What government healthcare reforms are likely to mean for the private sector

The private sector generally is a ‘very small part of the healthcare economy in the UK and is dominated by five key players’, Jill Watts told Care Conversation delegates. The private market had been ‘steady and flat’ for a long time, she told the seminar, but the previous government’s reforms had opened up opportunities in the NHS market. ‘That has been our focus over the last three years,’ she said

Ramsay Health Care was a private hospital operator located on three continents, with 38 facilities – primarily private acute care hospitals – in the UK. The reality was that most private operators now took NHS patients, she said, with the private sector carrying out almost half of all hip and knee replacements. Recommendation levels were ‘incredibly high’, she stressed.

Last year the private sector commissioned some independent research on perceptions of private hospitals, they surveyed over 1000 voters she told the event. ‘What’s interesting is that while voters view the NHS as a UK icon, they like it for its universality rather than for its outcomes.’ The research had found perceptions of private hospitals to be very positive, she said, with 45 per cent of respondents saying they would take out private health insurance if it were affordable. ‘So, while there’s a view that the NHS is untouchable, it’s not quite as straightforward as that.’

The ‘whole state of play’ was now shifting with the coalition government’s healthcare reforms, she said, but changing a system as large and monolithic as the NHS would not be easy, and there was a good deal of resistance within the system. In order to become involved in the ‘any willing provider’ model, for example, private providers had to sign up with every individual PCT, each with its own process. ‘It’s like going through a mammoth, burdensome procurement process to continue to do what we’re already doing.’ The end result was a reduction in the amount of work going to the private sector, which was ‘not in line with any kind of government policy’, she said.

This had more to do with behaviour in the field, however, than with the view of the Department of Health, she stressed. There was resistance to competition from PCTs and Trusts, who were themselves trying to cope with budgetary pressures. ‘I believe there’s a real lack of understanding about what the rules and regulations are, but we all need to be moving in the same direction.’

The other major shift was from hospital to community care, she told delegates, and this meant a large number of new providers entering the market. ‘The questions are around the procedures that can be done safely in the community. It doesn’t matter where services are delivered, what matters is quality of service, and we are getting to see a lot of people dabbling in procedures – doing a little bit of a lot of things, and not doing it well.’ The regulatory system would need to robustly address this, she stressed.

The biggest challenge to her organisation, however, was the size of the sector. ‘We’re trying to move towards this pluralistic marketplace, but private providers have a very small voice at the moment’, she said, with the ‘level playing field’ likely to remain an issue for many years in terms of access to patients and facilities.

‘The private sector has a lot of quality outcomes that we should be able to go out and promote,’ she told the seminar. ‘It’s about getting the right information out so that people can make informed decisions, while being careful not to send out bad messages about the NHS. You need good information in a form the public can understand, but you always have to be conscious about how it’s presented, because things can get manipulated. I’m a great believer that the system should be geared towards allowing the patient to make decisions, rather than protecting the provider.’

Fear of change within the NHS was a barrier to closer working between the two sectors, she said, which would need to be overcome for the good of both. ‘It’s a difficult time and it’s only going to get worse in the coming year. The reality is there’s going to be significant turmoil, but I’m optimistic – without some chaos in the system we’re not going to be able to shape it into something more sustainable and affordable. We’ll see new players come and go, and more consolidation as there are lot of smaller operators out there. But health is a growing industry, and demand is only going to go one way.