This analysis presents new evidence charting the impact of government policy on the use of outside providers to deliver and plan NHS care. <full report>
The data has been collected by recording submissions between April 2010 and April 2015, by all NHS Commissioners (CCGs/trusts/NHS/gov), on the official tendering websites (TED and supply2health/Contract Finder). From the subsequent analysis we have identified the services that are being put before the market, the providers that are winning these contracts and crucially how this has changed in recent years.
Summary - NHS Clinical Contract Data (Apr 2013 - 15)
Since the Health and Social Care legislation came into effect in April 2013 the amount of NHS care that is planned and delivered through the market (eg competitive tendering) has multiplied.
In Apr 2014-15, £9.6bn worth of NHS contract awards were made through competition. This figure has risen from £1.2bn in the year before the NHS changes came into effect (Apr 2012-13) and is up from £291m in the year after the last election (April 2010-11).
Overall, since the Health and Social Care legislation (Apr 2013) over £10bnworth of NHS contracts have been awarded through the market. So far £21bn worth of contract opportunities, containing over 1000 contracts to provide and plan NHS care have been advertised.
Awards to the private sector have seen a big expansion since the NHS changes in April 2013
The private sector has won £3.5bn in NHS clinical contracts over the last year, 5 times the amount they won in the first year after the NHS changes (Apr 2013-14). This year's total is also 40% higher than all of the four previous years combined (Apr 2010-14).
Overall 66% of these clinical awards have been won by Non-NHS providers – totaling nearly £4bn in value. Breaking this figure down - £3.5bn was won by the private sector (59% of contracts) and £396m (7% of contracts) by non-profitmaking bodies, including charities.
Virgin Care are one of the big winners - over £1bn of NHS contracts
A number of firms have built up large portfolios of NHS contracts. Virgin is the most successful having been awarded around £1 billion worth of NHS contracts. These range from running individual GP surgeries to managing all the community services in Surrey, a contract worth £450million.
More 'super' NHS contracts are being put before the market
Many more contracts over £100 million are being awarded through the tendering process, 13 this year, more than the previous 4 years added together. Six of the 13 £100 million plus awards were won by the private sector and five by consortia containing both non-NHS and NHS organisations; only two £100 million plus contracts were won by NHS organisations working alone.
The Prime/Lead Provider contract allows a single organisation awarded a contract to then sub-contract any amount of work, without another public tender process. The latest was awarded to Virgin for a £280million contract to co-ordinate care for long term illness and care of the elderly in East Staffordshire.
In February two ground breaking contracts were awarded - a £780 million contract, the largest awarded for the provision of clinical services, was shared by 11 private firms who will provide diagnostic and surgical procedures. In the same month NHS England published a contract award giving an approved list of NHS bodies and private companies the chance to provide NHS commissioning services to CCGs, worth up to £5 billion over the next four years.
A wider range of NHS services are being put before the market
Overall we counted over 80 categories of NHS services covering every aspect of the patient journey, including diagnosis, treatment and ongoing healthcare across every possible setting. In 2012 there were just 40 types of treatment covered by contract notices.
The most frequently advertised types of service since the NHS changes (including Any Qualified Provider scheme) in terms of contract notices are Diagnostics (156 contracts), GP Services/Out-of-hours/111 (99 contracts), Mental Health (78), Community Care (69), Pharmacy (54), Ophthalmology (49), and Ambulance/Patient Transport services (46)
Since 2010 there has been a marked increase in the number of contract awards being made to consortia containing NHS and non-NHS organisations; in the 12 month period April 2014 to April 2015, 15 contracts were awarded to this type of consortia, in contrast in the four year period from April 2010 to April 2014, just 13 contracts were awarded to this type of consortia. The implication is that as the size of the contracts on offer increases so organisations, both NHS and non-NHS, find that they cannot compete for the work as a single entity.