The public and private sectors cooperate everywhere in Wales except, it seems, in healthcare. Glyn Mon Hughes examines what is at stake.
You phone the doctor first thing
and, before the sun has risen, all the
appointments are booked. You find
out later, after a follow-up call from the
receptionist, that there’s a cancellation
two days later, just when that all-important
presentation is scheduled.
It’s a familiar scenario as the hard-pressed health service runs ever harder to serve the demanding population. That’s where NHS bosses and their masters in the Welsh Assembly Government must contemplate a conundrum.
Can enough resources – now £5bn in Wales – ever be devoted to satisfying the insatiable demand for health services? And just what role will the private sector be allowed?
In some areas of government business involvement is welcome. Regeneration minister Leighton Andrews describes the public sector as “a safe partner” for business, saying: “We encourage the private sector to deliver, while recognising that involvement with public sector plans provides security and confidence for private construction companies.”
The health department takes a tougher line. It is committed to eliminating the use of private sector hospitals by the NHS by 2011, rules out the use of the Private Finance Initiative and will end competitive tendering for cleaning contracts.
“The Welsh Assembly Government will keep the NHS publicly owned, funded and managed," says a spokesman, who points out that the health service puts cash into the economy through staff salaries and investment in equipment.
In Wales there is no political will to encourage (private health) growth,” says Joanne Longstaffe, clinical director of Independent General Practice, the private GP practice with clinics in Cardiff, Newport and Swansea. “The situation is different in England and it is a divisive issue on many planes.”
Wales is standing at a crossroads, according to Richard O’Neil, director in charge of the south Wales office of HLM Architects, which has been involved in some of the country’s largest projects including Cynon Taf Hospital for the Cwm Taf NHS Trust.
“Wales is in a position where it is able to invest on its own terms,” says O’Neil. “But it must decide whether it wants to learn from its neighbour across the border, or whether it wants to pursue a different path when working with the public and private sectors.”
Currently there is not a great deal of involvement by the private sector in comparison with England and there has been opposition, notably by the unions.
On the positive side, he highlights the health service’s energy life-cycle cost analysis programme. “If the private sector is involved the longevity of the estate is maintained, so cash flow is improved. Because it is up to the private sector to maintain the quality of the estate, there’s more cash to be spent on the clinical side. That’s why it’s time to see joined-up thinking in Wales. We need to bring the two sectors together when it comes to master planning, land sales and land use.”
Can they really co-exist, though?
Yes, according to Longstaffe. “There are big gaps in the accessibility of certain services, such as flu vaccines, minor operations, sexual health, wart treatments, travel health services, HPV vaccines and physiotherapy, for example,” she says.
“NHS care is evolving and the interface between private and NHS services has become blurred – in out-of-hours provision or medical care for institutions such as prisons, for instance.
“A significant section of the services we provide are not available on the NHS, therefore patient choice is enhanced. Look at single vaccines, aesthetics and cosmetic surgery, for example. It complements the NHS and – where responsibly managed – enhances services available and choice. But private medicine is not yet in direct competition with the NHS in Wales, though it will continue to grow.”
The growth of independent GP services has attracted the attention of the Royal Bank of Scotland. “There is a small but growing market for private GP services for people with busy lifestyles who find it difficult to fit into the restricted hours of their local NHS,” says Howard Crackle, head of healthcare for RBS in Wales.
“Cardiff and Swansea are seeing these services grow as individuals and employers reap the benefits of local, city centrebased service providing fast access, diagnosis and treatment. Whether paid for by the individual or the employer as part of a wider benefits package, we expect to see more opportunities for practices looking to provide a service for people during their working day.”
RBS is also investing in bigger projects such as Vale Healthcare, a joint venture between medical consultants in south Wales and Nuffield Hospitals. They recently opened a Cardiff Bay Clinic with help from Ospreys player Ben Lewis and will extend to a hospital at Hensol Castle near Cardiff next year.
That expansion is likely to increase the 120,000-plus acute patients treated privately per year. Many are treated at Spire Cardiff Hospital, whose hospital director Nicola Amery says: “The independent sector makes a big contribution to health provision in Wales, not only in the acute medical and surgical field but also in mental health and medium secure units.” She adds that Spire uses spare capacity to reduce NHS waiting lists.
Demand for acute services could be reduced if companies paid a bit more attention to their employees, says David Briscombe, a corporate and personal development specialist in Cardiff. “Firms must, by law, provide a safe working environment – they don’t comply simply because they don’t understand. But the authorities are getting tough.”
He quotes the example of one company, which had to to pay out £500,000 in compensation because an employee left with stress. “For every £1 spent on stress management, an employer will save £7 in better productivity and fewer days lost as a result of sickness.”
Caroline Pearson, business development director at health and safety consultancy Connaught Compliance, believes workplace culture may be changing thanks to the publication in March of Dame Carol Black’s report, Working for a Healthier Tomorrow, for the UK government. Its proposals focus on keeping people healthy at work and helping them return to work if they become ill.
“In the current climate companies need to squeeze every ounce of productivity from existing workforces,” says Pearson. “With redundancies likely there will be fewer people left to produce the same work, so they need to be well at work. Now more than ever companies need to drive down absence. Occupational health, when professionally delivered, can have a big impact on absence levels, which immediately drops to the bottom line.”
Assistance, though, goes beyond simply what happens in the workplace. Companies are increasingly taking an interest in problems that are not work related, but stop employees from attending work. These include absence reporting services where employees phone in to a nurse in a contact centre on their first day of absence and are given immediate clinical intervention and advice.
A major growth area for private provision has been in the elderly care sector, where people leading care businesses have sought to attract highly qualified personnel.
“It is going to take a lot of drive over the next few years to maintain the level of growth in the sector,” says Adam Carter, healthcare director at recruitment consultancy Wheale Thomas Hodgins. “But prospects are good.”
In the elderly care sector, government policy is directing funding towards providing care for people at home, which may be cheaper than paying for provision in care homes. However, this will place a burden on elderly people to manage their own care budget. Carter predicts the trend towards modern purpose-built facilities will continue for all parts of the care sector.
Also in: December 2008/January 2009
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