Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the NHS Consultants' Association (PS 17)


  The NHS Consultants' Association is an organisation of more than 600 consultants in clinical and public health medicine. Its role is to support the principles underlying the National Health Service and to comment on proposals for development with the aim of ensuring that the NHS provides the highest quality and most comprehensive care possible for individual patients and the population of the UK as a whole. The NHSCA produces regular reports on aspects of the NHS and provides information for its membership on current issues.


  There are major concerns about the increased involvement of the private sector in capital development and provision of care within the NHS. The NHS needs to increase capacity to provide the quality of care appropriate for the twenty-first century and it is accepted that it might take some years for this to be achieved. During this phase, it seems reasonable to explore short-term options to increase capacity, including the use of spare capacity in the private sector. Information so far suggests that the use of the private sector is almost invariably more expensive than providing services within the NHS. It is also accepted that the private sector may have a small, peripheral involvement in provision of care in the long-term to guarantee that care will be provided. However, the large scale involvement of the private sector in the form of the Private Finance Initiative for capital developments, the concordat with the private sector for provision of care and public/private partnership in both is unproven, is likely to lead to higher expenditure from tax-funded resources than the planned development of NHS facilities.

  Other individuals and organisations can provide better evidence on the economic risks of current proposals and this evidence is intended to give some information on early experiences of clinical staff within the NHS. The evidence will be provided in three sections, as indicated in the invitation for evidence.


    (i)  This involvement is to be planned in three main areas, elective surgical procedures, critical care and long-term and intermediate care for elderly care and other patients.

    (ii)  Elective surgery is one of the safety valves for acute hospitals when capacity is short. If a portion of this is moved to the private sector, then it is unlikely to significantly alter the ability of NHS managers and clinical staff to continue to run their services during times of pressure.

    (iii)  Already, many consultant surgeons and anaesthetists are expecting to be paid enhanced rates if they work within private facilities for NHS patients.

    (iv)  The acknowledged shortages of clinical staff within the NHS can only be worsened if there is increasing activity in the private sector.


    Trust Managers in a west country hospital arranged for a consultant surgeon and a consultant anaesthetist to undertake an NHS list in a private facility eight miles from their base hospital. Other surgeons and anaesthetists were unwilling to undertake this activity unless enhanced payment was available. Due to travelling, etc, the team was only able to undertake half its normal volume of work during the sessions, which had to be arranged some weeks in advance. Whilst working in the private facility, they were not available for the ward and post-operative care of patients in their base hospital, nor for the supervision and training of junior doctors.

    As the lists were planned in advance, it was not possible to predict that beds and theatre time were available or not in the District General Hospital. In fact, they were at the time of lists being undertaken, although other patients were cancelled during the same week because of shortage of beds and/or theatre time.

    (v)  In critical care services, the medical staff caring for patients are also those who provide clinical care for these patients in the NHS. They have to be immediately available and in most areas this would not be possible on two sites. In the majority of private hospitals, especially outside London, Intensive Care Units are unable to provide the same complexity and extent of care as in the NHS and often transfer patients into the local District General Hospital for this sort of care.

    (vi)  For long-term and intermediate care, there are real issues about the quality and quantity of beds available outside NHS facilities. This varies hugely around the country and evidence from the membership of the NHSCA shows that private facilities are often inadequate for patients' needs. Rehabilitation is almost non-existent, as there is no incentive to shorten patients' stay. Although it is proposed that these facilities will have the same degree of inspection as NHS facilities, the mechanism of this is not clear. There are insufficient medical, nursing and rehabilitation staff to provide appropriate care on a multitude of sites.

    (vii)  In all three proposed areas, private companies will wish to charge the full private cost of care, rather than the more appropriate marginal cost, which should be the case if spare capacity is being used.


    Reports from around the country suggest that quoted figures for the use of private intermediate care beds are up to £1,000 per day.


    (i)  The NHSCA has produced a report on its concerns about the Private Finance Initiative (Private Finance in Health Care—Why Not?—enclosed). More recently a report has been produced for Scotland with the support of the NHSCA concerning the proposals for down-sized hospitals—(enclosed). Both of these reports raise major concerns about the future of the NHS and its facilities if this initiative is used as the main source of financing capital development.

    (ii)  Experience so far suggests that estimates of hospital size, including bed numbers, management efficiency, and quality of build requirements are hopelessly inadequate in many PFI developments.

    (iii)  There are already disputes in some PFI hospitals where staff are required to accept worse terms and conditions of service than they have enjoyed within the NHS, despite assurances to the contrary. It is already acknowledged that one of the difficulties in maintaining NHS services is the difficulty in recruitment because of generally low pay rates and poorer terms and conditions of service than for competing employers outside the health service.

    (iv)  The long-term future of the NHS must be threatened if capital assets are given up to private companies.


    In a PFI development in south London, changing a light bulb has been costed at £85 as the work is sub-contracted and costed on an hourly basis.

    In the same unit the change of use of a room had to be negotiated with another Trust and these negotiations could take up to nine months incurring a cost of about £68,000. Facilities in this unit make it very difficult to provide adequate care as they are often of inadequate size to accommodate the staff required.

    One PFI development in the heart of England has increased in cost from £35 million to £44 million since agreement, although work has not yet started.

    Other examples of the inadequate quality and size of PFI developments are regularly reported to the NHSCA, demonstrating that contractors have little understanding of the needs of hospital buildings which will be used 24 hours a day, seven days a week.


    (i)  Both the concordat and PFI represent some aspects of the public/private partnerships proposed.

    (ii)  Other proposals suggest that private management may have skills that can make some parts of the NHS function more efficiently. There is little evidence to support this and the history of private managers working in the NHS since the early 80s suggests that most struggle and fail when faced with the complexities of NHS management. The NHS needs to be managed as a whole locally, with co-operation with social services and other agencies for maximum efficiency and effectiveness. To remove easily managed sections of care from the NHS to private management only makes the NHS more difficult to manage.


  There is no evidence so far that suggests that greater involvement of the private sector in NHS care provides improved quality, greater efficiency, or greater value for money. In the absence of this evidence, further involvement should be viewed as short-term whilst NHS facilities are developed. In the longer term, the future of the National Health Service is threatened if there is a gradual transfer of work into the non-NHS sector, which contradicts much of the Government's NHS Plan, published in July 2000.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 15 May 2002