Private hospitals massively underused in many areas of the UK during the pandemic

Private hospitals were paid around £2bn to help the NHS during the first year of the covid pandemic. But an investigation by The BMJ has found that just 30 of the 200 private hospitals were used to treat patients with covid-19 in April 2020 when the first pandemic wave hit its peak.

While there is no suggestion the hospitals breached their contracts by treating so few patients with covid-19, investigations reporter Esther Oxford shows that the private sector was massively underused in many areas of the UK during the pandemic.

In light of the findings, experts are now questioning why NHS England bought up hospital capacity rather than paying for activity that was delivered.

In a "major deal" announced on 21 March 2020, NHS England bought the entire capacity of 200 private hospitals, including 8000 private beds, 1200 ventilators, 700 doctors and 10,000 nurses, to help the NHS care for patients with covid-19, with cancer, or needing urgent operations.

Yet, between 30 March 2020 and 30 April 2020, only 0.62% of the private sector's contracted beds were used to treat patients with covid-19.

By 12 April 2020, when the number of patients with covid-19 in England's hospitals had hit its peak, NHS hospitals in England were treating 18,921 inpatients with covid-19, 2881 of them on mechanical ventilation. On the same day, only 52 were being treated in private sector hospitals under the national contract, The BMJ has found.

The Independent Healthcare Providers Network (IHPN), which represents private hospitals, said that private hospitals "did not neglect to treat covid patients": that treating patients with covid-19 was never the priority in the contract and was a last resort if the NHS was overwhelmed.

In May 2020, the private sector was advised to shift its focus to tackling non-urgent (elective) care that had been put on hold by NHS trusts swamped by patients with covid-19.

Yet data show that, together, Nuffield, Circle, Ramsay and Spire's 143 private hospitals delivered just 51% of their total episodes of inpatient care to NHS patients in the first year of the pandemic.

For instance, Nuffield devoted 64% of its episodes of inpatient care across its 29 contracted hospitals to private patients rather than NHS patients in the first year of the pandemic (1 April 2020 to 31 March 2021), despite NHS England paying the hospitals' expenses, while Spire devoted 62% of its episodes of inpatient care across 36 of its private hospitals to private patients.

Meanwhile, 44% of episodes of inpatient care at Circle's 47 private hospitals were private patients; at Ramsay's 31 hospitals nearly 27% of episodes of inpatient care were private.

IHPN said that the contract with NHS England paid for independent hospitals' capacity, staff and equipment rather than specific levels of activity and that the hospitals were always available to treat NHS patients. IHPN said that private work was only carried out when facilities were not required by the NHS, as was permitted in the contract. Focusing on inpatient care does not reflect the broad range of services delivered by the private sector during the first year of the pandemic, a spokesperson added.

But in November 2022 NHS England finally released a breakdown of the data showing how much NHS work the private sector actually did during the first year of the pandemic. It  suggests that while the sector carried out millions of diagnostic and outpatient activities, some of London's most prestigious independent hospitals treated few NHS patients, despite crisis level NHS waiting lists.

BUPA's Cromwell Hospital in London, for example, provided just 1588 NHS inpatient, outpatient and day case activities, and 1173 diagnostic activities between 29 March and 13 September 2020, despite having 137 beds. And yet it managed to carry out 7550 episodes of care for private inpatients between 1 April 2020 and 31 March 2021, according to data from the Private Healthcare Information Network. The government's contract with BUPA Cromwell Hospital was worth £27.5m.

When it came to cancer, only seven of the 27 private hospital businesses signed up to the national contract treated NHS patients with chemotherapy or radiotherapy between 22 March 2020 and the week ending the 4 April 2021, including Circle and Spire, which completed 16,253 and 24,075 activities, respectively.

IHPN said that additional cancer care was carried out by NHS teams in private hospitals, and this is not captured in this data.

An NHS England spokesperson said that The BMJ's analysis "does not reflect the flexibility of the arrangements, including activity that NHS providers were able to deliver themselves based in independent facilities, or capture that staff and equipment were also available for the NHS to use in their own facilities."

Nevertheless, Allyson Pollock, clinical professor of public health at Newcastle University, says that the National Audit Office or Public Accounts Committee should conduct a detailed and urgent inquiry into the private sector contracts. "The lack of transparency and accountability for public funding in the national contract is quite shocking," she said.

However, the prime minister Rishi Sunak and shadow secretary of state for health and social care Wes Streeting are holding discussions with the private sector about how it might continue to help reduce NHS waiting times as part of a recovery plan to tackle waiting lists.