Guardian comment: The NHS should use private sector beds

Leader
Guardian

Wednesday November 1, 2000

Does it make sense for the health service to use spare capacity in the private sector? Of course. Only the ideologically obtuse would ignore the under-used capacity in the private sector, where bed occupancy is barely 50%, while NHS facilities are overstretched. This would be true at any time in the year, but is even more relevant now as winter approaches and the pressure on the NHS intensifies. So there is nothing wrong in principle with the "concordat" which the health secretary Alan Milburn signed with the private sector yesterday, allowing NHS patients to be transferred to private critical beds. This is no new phenomenon. NHS hospitals have been doing deals with private hospitals for years. Last year £1.25bn of NHS spending on hospital and community health services, almost 5% of the total, was spent with private hospitals. This involved 350,000 operations in an NHS performing 6m. The new deal might add a further 100,000.

The health secretary was right to say the problem with the NHS was lack of capacity, not of cash. In the next five years, the NHS will receive its biggest funding increase since it was founded 50 years ago. The aim is to transform the system into a quicker, more responsive, more patient-friendly service. This in turn - particularly the much shorter hospital waiting times - should further reduce demand for private medicine. But not overnight. Hence yesterday's deal. The spare capacity in private hospitals allows local block contracts (say 20 hip replacements by March) to be secured at marginal cost, and that means lower prices. This is good for taxpayers as well as patients. Some deals, where NHS doctors and nurses use the spare private operating theatre, will be even cheaper.

There are three caveats. First, the plan does not have a timespan attached. It should have. If the modernised NHS lives up to its ministerial billing, the private sector should become less important. Yet the agreement suggests it will help "longer term" planning. Second, it makes no mention of private "freeloading" - the fact that all training costs fall on the NHS, and not on private hospitals. This should not be ducked. Third, it fails to clarify what ought to happen when the private sector gets things wrong. At present, uncertainty reigns when because of private hospital failure a patient has to be transferred to an NHS intensive care bed. PPP pays the NHS; Bupa does not. PPP has the right approach.