Experts say independent sector has ‘limited impact’ on clearing NHS backlog

22nd May 2023

Increased use of the independent sector to drive down waiting times is having a ‘limited impact’ on NHS backlogs, a major think tank has said.

A report published by the Health Foundation concluded that greater use of the independent sector providers (ISPs) is ‘no substitute’ for addressing wider issues such as staff shortages, social care and underfunding.

Analysis by the foundation examined the use of ISPs in the delivery of NHS-funded ophthalmic and orthopaedic care – two areas where the independent sector’s share of care has grown most.

But it found in ophthalmology, the NHS was treating patients more quickly than the independent sector in November last year.

By comparison, in 2018, there was almost no difference with approximately 75% of patients waiting for ophthalmic treatments in England being treated within three months by the NHS or an ISP.

Charles Tallack, director of data analytics at the Health Foundation, said: ‘While it has an important role to play, the independent sector is not a panacea for bringing down waiting lists, despite it being at the heart of the elective recovery plan.’

Increasing waiting times

The waiting list for planned hospital care – which stood at 7.21 million in January – has grown by 58% since just before the start of the pandemic. Children waiting for consultant-led care is now at all-time high.

To help expand capacity and address this backlog the NHS has been looking to ISPs to treat more NHS patients.

NHS performance bounced back in 2021 and 2022, but the independent sector has seen that figure drop to below 60% in 2022.

For orthopaedic care, waiting times have increased across both the NHS and ISPs since 2018, though this has been more pronounced for ISPs, resulting in patients facing similar waits regardless of whether they are being treated by the NHS or an ISP.

The report suggests that while ISPs might be supporting activity levels, much like NHS providers, they are struggling to deliver care quickly and are unlikely to help bring down overall waiting lists.

Mr Tallack added: ‘To truly increase activity and bring down waiting lists, the government must address the major problems facing the NHS – from the lack of an adequate workforce plan to historic under-investment, as well as pressures in social care.’

The study also raised questions about inequalities in access to independent-sector-delivered NHS care. In ophthalmology, the analysis found that post-pandemic, overall treatment volumes in the most deprived areas were still 1% lower than before the pandemic, while in the richest areas they were 5% higher.

And in both specialities, white patients were consistently more likely to receive NHS-funded care delivered by the independent sector than patients from other ethnic groups.

A version of this story was originally published by our sister publication Pulse.

Children waiting for consultant-led care at all-time high

15th May 2023

The number of children waiting for NHS hospital appointments has reached an all time high, the latest NHS figures show.

There are currently 403,955 children waiting for consultant-led care, of which 18,000 have been waiting for more than a year for essential treatment, the UK’s Royal College of Paediatrics and Child Health has warned.

The College notes that while there has been considerable progress made in shrinking the adult backlog, the children’s list ‘continues to rise at an unprecedented rate’, with ‘children not being prioritised’.

Long waits for children are of particular concern, given many treatments and interventions must be administered within specific age or developmental stages, a statement from the College said. And the data does not capture the full scale of the problem, it added, with hidden and growing waiting times for community care.

The RCPCH has called on the Government to set aside ringfenced funding for children’s service recovery at all community, elective, and urgent care levels, as well as publishing a fully-costed NHS workforce plan immediately.

‘Stuck in limbo’

The figures come as NHS England said the number of patients waiting more than 18 months fell to just 10,737 by April – down by more than 90% from 124,911 in September 2021 and by more than four-fifths since the start of January when there were 54,882.

RCPCH president Dr Camilla Kingdon said: ‘It is a national scandal that over 400,000 children are stuck in limbo on a list, waiting for treatment.

‘These children could fill Wembley stadium four times over. NHS England has a zero-tolerance policy for 52-week waits, so it is deeply concerning that these targets are being missed.

‘The clear regional variation in size of waiting lists also means that this is an equity issue for children and their families. Child health teams are working tirelessly to address the growing backlogs, but without proper support, their efforts are unable to make a meaningful dent in the problem.’ 

Calls for Government support

RCPCH officer for health services, Dr Ronny Cheung added: ‘It’s clear now that the voices of children are not being heard. It seems that the focus in the lead up to the next election is primarily on voting-aged adult issues.

‘Lengthy waits are unacceptable for any patient but for children and young people the waits can be catastrophic, as many treatments need to be given by a specific age or developmental stage.

‘In recent months we’ve heard about children missing school, quitting sports, and missing out on the important aspects of a healthy, happy childhood. This is not a trivial matter.’

Meanwhile, statistics published by NHS England showed that the overall elective waiting list has grown to a record high, with 7.3 million people now waiting for treatment.

A version of this story was originally published by our sister publication Pulse.