“More independent capacity” was promised by the Prime Minister in his priorities for 2023. It hasn’t happened – but why not?

White paper produced by waiting list expert Dr Rob Findlay, Director of Strategic Solutions, Insource

The promises

“More independent capacity”, was promised by the Prime Minister in his priorities for 2023.

“Increasing use of the independent sector”, pledged NHS England’s National Director of Elective Recovery before Christmas.

“We will also be making greater use of the independent sector”, gushed a previous Health Secretary a year ago.

“The independent sector will reallocate practically its entire national hospital capacity en bloc to the NHS”, trumpeted NHS England at the start of the pandemic.

“In practice, however, it simply hasn’t happened”, groaned the Independent Healthcare Providers Network last summer.

It hasn’t happened – but why not?

The Independent Sector (IS) – which provides NHS healthcare in non-NHS facilities – has plenty of elective capacity. It could turn today’s rapidly lengthening waiting times into a full-blown recovery almost overnight. And yet the NHS persistently fails to make good use of it.

IS providers are much smaller than acute NHS hospitals, and not equipped with the critical care facilities and overnight cover needed to handle complex surgical patients. So, the NHS has to choose straightforward cases for transfer, and only those in services that the local IS hospital provides.

It is also difficult to transfer patients after they have had an outpatient appointment. When a patient has met their surgeon, they are understandably reluctant to transfer to an unfamiliar hospital and be opened up by someone they do not know. So, the best time for IS transfers is before the first outpatient appointment, and ideally at the point of referral.

The snag

But there’s a snag. Hospitals don’t know much about their patients at the point of referral. Their clinical information tends to be confined to a referral letter attachment, which has to be opened and read by a human being. This takes time. And the referral letter only says what the GP chose to say, which is often not enough to tell whether the IS could accept them.

So the IS has grown wearily accustomed to NHS hospitals saying they would like to send lots of work over, and ending up with “dribs and drabs of patients sent across ad hoc”. Then there are onerous reporting requirements, for which NHS hospitals have whole information departments, but IS providers struggle to satisfy.

Data issues

A common thread runs through all of these problems: data! Which is something that Insource can help with.

Hospitals referrals need to contain more and better-structured data from primary care. We can bring that across and unify it.

The IS knows best what kind of referral it can accept, and we saw how difficult and time-consuming it is for NHS staff to triage them manually. Our software can build worklists of suitable patients directly from the NHS waiting list, based on on the relevant primary care information for the purpose of direct patient care, so that the right patients can be passed to the IS for their whole elective pathways.

Getting elective recovery underway – at last

At Insource we even automate reporting, so that nobody at the IS needs to worry about it. More relevant and available data can transform the IS’s relationship with the NHS and get the long-awaited elective recovery underway. And turn successive politicians’ words on the subject into truth at last.

For more information on how other independent providers have optimised NHS workloads see – here