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More NHS patients choose private care

Some 17% of all NHS hernia operations were carried out privately last year

Mark Gould

Monday, 19 November 2012

There has been a significant fall in the proportion of patients being seen in their local NHS trust in the last five years with GPs increasingly referring patients to a wider range of providers including private hospitals

A report by researchers at the Institute for Fiscal Studies, commissioned with the Nuffield Trust reveals that the choice reforms implemented under the Blair government in 2006 and 2008 have changed where care takes place.

Independent Sector Treatment Centres (ISTCs) introduced alongside greather patient choice have taken an increasing proportion of both outpatient and inpatient care across a range of operations and specialities.

In 2010 most patients still receive outpatient care from their local NHS hospital and the overall volume of patients seen has increased for all types of provider since 2006.

But there was a decrease in the proportion of patients using their nearest NHS trust and an increase in ISTC use.

By 2010 ISTC outpatient provision had risen from an almost negligible proportion to 3.5% of all first appointments – almost half a million episodes in that year alone.

ISTCs have increased their market share for a range of inpatient treatments. In 2006 68% of all hip replacements were performed at a patient’s nearest NHS hospital. But by 2010 this had fallen to 54% with a commensurate increase in the proportion treated in private centres. The size and speed of this shift of care varied by operation according to the authors with elective unilateral inguinal hernia repair seeing the fastest change with 17% of all patients being treated in an ISTC by 2010/11.

“These changes in the location of care mean that by 2010/11 more GPs are referring to a wider number of secondary care providers. Referrals to ISTCs account for approximately half of the change in where GPs refer patients since 2006/07,” the authors say.

Elaine Kelly, a Research Economist at IFS and one of the authors of the report, said: “The use of private providers to treat NHS patients is no longer a marginal policy reform and deserves greater investigation. There has been a significant shift in market shares over the past five years from patients’ nearest NHS hospitals to private providers. For some procedures, almost one-in-five NHS funded operations are now carried out by the private sector. However, despite these relative shifts, increases in the number of NHS-funded treatments over the last five years have been so substantial that the total number of patients treated at NHS hospitals has not declined.”

Responding to the report Anita Charlesworth, Nuffield Trust Chief Economist, said: “Following reforms to patient choice in 2006 and 2008 and the expansion of ISTCs since 2007, hundreds of thousands of hospital care episodes which might once have taken place at the nearest NHS trust are now taking place in the independent sector.

“Together, increased private provision and choice reforms have achieved major steps towards the Government’s goal of providing viable alternatives to existing providers and GPs, and patients are now exercising choice over where treatments take place. Interestingly the research finds little overall change in treatment patterns among NHS hospitals. The lack of change for emergency inpatient treatment also suggests that this would not be happening without the introduction of ISTCs.

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