Financial details of independent sector deal promised shortly

Today, NHS England and NHS Improvement announced they had agreed a new national contract with 10 independent sector providers (ISPs) for the final quarter of 2021/22. The contract, agreed under the direction of the health secretary, has two elements – supporting NHS elective care capacity and offering additional surge capacity if Covid threatens the service’s ability to provide urgent care over the remaining three months of the financial year.

The new arrangements replace clinical commissioning group and trust sub-contracts with independent providers from 10 January until 31 March.

In the first part of the contract, known as pre-surge, systems and trusts can work with ISPs to agree levels of elective activity to be carried out. A wider range of patients can be sent to the independent units, including those who need some forms of cancer surgery and other treatments not normally delivered under existing arrangements.

In a letter to the service, NHS chief financial officer Julian Kelly (pictured) and chief operating officer David Sloman said this activity would be paid through priority tariff uplifts.

After that, in 2022/23, the tariff consultation has proposed that activity under the Increasing capacity framework with the independent sector should be subject to unit prices and not the aligned payment and incentive approach, which is due to be implemented widely across the NHS. 

Surge status

The second part of the three-month contract for 2021/22 deals with surge capacity support, allowing systems to make flexible use of ISPs and staff. During a surge, ISPs will suspend routine services to make facilities and staff available to the NHS.

Surge status could be invoked in three circumstances – if there is insufficient bed capacity for care of urgent, higher priority (P1/P2) patients, or cancer treatment; if staff absences present a significant risk to patients; or if there is insufficient critical care capacity to support the Covid response.

Thresholds have been set and, if breached, will automatically trigger discussions between NHS England, the relevant region, and local independent providers. The letter acknowledges that there may be a significant risk to patient safety due to staff absence, even if the threshold on staffing has not be breached. In these cases, the surge response may be triggered.

The letter added that use of the independent sector provision should only be made in extreme circumstances, and the national bodies were keen to ensure systems and trusts work with independent providers to maintain non-Covid services. It added: ‘To support this, payments to ISPs will continue to be made by NHS systems and trusts to facilitate optimal use of ISPs locally. Further detailed financial guidance on the pricing and funding of the arrangements will follow in the next few days.’

Mr Sloman said the deal would mean as many people as possible would get the care they needed. He continued: ‘It also places independent health providers on standby to provide further help should hospitals face unsustainable levels of hospitalisations or staff absences. Just like the Nightingale hubs being created across the country, we hope never to need their support, but it will be there if needed.’

NHS Confederation chief executive Matthew Taylor (pictured) said: ‘This deal – on top of the NHS building extra capacity and assistance we have seen from the military – means there is some further support if it is necessary over the coming months.'

But he added: ‘These emergency measures will not be a silver bullet and they should not mask the longer-term issues facing the NHS, such as huge staff vacancies. We know that the backlog will disproportionately impact people from poorer backgrounds and so a fair and equitable way of addressing this waiting list is critically important.’