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20% of patients treated by private firms

Almost one in five NHS patients seen in secondary care is now treated by a private firm, after Labour’s ‘patient choice’ reforms led to an expansion in the independent healthcare market, a report by the Nuffield Trust and the Institute of Fiscal Studies concludes.

Private firms are now a ‘significant’ provider of NHS-funded operations, carrying out 17% of hip replacements, 17% of hernia repairs and 6% of gall bladder removals each year in England, said the report.

The number of ‘independent sector treatment centres’- private providers that carry out treatment funded by the NHS - expanded rapidly between 2006/07 and 2010/11.

GPs and patients were given a more explicit choice over where to book their first outpatient appointment by the Labour Party, which has vehemently criticised the Coalition Government’s plans to increase competition in the NHS.

By 2010, GPs referred patients to an average of 18 providers, compared with 12 – mainly NHS – providers in 2010/11.

In 2010/11 private firms carried out 8% of patients’ first orthopaedics and trauma appointments, 4.8% of gastroenterology appointments and 2.3% of ophthalmology appointments, compared with  less than 1% prior to 2008.

The report also found a decline in the percentage of patients attending their nearest trust, although they are still in the majority.

The closer a patient lived to a private provider, the more likely they were to attend, the report found. However, private firms treat a ‘significant’ amount of patients who were travelling more than 15km further than their nearest trust, the report said.

It found that patients are travelling further for care, with the average distance travelled for orthopaedics, trauma and gastroenterology treatment increasing by 0.8km from 2006/07 to 2010/11.  

Although patients are travelling further, they were not exercising choice between hospitals, as there was no statistically significant change in the proportion of patients attending an NHS trust that is not near to them, in any year and for any specialty.

The report concludes: ‘The analysis here has not demonstrated the extent to which the shift in treatment location represents a shift from lower- to higher- quality providers.’

It added: ‘While there has been some shift away from the treatment at the nearest NHS trust, the majority of patients with the conditions examined in this study are still treated by their nearest NHS provider.’

‘This suggests that while some patients may have exploited the reforms, others may not. Exploring which patients have been affected will be important in understanding how different types of individuals have been, and will be, affected by increasing choice and competition.’