Written Evidence Submitted by Spire Healthcare

(CLL0026)

Introduction

1. Spire Healthcare is pleased to submit evidence to the Inquiry on Coronavirus: Lessons Learnt.

2. Spire Healthcare is a leading independent hospital group, operating in England, Wales and Scotland. We have 39 hospitals and eight clinics, which encompass five intensive therapy units, 21 Macmillan-accredited cancer sites, over 13,000 staff, and work in partnership with around 7,300 consultants.

Contract between the NHS and the independent sector

3. On 21 March, Spire Healthcare, together with the rest of the independent sector, signed Heads of Terms with NHS England to make its staff, facilities, services and equipment available to the NHS during the pandemic. We receive cost recovery only for our services, and will make a loss on this activity.

4. Similar agreements were signed between the independent sector and NHS Wales on 6 April, and between Spire Healthcare and NHS Scotland on 9 April.

5. On 13 August, a variation to the contract in England was agreed, which guarantees a fixed capacity for NHS and for private activity in each of our 35 hospitals in England. Under the variation, a rebate is applied to the costs for which NHS England reimburses us, which is commensurate with the amount of private care provided. This reduces the amount that NHS England pays us.

6. Since the end of October, a number of our hospitals have received so-called surge notices from NHS England in areas which have seen the greatest increase in cases during the pandemic’s second wave, and the local Trust has consequently had to suspend elective procedures. The notices require our hospitals to return to prioritising all capacity for NHS activity, with private procedures only permitted in any remaining capacity, enabling elective care for NHS patients to continue in those areas.

Support provided by Spire Healthcare

7. Since the start of the contract, Spire Healthcare has cared for around 180,000 patients in its 39 hospitals. These are people who would otherwise have seen their treatment or diagnosis delayed or cancelled, ranging from young children to people aged over 100.

8. On a national level, our support has contributed to ensuring that the healthcare system as a whole has had sufficient capacity to cope with the surge of patients, over the course of the pandemic. On a local level, we have responded to the needs of local healthcare systems in a range of ways, tailored to local circumstances, with the aim of maximising each system’s ability to treat COVID-positive patients and provide care for other patients who need it.

9. In the first few months of the contract, we took on urgent services that would normally be performed within the NHS. This allowed the corresponding local Trust to focus on treating COVID-positive patients. These services included urgent and complex cancer surgery, chemotherapy, cardiac surgery, diagnostics and imaging, and the process usually entailed NHS and Spire Healthcare colleagues working side-by-side to treat patients.

10. In the summer, as the NHS’ focus moved towards reduce waiting lists, the nature of our work changed so that we could best support the NHS in achieving this aim. We ramped up our elective work for NHS patients, including orthopaedic care, general surgery, gynaecological treatment and also stepped up diagnostic activity. 

11. We have been well-utilised and have worked very closely with the NHS to ensure that we are as busy and providing as much care as possible. At a local level, we have been proactive in developing relationships with local trusts and regional leads to ensure that every site is relieving pressure on the NHS as much as possible. Nationally, we have worked closely with NHS England Directors to identify opportunities to increase the level of support provided by Spire hospitals, especially at the start of the contract, which led to increased utilisation in those cases. We have also extended our opening hours to enable us to provide more patient treatment.

12. We have also made our equipment available to NHS trusts. This included supplying over 50 ventilators, each of which is estimated to have saved 20 lives, during the first peak – meaning the potential saving of over 1,000 lives. In the early days of the crisis, we supplied items of personal protective equipment (PPE) to NHS trusts, where our stocks have permitted this. In addition, around 250 colleagues transferred to their local Trust or one of the Nightingale hospitals, including almost the entire nursing department at Spire Clare Park Hospital in Surrey, who moved across to support the team at Frimley Health NHS Foundation Trust.

13. After the initial peak, we were able to relaunch its services for self-paying and insured customers, provided that treating private patients did not conflict with the demands of the NHS. This has made an additional contribution to relieving waiting list pressures in the NHS and also reduced the cost of independent sector provision to the taxpayer, because the NHS receives a rebate on the sum it pays us for every private patient treated. 

Lessons learnt to date

14. Spire Healthcare, and the independent sector more broadly, have played a crucial role in:

• Enabling elective care to continue since the start of the pandemic;
• Enabling cancer surgery and diagnosis to continue during the pandemic;
• Reducing waiting lists significantly below the 10m forecast during the summer;
• Consequently, saving lives.

15. Instrumental in this has been Spire Healthcare’s ability to transform its hospitals into COVID-secure hospitals. This has included:
• Separating those coming in for elective surgery from other patients, by creating so-called “green” and “red” areas of the hospital with separate entrances and treatment areas;
• Requiring those coming in for elective surgery to take a COVID swab test at least 72 hours before admission, test negative and to self-isolate between taking the test and coming in for their procedure;
• Regular testing of staff;
• Temperature testing of anyone coming into the hospital.

16. The relationships forged between Spire Healthcare and NHS leaders, especially at a local level, have been very productive, and in many areas, have been built up where very little relationship previously existed. NHS leaders across the country are cognisant and highly appreciative of the role we have played in enabling them to keep services running during the pandemic.

17. An example of a message received from a Trust Chief Executive is set out below. Others were highlighted in previous evidence from Spire Healthcare to the Health and Social Care Select Committee.[1]

Our mission is to care for our patients, whether they have Covid-19 or other urgent care needs which are unrelated to the pandemic. The support we have received from Spire has been tremendous and we are delighted to be working in partnership to benefit the local community at this difficult time.

Sam Higginson, Chief Executive, Norwich and Norfolk NHS University Hospitals NHS Foundation Trust, Trust / Spire press release, 20 April 2020

Looking forward

18. The capacity provided by Spire Healthcare and the independent sector more broadly, will be key to providing the maximum possible treatment to patients during the current and future surges, to minimising the scale of the long term waiting list and the duration of waiting times, and enabling the healthcare sector to recover more broadly.

19. As well as additional capacity, Spire Healthcare has other key credentials which it can bring to support the NHS in the coming months. These include: its expertise in cancer and high acuity conditions, its digital technology and diagnostic capabilities, and the adaptability of its staff, as demonstrated by their ability to respond so quickly to what was needed at the start of the pandemic and subsequently.

20. However, the benefits that Spire Healthcare, and the sector more widely, can deliver, will only be maximised if they are involved in planning all aspects of the recovery from the outset.

Conclusion

21. The coronavirus pandemic has been the worst public health crisis for many generations and its impact on public health will continue well beyond the current peak subsiding. The partnerships formed between the NHS and the private sector have been extremely productive in ensuring high quality care for patients, relieving pressure within the NHS and providing value for the taxpayer. We hope that the positive relationships that have been built up provide the foundations for further close working in the years to come.

(November 2020)