The range of clinical care being put out to tender now covers most of what the NHS provides to patients. Competition rules that went live in 2013 created a step change in private sector involvement. They greatly widened the scope of NHS contracts being advertised. Despite this the NHS still provides most care to its patients but in services like diagnostics, mental health and surgery the NHS is becoming reliant on private provision.
Outsourcing of NHS services to firms and charities is not new as successive governments have shown a willingness to experiment with private sector involvement.
Who wins the contract race? Our research in shows that the private sector wins 43% of the value of all contracts advertised and 70% of the number of contracts put up for tender, although these are predominantly smaller contracts.
Recently discussions around a potential policy change has led to a reduction in larger contracts being advertised over 2018/19, but in the previous year private firms won 13 out 20 of the most lucrative contracts.
NHS England plans to switch funding from hospitals into community based healthcare as part of its new 10 year plan for the NHS.
Outside of hospital NHS organisations provide just over a half of community services, therefore to implement the new vision either mean greater use of non-NHS organisations or require a big expansion of the NHS workforce working in the community.
In most areas private provision is increasing, but the NHS is still the main provider. However the private sector have moved into areas where they can generate a reliable return eg 1 - common surgery such hip operations where private firms now perform a third of these procedures.
eg 2 - Private firms dominate the supply of inpatient mental health and supply 30% of child and adolescent care
eg 3 - Community services the NHS are now heavily reliant on non NHS providers to deliver services. In the last decade many NHS community beds have been closed.
And this raises the questions where is the tipping point, when, like in dentistry or long term care non NHS organisations become dominant?
nationally 6% of NHS by the private sector, this includes a third of all hip operations
LONG TERM CARE
"the vast majority of both home care and residential care in England is now provided by private companies." Around 72% of the adult social care workforce are now employed by the private or voluntary sectors with only 14% still employed by local authorities.
A Health Foundation study found that NHS providers hold over half (53%) of the total annual value of contracts
awarded for community services. Contracts are also provided by organisations including
general practices, local authorities, charities and private companies.
• in their sample private providers held 5% of the total
annual value, but 39% of the total number of contracts issued.
Nationally, just under three fifths (58%) of all respondents stated they had visited an NHS dentist in the last two years. Of the remaining, 10% didn’t try to see an NHS dentist because they stated they “didn’t need to go” or “don’t like going” and 8% didn’t try because they prefer private dentistry.