As I write, we are still waiting for the outcome of some very significant government announcements on the NHS. The Elective Recovery Taskforce met over the winter to shape proposals to reduce waiting lists. Although publication of the full report has been postponed from April until later this summer, there have been some interim announcements.
One of these promoted greater choice for patients and more control over where they receive their care. With waiting lists currently running to 7.4m patients, this will encourage greater choice for patients to attend services that are more convenient and have shorter waiting times.
The Independent Healthcare Providers Network welcomed this announcement, adding that too often patients are unclear that they have the right to choose a healthcare provider to deliver their NHS care, whether an NHS organisation or an independent sector one, free at the point of use.
Continued engagement with the independent sector will persist and, whichever party wins the next election, we are still very likely to have large volumes of care delivered by the independent sector.
On the face of it, it is difficult to argue against supporting services with shorter waiting times delivered by providers who work at NHS tariffs with excellent complication and safety data.
However, the debate is more nuanced. The Royal College of Ophthalmologists Workforce Survey, published in March, 2023, found that 63% of members believe it will take a year to clear the backlog. With almost 50% provision of cataract surgery delivered by the independent sector, members noted the positive impact the independent sector has had in this regard.
Yet the survey also identified some concern that independent sector provision may affect the financial stability of the traditional model of NHS eye services.
The Royal College of Ophthalmologists’ president, Professor Ben Burton, had a chance to lay out his stall for the next three years at the College’s annual congress last month. He stated that the arrival of independent, high-volume day surgery centres using the same workforce as NHS trust eye units reduces the ability to provide more complex care and 24-hour emergency cover. This was outlined in an interview quoted in The Independent in early 2022.
In my view, there are some aspects of ophthalmology that require the services of big hospital systems, such as general anaesthesia and multi-disciplinary teams for complex disease.
These systems need to remain and be properly funded for a comprehensive eye care service. But an ageing population and many years of underinvestment have created huge backlogs in the system. These were evident before the Covid-19 pandemic and have become greater since.
On this point, could the government come to Prof Burton’s rescue? The NHS Long Term Workforce Plan has recently been published. This endorses more apprentice-style training in medical fields and a massive increase in nurse and doctor training places.
This is a welcome move but, even if we provide more people, crumbling hospitals and out-dated equipment indicate a real shortage of infrastructure that is needed for staff to effectively ply their trade. Plus, there is a worrying trend of junior doctors moving abroad and this poses a serious threat for the future.
Surely the arrival of efficient day surgery services to aid the NHS would be a stimulus for traditional NHS units to up their game?
They could compete in terms of waiting times and access to consultant delivered care and there were one or two people at the College meeting who pointed this out. The opportunity is there to create genuine patient choice, which enables them to exercise more control over the care they receive.
Bearing this in mind, there is a third recent government development that might help patients choose their venue for care. Have a look at the NHS My Planned Care platform and app, where real-time waiting data for both out-patients and surgery are presented for individual departments across the NHS trusts and independent sector providers at specialty level.
The app serves as a digital front door to the NHS. It already has over 32m sign ups and receives around 75m visits a month. As patients can manage their hospital referrals through the app, anyone giving patients the information they need to make informed decisions would do well to pay close attention to this data.
From my rapid analysis of NHS units alongside independent sector providers nearby, the independent sector seems to offer care approximately three times faster than the comparable local trust.
- Nigel Kirkpatrick is consultant ophthalmologist and medical director of Newmedica.