Could private hospitals help clear Preston and Chorley's NHS waiting list?

The boss of a private hospital in Preston says that independent healthcare providers could make a greater impact in reducing the lengthening waiting list for patients in Central Lancashire - if the government made a long-term commitment to the role of the sector in the NHS’s recovery from the pandemic.
Watch more of our videos on Shots! 
and live on Freeview channel 276
Visit Shots! now

Gwam Rajiah, managing director of the Ribbleton-based Greater Lancashire Hospital, said that his facility is currently working “flat out” undertaking diagnostic tests and surgical procedures for the Royal Preston - but that it faced uncertainty about the work it could expect from the end of March, when the current government contract funding expanded use of private providers comes to an end.

Figures obtained by the Health Service Journal show that a total of 4,825 patients had been waiting over twelve months for treatment at either the Royal Preston or Chorley and South Ribble Hospital at the beginning of January. Pre-pandemic, a year earlier, just one patient had faced such a delay.

Hide Ad
Hide Ad

As the Local Democracy Reporting Service (LDRS) revealed last month, pressure caused by the pandemic has forced Lancashire Teaching Hospitals (LTH), the trust which runs the two facilities, to postpone some non-urgent, pre-planned surgery - and temporarily stop booking any new such appointments.

The number of patients waiting more than a year to start treatment in Central Lancashire is nearing 5,000, because of the pressures caused by the pandemicThe number of patients waiting more than a year to start treatment in Central Lancashire is nearing 5,000, because of the pressures caused by the pandemic
The number of patients waiting more than a year to start treatment in Central Lancashire is nearing 5,000, because of the pressures caused by the pandemic

When the pandemic struck last spring, the independent sector was block-booked by the NHS in England under an "at-cost" deal, giving local hospital trusts access to almost every privately-operated bed and theatre in the country for both Covid and non-Covid care.

That arrangement changed at the turn of the year, when the private capacity open to the NHS was reduced to the level equivalent to that being used back in the autumn, when the system was under less severe pressure. However, 'surge' clauses in the contracts - once again allowing full use of independent facilities - were activated late last month as the service faced being overwhelmed by rocketing Covid admissions.

It is that volatility which Mr. Rajiah says is stymieing a more effective strategy to bring waiting times back under control.

Hide Ad
Hide Ad

“We are doing all kinds at the moment - from pain management and spinal injections, to plastics, vascular and respiratory services. Yet during the first lockdown, [the work] was very flat.

Gwam Rajiah, managing director of Greater Lancashire Hospital in PrestonGwam Rajiah, managing director of Greater Lancashire Hospital in Preston
Gwam Rajiah, managing director of Greater Lancashire Hospital in Preston

“If the NHS has the volume, the private sector can create the capacity. There is a building next door to our hospital that I could take over tomorrow if the government committed to a contract for, say, six to 12 months.

“We have got a good collaboration with the Royal Preston and are removing hundreds of people from their waiting lists - and you have to give the government credit for saying the money is there until the end of next month.

“But, locally, it's not very clear what is going to happen after that,” said Mr. Rajiah, who was general manager for specialist services at LTH before leaving to set up his own healthcare company in 2006.

Hide Ad
Hide Ad

The LDRS that trusts across Lancashire and South Cumbria are currently co-operating over the use of the independent sector for priority cases, in line with patients' post-operative needs.

The region’s integrated care system (ICS) did not put a figure on the level being utilised by the NHS in the area when approached on the subject.

The vast majority of work undertaken by Greater Lancashire Hospital is done on behalf of the NHS - and Gwam Rajiah says that independent providers like his complement each other in terms of what each can offer to the health service.

“We don't provide overnight stays - but others do. And, in fact, we know that the bulk of the work that needs doing is actually day cases.

Hide Ad
Hide Ad

“We can do a huge amount of surgery and some quite complex stuff like lung function tests.

“If the commissioners wanted to have a cohesive strategy about how to deal with these long-waiting patients, there is no reason why we can’t all sit round the table, look at the different groups on the list and split them up - even setting targets for how many need to be cleared by a certain date.”

Mr. Rajiah rejects any claim that the absence of intensive care facilities in private hospitals limits their usefulness to the NHS, stating that many procedures do not require that back-up option.

However, that was exactly the suggestion at a recent governing body meeting of the Greater Preston and Chorley and South Ribble clinical commissioning groups (CCGs), which heard a lack of suitable recovery facilities for patients in need of the most complex surgery could explain why private health providers are not making more of a dent in the waiting list in Central Lancashire.

Hide Ad
Hide Ad

Referring to the national arrangements with the independent sector, the CCGs’ chief officer, Denis Gizzi, said: “It is of concern to me why, with that place, we are still seeing the numbers [of patients] increase month on month.

“I think we have to start asking some questions about when we are going to start seeing a difference to the clearance [rate].”

He added that he had seen no evidence to suggest that private providers were engaged in the “game-playing” of which they were sometimes accused in the 2000s when it was claimed that they were selecting easier-to-treat cases and leaving the most difficult ones to the NHS - but warned of the need to guard against it.

“If an independent surgical unit doesn’t have the clinical support services - like ICU [intensive care unit]-type facilities - that surgical interventions sometimes need, they will quite rightly select the [patients] that are amenable for their facilities.

Hide Ad
Hide Ad

“They can’t accept somebody who has got a higher clinical risk, because if something happens, they won't have the back-up services.

“But saying that, we have to be vigilant, because we have seen some examples in the not-too-distant past where a very marginal clinical risk will be sufficient for the independent sector to say: ‘We’re not doing that [procedure]’,” Mr. Gizzi cautioned.

The meeting also heard that the prioritisation of patients on the waiting list meant that those of the highest clinical risk will be cleared first - with those further down the priority order perhaps more likely to be treated at a non-NHS location.

Governing body members were told that LTH was contacting all patients on its waiting list to advise them what to do if there was any change or deterioration in the symptoms and conditions for which they were awaiting treatment.

Hide Ad
Hide Ad

“We have supported [a national campaign] encouraging people to present to primary care and not sit on symptoms,” explained Jonathan Bridge, the CCGs’ communications manager.

However, he added that there were still examples of hospital clinics where large proportions of patients were not turning up for their appointments.

Meanwhile, Tricia Hamilton, the nursing representative on the governing body, said it was important to communicate effectively with people who had been waiting a long time for treatment, so that they did not feel like “they are just being shunted around a system” - especially if the use of the private sector is not the answer in their particular case.

She cited the experience of a friend who had a telephone consultation with an independent provider ahead of knee replacement surgery - but was then told she did not fit their “criteria” because of the presence of other conditions and so was referred back to her GP.

‘THE WAIT WILL GO ON’

Hide Ad
Hide Ad

A recent meeting of the board of Lancashire Teaching Hospitals NHS Foundation Trust (LTH) heard that the Royal Preston and Chorley and South Ribble Hospital had been “on track” with the national NHS recovery programme for pre-planned surgery in December until a spike in Covid pressures derailed the plan.

“The waiting list...will continue to grow, our 52-week waiters and long-waiters will continue to deteriorate,” said chief operating officer Faith Button.

She added that cancer treatment - which is “protected” and a “continued priority” - has nevertheless faced challenges, as it has across the NHS. In December 2020 - the latest period for which figures are available - 75 percent of people urgently referred to LTH with suspected cancer were seen by a specialist within the 14-day national standard, against a target of 93 percent.

“We are unable at the moment to book those patients in for 14 days, we are booking [at] 21 days. However, it is a one-stop service, so the patients do get their diagnostic [test] at the same time they come in for their appointment, so they’re not coming back in for a further wait,” Ms. Button explained at the meeting earlier this month.

Hide Ad
Hide Ad

The delay had been caused by an increase in referrals coinciding with Covid-related sickness amongst trust staff and those at an independent provider used for cancer patients, the board heard. A recovery plan is now in place.

Separately, Ms. Button said that while priority diagnostic tests of all types had been a focus in recent weeks, routine work had “dip[ped] off plan” and will “take a long time to come back..to the pre-Covid position”.

In December, 42.5 percent of LTH patients waited longer than the national standard of six weeks for a diagnostic test.

The move to postpone some non-urgent elective procedures at LTH came as a result of pressure on critical care capacity last month, with the number of beds in operation reaching the so-called “super, super surge” level - up from 28 to 44. Not all of them were filled with Covid patients and some had been transferred from elsewhere across Lancashire, Cheshire and Merseyside.

Hide Ad
Hide Ad

According to NHS England, 44,085 people were waiting to start treatment at LTH in December - up by just over 9,000 from a year earlier.

A new national framework was published late last year for “validating” waiting lists, which have lengthened across the country as a result of the pandemic.

Hospital trusts are encouraged to maintain good communication with long-waiting patients, check on their condition and “find out what their symptoms and needs are now, rather than at the time their surgery was booked”.

Patients should also be given the option of deferring their treatment if they have concerns over Covid-19.

WHAT THE NHS SAYS

Hide Ad
Hide Ad

NHS England did not comment directly when approached regarding the possibility of any extension to the arrangements with private providers.

It said that over two million consultations, tests, operations and chemotherapy sessions had been carried out for NHS patients by independent hospitals since March 2020, when the original agreement was struck.

NHS England said that, under the terms of the deal, the NHS’s use of the independent hospitals’ resources had been "on an at-cost basis, with no profit being made by the independent providers from NHS work during this time, to ensure maximum value for taxpayers".

In a statement on the subject, issued late last year, Amanda Pritchard, NHS England's chief operating officer, said: “The NHS is working around the clock to tackle the biggest global health threat in a century, and has already provided care to around 200,000 people with coronavirus, while also delivering urgent operations and cancer treatments to non-Covid patients.

Hide Ad
Hide Ad

“During the Covid-19 pandemic, the NHS is continuing to work with partners across the country to expand treatment capacity, but we cannot do this alone and need the public to help by both socially distancing and taking up the opportunity to get a Covid vaccination when invited.”

Comment Guidelines

National World encourages reader discussion on our stories. User feedback, insights and back-and-forth exchanges add a rich layer of context to reporting. Please review our Community Guidelines before commenting.