Private healthcare in the United Kingdom
[1] According to LaingBuisson in 2018, the total private acute healthcare market is worth £1.47 billion (not including consulting or diagnostic work outside hospitals) and 40% of the demand is in London.
[2] The inability of the NHS to meet waiting time targets for planned surgery led to an increase in the numbers paying personally for private operations.
[5] In London there was a 3% decline in revenue for the 25 private hospitals and clinics in 2017, because of fewer clients from the Middle East.
[7] 481 medical consultants, 73% of them NHS employees, owned shares in 34 joint ventures with for-profit healthcare companies in 2020.
[8] The medical consultants who are part of these joint ventures receive a share of the profits of the company as a dividend, giving them a vested interest in the success of the business.
Between December 2020 and November 2021 NHS Trusts in London paid £36.4 million to HCA Healthcare for cancer services.
As of 2019, private expenditure on healthcare consisted of 20.5% of the total spent on health, a minor increase over the past 15 years.
[13] It led to a number of health contracts being awarded to the private sector, increasing competition and diversity amongst providers.
There were at that time 116,564 people aged 65 or over in residential accommodation provided by or on behalf of local authorities, compared with 51,800 patients in NHS hospital departments of geriatric medicine.
In 2021 it was reported that there were about 700 operating theatres in private hospitals, mostly staffed by NHS anaesthetists and surgeons working evenings and weekends.
The Commission was told that the existence of private practice within the NHS facilitated and encouraged abuse, chiefly by patients avoiding waiting lists.
In 1971/2, about 2% of general practitioners’ income was derived from hospital, local authority and non-NHS public sector work, and about 6% from private practice.
[17] When NHS foundation trusts were established, they were required to limit the proportion of their private income to the level it had been in 2006.
The Health and Social Care Act 2012 permitted foundation trusts to raise their private income to 49% of the total.
HCA Healthcare has run a specialist private cancer unit in partnership with The Christie NHS Foundation Trust in Manchester since 2010.
[22] The 1997 Labour Party manifesto made a specific commitment to end the Conservatives’ internal market in health care, but in government they retained the split between purchasers and providers of healthcare.
In 2000 the Labour Government agreed A Concordat with the Private and Voluntary Health Care Provider Sector with the Independent Healthcare Association.
The NHS Plan led to the development of independent sector treatment centres which provide fast, pre-booked surgery and diagnostic tests for NHS funded patients separating scheduled treatment from emergency care.
These centres played a role in reducing the price paid for ‘spot purchases’ with private providers.
Although NHS waiting lists had risen significantly there did not appear to be any concrete plans to employ private providers to reduce it.
[31] Scottish health boards spent £130,866,841 on private providers from 2015 to 2018, about 0.5% of the budget compared to 7.3% in NHS England.
As a result, large numbers of patients are admitted in crisis to private institutions, often in remote locations.
[34] After series of scandals in services run by Cygnet Health Care, NHS England set up an independent oversight board in October 2019 to scrutinise inpatient mental health, learning disabilities and autism services for children and young people and a taskforce to make a rapid set of improvements in care.
[37] It is suggested that surgery in private hospitals may be dangerous because of inadequate equipment, lack of intensive care beds, unsafe staffing arrangements, and poor medical record-keeping.
[39] The Care Quality Commission reported in April 2018 that 30% of the 206 independent acute hospitals required improvement, mostly because of a lack of formalised governance procedures.
