Delivering core NHS and care services during the pandemic and beyond

Health Select Committee inquiry – Transform Hospital Group response

Following the Health and Social Care Select Committee’s call for evidence as part of its inquiry into ‘Delivering core NHS and care services during the pandemic and beyond', this document sets out Transform Hospital Group’s response, to be included in the Independent Healthcare Providers Network’s written evidence.

How to achieve an appropriate balance between coronavirus and ‘ordinary’ health and care demand  

• Transform Hospital Group is proud of be part of the ground-breaking partnership between the NHS and independent healthcare providers, designed to ensure the NHS can deliver the critical capacity needed to fight COVID-19.
• Research undertaken by UCL found that the impact of COVID-19 is likely to result in around a fifth more cancer deaths over the next 12 months[1]. Anecdotally, independent health providers have seen a 25% increase in cancer-related fatalities since the start of the COVID-19 lockdown on 23 March.
• Independent providers have the capacity and facilities to deliver cancer patient treatment from diagnosis to recovery using ‘cold sites’ in clinic and hospital facilities. Unused capacity in the independent sector is currently at 80-90% with critical care capacity at about 60% utility.
• The additional capacity in private healthcare settings could be used to support other health and care demands, such as delivering coronavirus testing to support the UK Government’s targets or outpatient procedures to prevent exponential growth of NHS waiting lists.
• Transform Hospital Group supports the NHS’s decision to segregate ‘cold’ and ‘hot’ clinical and surgical sites, protecting patients, clinicians and staff from the spread of COVID-19 whilst delivering high quality continuity of patient care. This strategy should continue to be implemented to reduce the potential for cross-contamination between patient groups.
• Transform Hospital Group and other independent healthcare providers have a large social media following across multiple platforms and their online presence that could be deployed as part of wider public information campaigns around access to healthcare services during COVID-19. This could be used to help spread the word that there is a low risk of infection at ‘cold’ sites, and patients with health issues or concerns other than COVID-19 should feel safe to come forward and receive care.
• Finally, it is important to remain vigilant in ensuring that prevention of other known contagious infections are not neglected within the hospital setting, given the current focus on COVID-19 in clinical environments.

Meeting the wave of pent-up demand for health and care services that have been delayed due to the coronavirus outbreak 

• Due to the threat of contracting COVID-19 in NHS hospital settings, there will be a significant pent-up demand for health and care services, as patients are showing increasing reluctance to seek medical assistance when they develop symptoms of illnesses unrelated to COVID-19. This will inevitably stretch services when they return to normal functional capacity.
• As noted above, Transform Hospital Group supports the need for segregation between ‘cold’ and ‘hot’ clinical and surgical sites. As a result, the Group recommends that the NHS utilises the capacity that has been made available by independent providers to a greater extent, thus increasing the ability to treat patients in settings that are not being used to care for COVID-19 positive patients.
• At present, an average of 10% of beds at independent facilities are currently being utilised. This leaves significant capacity for independent providers to deliver further services to support the NHS, with clear scope to support outpatient needs. Other services could also be provided by the independent sector, including post-natal care.
• Transform Hospital Group is proud to have made two of its facilities available to the NHS during the COVID-19 pandemic, however the NHS’ use of these additional resources has been limited. For example, the Pines Hospital near Manchester currently has no NHS patients on site, with the capacity for 22 patients. A similar scenario is in play at Transform Hospital Group’s facility near Birmingham – Dolan Park Hospital. Here, an average of ten to twelve cancer patients are receiving care on site each week, but capacity remains for 30 patients.
• It is also important to recognise that bed capacity at NHS Trust sites is around 60% utilised. While this is positive in the circumstances, it is important to stress the need for the effective segregation of patients while the COVID-19 pandemic is ongoing. Therefore, it is essential that ‘cold’ and ‘hot’ settings are recognised and utilised as much as possible.
• Finally, independent providers can also assist the NHS with its public information campaign, encouraging the general public to make use of NHS services available during the pandemic, providing reassurances about the provision of ‘cold’ sites. While NHS communications channels are reaching a broad audience, utilising the specific digital and social media channels of independent healthcare providers, such as Transform Hospital Group, presents the opportunity to reach a larger cross-section of society.

Meeting extra demand for mental health services as a result of the societal and economic impacts of lockdown 

• The mental health implications of the pandemic and the lockdown measures more broadly have been well-documented. This has resulted in an increased demand for mental health services, placing further strain on the NHS.
• Despite the increased demand for services, COVID-19 has reduced access to mental health care in NHS facilities. However, should demand require it, the independent sector has numerous facilities available to support the additional demand for mental health services, including clinically regulated locations (such as city centre outpatient clinics) that could be utilised by the NHS, or wellbeing facilities such as gyms, given the known mental health benefits that exercise carries.

Meeting the needs of rapidly discharged hospital patients with a higher level of complexity 

• Due to the increasing number of rapidly discharged patients, Transform Hospital Group believes that there is scope for the independent sector to further support the NHS in this regard.
• At present, patients are currently being discharged back to their homes or care homes without the same level of therapy and post-operative care as would ordinarily be provided. Therefore, independent hospitals could support the discharge process by offering their facilities to patients for rest and recovery before they return home.

Providing healthcare to vulnerable groups who are shielding 

• As has previously been highlighted, providing healthcare to vulnerable groups during the COVID-19 pandemic is also dependent efficient and effective segregation of services.
• While the differentiation between ‘cold’ and ‘hot’ sites are recognised within the clinical and healthcare community, it is vital that this information is more readily available to the general public. Transform Hospital Group proposes a form of certification whereby ‘cold’ sites are proactively marked out to patients. This information will help appease public concerns about the likelihood of contracting COVID-19 while attending appointments for a number of unrelated conditions, including cancer.

Supporting mass testing and vaccination once they become available. 

• The availability of mass community testing across accessible locations throughout the UK will be fundamental to the success of the de-escalation of lockdown measures.
• In order to support mass testing, and vaccination administration once it becomes available, independent providers could offer the NHS access to outpatient facilities. These are clinically regulated environments and would be easily accessible to the general public, while already connected to NHS supply chains due to our ongoing partnership.

How to ensure that positive changes that have taken place in health and social care as a result of the pandemic are not lost as services normalise.

• The collaborative work between the NHS and independent providers has been a ground-breaking achievement, building new partnerships with the potential for long-term benefits for the delivery of integrated healthcare in the UK.
• Most importantly, all achievements and learnings from the partnership between the NHS and independent providers should be documented centrally.
• Examples of accomplishments achieved during the partnership include a reduction in the time spent by cancer patients in hospital, thus decreasing the likelihood for contracting infectious diseases. Since the start of the pandemic, cancer patients have reduced their stay in hospital from three to four nights, to one to two nights – which has been made possible by adapting existing aftercare follow-up procedures. Not only has this reduced the spread of infectious diseases, but it has alleviated pressure on hospital facilities, which will be vital for the NHS to sustain delivery of continuous patient care in the short and longer term.
• The pandemic has also encouraged innovation in the health sector, such as follow-up and low-level appointments being carried out over video conferencing. Where appropriate, this should certainly be harnessed going forward and could result in an increase in attendance of such appointments and, as a result, increased effectiveness in supporting positive health outcomes for patients

[1] Lai et al., University College London, Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency, 28 April 2020.