Evidence submitted by the Independent
Healthcare Advisory Services (WP 87)
INDEPENDENT HEALTHCARE
ADVISORY SERVICES
(IHAS)
The IHAS represents independent health care
providers including independent sector treatment centres and other
specialist groups.
The IHAS:
— facilitates effective communication
between all its members, the government and external organisations;
— drives policy advancement through
shared member input and consultation; and
— delivers focused, practical information
and guidance in all areas of regulation and policy, sharing and
distributing knowledge.
The IHAS facilitates an Education and Training
Working Group with the following terms of reference:
1. Progress and monitor the "pledge
of assistance" offered to the Department of Health for the
provision of Clinical (Practice) placements.
2. Share examples of best practice in education
and training within, and for, the independent sector.
3. Take the lead in visioning the future
independent sector workforce and the educational needs which partner
this.
4. Influence members of the healthcare sectors
by using strategies that promote wider involvement in the development
and delivery of healthcare education.
5. Take every opportunity to raise the profile
of the independent sector within the public sector and other professional
organisations.
6. Establish robust working relationships
with learning and professional organisations to facilitate best
practice and equal opportunities.
A separate group was meeting when the Workforce
Development Confederations were first formed with the following
objectives:
1. Share examples of best practice with
regard workforce issues within, and for, the independent sector.
2. Seek to promote wider involvement and
influence by the independent sector within the Workforce Development
Directorates and Strategic Health Authorities.
3. Establish robust communication strategies
within and between the independent sector and the Workforce Development
Directorates.
The independent healthcare sector makes a vital
contribution to the provision and delivery of healthcare in the
UK and to the economy. The independent sector is made up of healthcare
providers and private medical insurers working together. In addition
many patients opt to be treated in the independent sector on a
self-pay basis.
The independent sector works with a wide range
of stakeholders including the NHS and Primary Care Trusts, GPs
and community health, consultants and their professional associations,
regulatory bodies, intermediaries, patients and customers.
INDEPENDENT HEALTH
CARE PROVIDERS
In England alone, independent sector health
care providers:
— Treat nearly one million patients
a year, saving the NHS around £700 million a year. As a result
the Government is now looking to independent hospitals to undertake
up to 15% of elective surgery for the NHS.
— Help reduce waiting lists to roughly
half what they would otherwise be—when the Government announced
a reduction in waiting lists for heart operations recently, 80%
of that was achieved by the independent sector.
— Contribute around £1,550 million
in tax—the equivalent of paying for 82,331 newly qualified
nurses (without London weighting).
PRIVATE MEDICAL
INSURANCE
In addition to the essential contribution of
independent health care providers, private medical insurance,
valued at £2.2 billion per annum, helps to reduce costs and
pressure on the NHS.
— In 2004 private medical insurance
saved businesses 2.5 million working days that would otherwise
have been lost to illness, saving businesses at least £325
million.
— In 2003 medical insurers paid for
over £6.2 million worth of healthcare every day, substantially
reducing pressure on NHS budgets.
The following contains information about some
of the services and facilities provided by providers in the independent
sector. It is based on an audit that was carried out by the Independent
Healthcare Forum (IHF) the predecessor organization to IHAS last
year using data from 2004.
The purpose of this audit was to:
— promote the wide range of procedures
undertaken within the independent sector; and
— make the data collected more accessible
to stakeholders and the general public.
Patient Numbers
In 2004 members of the IHF looked after nearly
700,000 patients on an in-patient/day case basis of which nearly
500,000 underwent an anaesthetic episode. Additionally, nearly
two and a half million patients attended members' facilities on
an out patient basis.
Patient Satisfaction
Over 97% of patients treated by IHF members
in 2004 said they would recommend the hospital or treatment centre
to others, 92% of patients rated the service they received very
highly and more than 90% rated the cleanliness of the facility
as excellent or very good.
Members of the IHF received very few complaints
from patients, in fact the number of complaints made to members
of the IHF in 2004 represented only 0.9% of all inpatient and
day case discharges.
Clinical quality
In his June 2003 report, Making Amends, England's
Chief Medical Officer reported that 10% of hospital in-patient
admissions may result in some kind of adverse event. Members of
the IHF and now IHAS work hard to control against the risk of
adverse clinical events. In 2004 only 0.3% of all patient discharges
from IHF member facilities over the course of the year resulted
in unplanned returns to the operating theatre, and only 0.2% were
transferred to NHS facilities in the area.
Workforce
There is great potential within the UK independent
sector to contribute to the development of effective, skilled
health care workers. The NHS Plan (Department of Health 2000)
acknowledges this by stating that:
"NHS organisations should work closely with
higher education, the independent sector and voluntary healthcare
sectors to plan for expansion in practice placements and relevant
infrastructure to begin to build sufficient placements to deliver
new training commissions set out in the NHS plan".
Delivery of Quality Practice Placements
There is pressure to increase the number of
practice placements in order to support current and future training
needs. However, the independent healthcare sector recognises that
successful placement delivery requires:
— High quality experience available
to students—the standards set by professional and statutory
bodies, together with the requirements of the Quality Assurance
Agency for Higher Education must underpin the experience offered
regardless of location.
— Teachers with close links to both
the academic and practice based elements of education.
— High levels of support from expert
educators, practitioners, managers and front line staff.
— Commitment and expertise from service
providers at all levels.
The willingness of the independent sector to
participate in the delivery of practice placement experience is
not in doubt. The effective utilisation of all potential practice
placements is within the remit of the Workforce Development Directorates
(WDD's) within the Strategic Health Authorities. It is important
that this is not lost within the reorganization of the Strategic
Health Authorities from 28 to 10.
The independent sector provides more health
and social care beds than the NHS and local authorities combined,
so the potential contribution is immense. However, there are constraints
to the effective mobilising of this resource, most of which are
logistical and organisational in nature. Unlike their public sector
counterparts, independent sector providers are seldom locally
grouped. They are often part of corporate bodies spanning areas
covered by two or more directorates. Furthermore, WDD's, not all
of which foster a close relationship with their local independent
sector, may not always be aware of the nature and number of potential
providers.
Because of the lack of a traditional educational
infrastructure within the independent sector clinical credibility
has in the past been adversely affected however, independent hospitals
already undertake significant post-graduate training for nursing
and professions supplementary to medicine. Numerous links with
university nursing departments exist and examples of shared initiatives
can be found throughout the sector. The independent sector is
not only making a contribution to training costs through the provision
of post-graduate courses but is also funding basic training eg
occupational therapists, operating department practitioners. Staff
benefiting from this may well move from the independent sector
to the NHS at some point with transferable skills.
The sector also contributes towards training
eg through no cost placements for students and health care assistants,
through sponsored student bursaries and EN/RGN conversion courses.
In addition it contributes significantly to training NVQ staff
and return to nursing courses.
The sector is retaining registered nurses in
the profession who may otherwise leave the profession totally
and its education and training provision contributes to their
continuing professional development. For example BUPA Hospitals,
through their Clinical Education Manager, have offered a Return
to Practice programmed for nurse returnees since 1988. They have
returned nearly 400 nurses to NHS Trusts, primarily in the West
Yorkshire region. This trend continues with a substantial partnership
through the University of Huddersfield. At least 15 students per
university cohort are returning to the profession. This is currently
to continue through to February 2007.
Role of the Healthcare Commission (HC) with
workforce planning—The HC currently registers and inspects
the following:
— 188 Mental Health Hospitals.
— 260 registered private doctors (mostly
GPs), 300 single speciality services (eg IVF, Dialysis) 1,000
non-clinical services (non-surgical lasers, intensed pulsed light,
type 3 hyperbaric chambers).
— In the future it will regulate approximately
2,500-3,000 new establishments performing non-surgical procedures.
All these organizations will submit their workforce
figures on a yearly basis.
The IHAS strongly recommends that the Health
Committee consider that the Healthcare Commission could through
a service level agreement agreed by providers provide an accurate
picture of the acute healthcare independent sector to the Workforce
Review Team.
WORKFORCE REVIEW
TEAM (WRT)
The WRT has a recommendation in its current
business plan as follows:
Locally and nationally, there is a need to assess
the impact of sharing service delivery with the independent sector
and social care on demand for staff and skills, and to find ways
of sharing plans and workforce information across sectors. The
role of the independent sector in providing training and clinical
placements must be explored further.
This could be fulfilled by taking into consideration
the recommendation under the HC section.
SKILLS FOR
HEALTH
The IHAS and its predecessor organizations have
worked closely with Skills for Health and have ensured that the
development of competency frameworks have independent sector representation
to ensure that their products are appropriate across all healthcare
organizations wherever healthcare is delivered. A best practice
example is the new National minimum standards developed for Long-term
Condition organizations regulated by the HC have utilized the
competences that were piloted successfully in two independent
sector long-term condition organisations. In addition, a representative
of BUPA Hospitals represents the IHAS on the Skills for Health—
Health Awards Strategic Advisory Group. BUPA Hospitals is approved
to offer 11 of the new NVQ Health awards and is only the second
venue to offer the NVQ health award in decontamination. They currently
have 124 registered health award candidates and assessor candidates
across all the disciplines they provide. Candidate registration
is growing at 8-10% per month. The new awards are extremely popular.
NEW ROLES
WITHIN THE
INDEPENDENT SECTOR
The sector through its working groups has taken
forward new roles such as the Advanced Scrub Practitioner, Surgical
Care Practitioner and innovative roles for support workers utilising
the Skills for Health awards.
Higher Surgical Training—IHAS members
are currently working under the chairmanship of Professor John
Lowry CBE to look at innovative models as to how training for
medical staff can be taken forward in the independent sector.
A model that is being considered is that developed for Cosmetic
Surgery Mandatory Training. The paper can be shared by members
of the Health Committee is requested. It is considered that this
model can be translated for other surgical specialities.
CONCLUSION
The recommendation to have a service level agreement
with the Healthcare Commission would give a baseline of the sector's
workforce should be taken forward. The IHAS is about to embark
on a number of workstreams in conjunction with the Chief Nurse/Independent
sector partnership meeting which includes the movement of the
workforce between the sectors which will include "myth busting"
to ensure that it recognized that the independent sector can make
a valuable contribution and should be included in workforce needs
and the planning for the service.
Sally Taber
Independent Healthcare Advisory Services
14 June 2006
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