commissioning both through eRS and sub-contracting routes remains subdued and below expectations. With better planning and co-operative work, we could provide significant more support to the NHS than we are at present. Use of the Increasing Capacity Framework, put in place to enable NHS organisations to procure services from independent sector providers by local health systems, primarily acute trusts, has been constrained and consequently not all of our available capacity has been utilised. This appears to be primarily due to funding constraints and conflicts in the incentives given to acute trusts in the 2022/23 contract, but may also be because the new Integrated Care Systems are still getting up and running and working out their priorities.
- In addition, in some areas, local systems are opting to build their own facilities in which to carry out elective care, rather than commission work to the independent sector. There is more scope for co-ordination in regional planning as our existing capacity is available now, whilst new facilities take 1-2 years to come on line. In the end both are almost certainly required to effectively support the backlog of elective care.
An alternative basis for utilising the independent sector
- We would reiterate the points we made in our previous submission to the Committee, that more effective arrangements could be put in place to use the capacity in the independent sector. In summary, what is needed is:
- A long term, 5-10 year overall strategy for clearing the backlog, agreed by all key stakeholders in the sector
- Contracts with the independent sector that are at least 3-5 years in duration. This would provide the platform to enable independent sector providers to invest, plan capacity and recruit to meet workforce requirements
- These contracts should be underpinned by guarantees around the activity levels required from providers or patient volumes, and by funding for the sector which is ringfenced
- They should reward those providers with a strong track record on quality, workforce and environmental matters
- They should include cancer and complex/high acuity care such as cardiac or neurosurgery.
- The right of patients to choose their provider of choice should be publicised widely across society as well as being included as an formal obligation within the contracts
- 7-10 year contracts for capital projects, which would enable independent sector providers to invest in additional capacity.
- Commissioning policy and guidance should be underpinned by incentives that encourage effective use of the independent sector. Our view is that Payment by Results is the best mechanism to ensure that funding follows the patients and supports their choice of provider.
- In order to cement the role that the sector can play, representatives from the sector should be facilitated to sit on and actively participate on Elective Care Boards within each Integrated Care System.
- During the pandemic, we welcomed up to 900 doctors in training who undertook placements in our hospitals. However, after the peaks of the pandemic, the arrangements which enabled this to happen lapsed. We would like to continue to offer placements to junior doctors, and woud like to see a clear strategy underpinned by commitment from the deaneries across the NHS to enable this to happen.
- Spire Healthcare, as a long term partner to the NHS, is keen to play a full role in reducing the backlog. However, our potential contribution is not being maximised.
- During the pandemic, a successful partnership was forged between the NHS and the independent sector. There was a will on both sides, at central and local level, to work together for the benefit of patients in a time of crisis. Funding was provided to ensure outputs could match the opportunity and ambition of both parties. We hope that this spirit can again be harnessed to forge a practical set of arrangements (along the model set out in 16 above) for the sector to help make inroads into the backlog.
- We would be happy to provide further information or discuss our views with the Committee.