Written evidence submitted by Nuffield Health (CBP0028)

About Nuffield Health:

• Nuffield Health is the UK’s largest healthcare charity, we invest all our income back into our purpose of building a healthier nation. Our connected health services - hospitals, fitness and wellbeing centres, medical centres, workplace wellbeing facilities, nurseries, and flagship programmes for local communities – make us stand out from other healthcare organisations and support our patients, members and the public whenever they need us, from fitness and wellbeing to treatment and recovery.

• During the Covid-19 pandemic, our 31 hospitals across the UK have cared for over 385,000 NHS patients. This includes Covid-19 positive patients, those needing intensive care or oxygen support, cancer treatment (shielding vulnerable patients from Covid-19), urgent surgery and palliative (end of life) care. During last winter, over 60 Nuffield Health employees were seconded into NHS trusts, including Barts Health NHS Trust, University College London Hospitals NHS Trust, Buckinghamshire Health NHS Trust in intensive care nursing support, COVID-19 vaccination and hospital ward roles.

• Our experts work in collaboration with all parts of the health service to make the nation fitter, healthier and happier. As well as working with the NHS to increase capacity throughout the pandemic, in the last year Nuffield Health developed a free COVID-19 rehabilitation programme. This blends physical and emotional support to help the ever-growing number of people who are experiencing the long-term effects of COVID-19. The programme is now running in 40 locations across the UK with 900 people on the programme and more than 1,600 referrals. We are making it available in all of our 113 fitness and wellbeing centres by the end of the year. We have presented to NICE about our programme outcomes to support them as they update their guidelines for Long-COVID.

Our reason for submitting evidence:

• We are submitting evidence because NHS Trusts are not using the available capacity in the independent sector. Our current NHS volumes are between 60 and 70% of pre-pandemic levels. The next 6 months Indicative Activity Plans through to end March 2022 will be at 100% of pre-pandemic levels. The Independent Sector Provider Network (IHPN) recently made the recommendation for the NHS to consider 175% of pre-pandemic levels so that the independent sector can support NHS trusts with the growing waiting lists.
• Current referrals through the NHS e-referral system are less than 50% of pre-pandemic levels. Approximately, one third of our hospitals don’t have eRS turned on by their local NHS trust. While the intention of trying to focus on long waiters is admirable, by keeping eRS at lower levels or switched off altogether, it will lead to a future bigger waiting list issue in the long run.

• We are seeing significant increases in patients self-referring to see consultants for self-pay consultation and diagnosis, who then try to be referred back into the NHS to try and beat the current hiatus in referrals.

• We would very much like to work with ministers and NHS leaders to help unlock this spare capacity and share our insights of what is happening on the ground and where the capacity of non-NHS providers is being used most effectively. We believe that the health system works best when it works together as one, with all sectors contributing to the response to the backlog and pandemic response. For example, during the Covid-19 pandemic, our Plymouth and Ipswich hospitals had NHS oncology departments transferred into them, incorporating and working alongside local NHS Trust teams. Speaking about the partnership between Nuffield Health Ipswich Hospital and East Suffolk and North Essex NHS Foundation Trust, James Cartlidge, the MP for South Suffolk, said in Parliament: “In January, Ipswich Hospital was able to more than double the number of intensive care unit beds it had available, from 11 to 25, precisely because it moved cancer patients to the Nuffield Health hospital in the independent sector. Does that not show the danger of ideologically ruling out the use of the independent sector, which immediately reduces the capacity of the NHS?”

Supporting the NHS through capacity collaboration:

• We could significantly increase our NHS work for the foreseeable future, given our volume and specialty-based patient first strategy. If we have long term certainty over funding (which we don’t have at the moment), we could increase our capacity by between 50% to 75% to support the NHS. With the security of long-term funding (through to 2024) and longer-term contractual certainty we would increase investment to expand capacity further (temporary theatres, modifications to premises to convert bedrooms and offices into day case units, additional diagnostic expansion and appropriate staff training).

• We strongly recommend NHS trusts utilise Nuffield Health and the wider independent sector to do what we do best, high volume, lower complexity work. This can be achieved by having closer collaboration with NHS trusts to forward plan, have complete visibility on their needs and sharing data more effectively. This happened during the COVID-19 pandemic and this approach allows us to efficiently help higher volumes of patients.

• To stop the waiting lists getting longer NHS trusts should switch on the eRS in every location and encourage referral into the independent sector. If this happens, Nuffield Health and the wider independent sector can manage workflow more effectively, absorb a greater volume and start to give more certainty to patients who are waiting.

• Currently, NHS England has few levers to pull to ensure that local capacity is used in the most efficient way. There needs to be a single co-ordinating and planning hub locally that has accountability for waiting lists, local relationships with the independent, charity and voluntary sectors. This should be part of the governance of the co-ordinating hub with collaboratively set targets, operational approach and sharing of operation data to ensure it is being managed efficiently.  We are not seen as partners or part of the solution and there is limited knowledge in the NHS around how the independent sector works. There is an opportunity to make better use of the wider sector to meet the needs of patients during this exceptionally challenging time. If there was more of a partnership approach and if NHS trusts got the independent sector involved at the early planning stage, we could help to significantly reduce the backlog with extra capacity. We would be very happy to share our insights on operational data sharing as it impacts NHS capacity if this would be helpful.

• More effort must be made to address the staffing and workforce challenges which affect the whole healthcare system – collaborative recruitment, shared staff bank, supporting staff in moving between NHS and non-NHS organisations, co-ordinating human resources to align with physical resources and managing this as a whole system should be the focus. As happens in integrated, open systems like those in Germany, Norway, the Netherlands, and Australia. Discouraging the existing workforce competition between organisations would ensure these resources can be allocated more efficiently and appropriately.

• Finally, it is easy to overlook the role of prevention in reducing demand for NHS services. At Nuffield Health many of our programmes are designed to prevent ill health and reduce demand for NHS services. For example, our COVID-19 rehabilitation programme upskills fitness professionals to deliver a rehabilitation programme that improves outcomes for people experiencing the effects of Long-Covid

The Integrated Care Systems design framework:

• The best examples of integrated care around the world are produced by dynamic, open, systems with independent, charity and voluntary sector representation such as in Germany, Norway, Netherlands and Australia. We are concerned that the latest Integrated Care Systems (ICS) design framework will soften some of the language from the original White Paper which talks of independent sector representation on ICS Partnership Boards.  The inclusion of independent, charity and voluntary sector representatives on ICS Partnership Boards should be a minimum requirement, not an optional one. This allows for more effective collaboration which would improve outcomes for patients and allow NHS trusts the greatest flexibility and opportunity for collaboration with the whole system.

• We believe the current proposals for ICSs have too little consideration for the wider system within which the NHS already operates. Opportunities exist for closer ways of working and care path alignment that works in the interest of patients. Independent and voluntary sector providers should be integrated in all decision-making bodies, especially ICS boards.

Sept 2021