NHS hospitals have been ordered to hand over swathes of operations to the private sector to ease a looming winter crisis, according to leaked memos. Health officials have also instructed hospitals to discharge thousands of patients in a bid to reduce record levels of crowding, while managers have been banned from declaring “black alerts”.
NHS trusts have been told to take a series of measures to dramatically reduce bed occupancy levels in an attempt to ensure that wards can cope as pressures mount.
Patients groups said the situation was “frightening”, while charities described the measures as an “extremely worrying” reflection of a system under “extraordinary pressure”.
The instructions from health officials come as hospitals are the most crowded they have ever been in the run-up to winter.
A memo from NHS England and regulators NHS Improvement, seen by the Telegraph, orders hospital trusts to take sweeping measures to bring occupancy down to a recommended safe limit of 85 per cent.
Hospitals have been ordered to “maximise elective activity” in the run-up to Christmas using the independent sector and schemes which pay NHS consultants lucrative overtime rates. The plans have been drawn up so NHS trusts can cut the number of operations they perform - freeing up more beds for urgent patients - without lengthening waiting lists. Under such schemes, consultants have been paid rates of up to £1,000 a shift.
But the schemes and heavy use of the private sector is likely to add to financial pressures on the NHS, which last year recorded the highest deficit in its history.
It comes as a separate leaked document shows that GPs are coming under pressure to provide emergency home visits. Local doctors groups are being asked to establish “A&E Delivery Boards” and to draw up rotas of medics able to respond to 111 requests for urgent care at home, which is currently reserved for those who are housebound. The boards are ostensibly responsible for easing winter pressures, but the new NHS England best practice guidelines state the measures should remain in place all year round because of the unprecedented demand.
Latest official figures - for the three months ending in September - show NHS trusts have the highest levels of occupancy ever recorded in the run-up to winter with an average of 89.1 per cent of acute and general beds full, compared with 87 per cent in the same period last year. It follows record levels of bed blocking, with high numbers of patients stuck in hospital for want of care at home.
The memo from health officials, sent to all NHS trust chief executives last month, calls for actions aimed at “lowering acute bed occupancy to 85 per cent from 19 December to 16 January.”
Such measures include farming planned surgery out to the private sector, and discharging patients earlier. “These plans will have to have full regard to both elective targets and financial delivery, as such systems will be expected to maximise activity either side of the period in an affordable way and where necessary using waiting list initiatives and the independent sector to ensure that elective throughput is not adversely affected,” the memo states.
A number of NHS trusts already have contracts with private providers, but will now be expected to ramp up activity, or agree new short-term deals. Under waiting list initiatives, consultants can earn around £1,000 a shift on premium rates for performing an extra session in an evening or afternoon.
Dr Mark Porter, chairman of the British Medical Association, which has criticised the "creeping privatisation of the NHS" said last night: “This is evidence of an over-stretched healthcare system that the government has failed to properly fund, which must outsource patient care to private providers to cope with predictable patient demand. Unmanageable pressures are now facing the NHS all year round, winter or not, and this has been made worse by cuts to social care provision.”
Caroline Abrahams, charity director at Age UK, said the signals from health officials were signs of desperate measures, with hospitals under “extraordinary pressure” even before winter set in. Hospitals had little hope of freeing up hospital beds, because social care was “in crisis” with too little funding to keep up with demand, she said.
Tim Farron, Lib Dem leader, said: “Using the private sector like this, on this scale, only runs down the NHS and will cost the taxpayer more in the long run. “The NHS needs more cash and this government is trying to pull the wool over people’s eyes by pretending otherwise."
NHS hospitals have also been sent separate guidance which requires them to stop using terminology such as “black alert” to warn the public of impending crisis. Instead, NHS England has devised a new system of Operational Pressure Escalation Levels (OPELs), which are numbered. Health officials said the four-point scale was an attempt to ensure consistency when hospitals were under strain and needed extra help or for patients to be diverted.
But patients groups said the diktat was an attempt to spin the NHS out of crisis, by hiding the true scale of problems from the public.
The guidance from NHS England, published last month, orders hospitals to follow a national framework to track pressures and decide whether help is needed to protect patient safety.
In recent years, most trusts have issued a “black alert” if they are becoming unable to cope with strain and require ambulances to be diverted. “Red alerts” are issued when services are struggling with “amber” and “green” status declared at other times. Instead, the new instructions instead NHS trusts to follow the four-point OPEL scale to track pressures, where OPEL 1 means services are working normally and OPEL 4 indicates that organisations are unable to deliver comprehensive care, with increased potential for patient care and safety to be compromised. The levels are used to determine how much help is needed from local, regional and national services.
Joyce Robins, from Patient Concern, said the situation had become “frightening”.
An NHS England spokesman said: “Anyone who needs to be in hospital or in another care setting over Christmas will be. Our ambition to reduce bed occupancy in hospitals over the festive period is about timely discharge and getting people to the most appropriate care setting ahead of the holidays, so there is capacity for early January when we know pressure is greatest.”