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COVID-19 – Impact on private sector healthcare

The following information was last validated on 19 June 2020.

Private hospital update

(This applies to England as we do not have information from Scotland, Wales and Northern Ireland.)

Original situation

  • All proposed treatments, whether funded privately or by the NHS, were assessed by an NHS England multi-disciplinary team and a priority level assigned.
  • The treatments were categorised as follows:
    • Priority level 1a Emergency operation needed within 24 hours/ immediate
    • Priority level 1b Urgent operation needed with 72 hours / urgent-expedited
    • Priority level 2 Surgery that can be deferred for up to 4 weeks / semi-acute
    • Priority level 3 Surgery that can be delayed for up to 3 months*
    • Priority level 4 Surgery that can be delayed for more than 3 months*
  • Treatments for levels 3 and 4 were not allowed.
  • Treatment was authorised for NHS patients and privately funded patients strictly on the basis of clinical priority.
  • This substantially reduced capacity for treatment.

What has changed

  • The contract remains in place until 30 June and for some facilities it is expected that the contract will be extended to 31 August.
  • The NHS retains the right to book NHS patients into private hospitals for elective treatment, but this is restricted to core hours of 9 to 5.
  • NHS England has given independent hospitals autonomy to treat private patients providing they meet their obligations to the NHS without referring to the authorisation team.
  • Treatments are still categorised according to the severity but treatment for levels 3 and 4 is now permitted.
  • This gives the opportunity for independent hospitals to work through their own waiting lists.
  • In practice, the independent hospitals have had plenty of spare capacity, which they have until now been unable to use for private patients, and many are taking steps to expand capacity further by running services over weekends.  This means that, although there are some capacity limitations and a backlog of patients to care for, almost all patients will now be able to access care.

What patients can expect

  • Patients can expect to be admitted based on clinical priority.
  • Patients will have to be COVID-19 free.
  • Hospitals will implement a testing and self-isolation regime prior to admission.
  • It is expected the patient will have to self-isolate for 14 days prior to treatment.
  • The hospital will admit a day early so the patient can be tested and held in isolation for 24 hours before treatment.
  • It is understood that medical insurers will pay for the cost of tests and additional accommodation.
  • The hospitals will be taking additional measures in relation to physical distancing and the use of personal protective equipment.

Implications for medical plan claims experience

  • Claim levels under most schemes have dropped significantly since late March, reflecting the suspension of the majority of elective treatments.
  • However, most claims will have only been deferred through the suspension and treatments are still required.
  • Therefore, claims are now likely to increase as the independent sector reopens.
  • There is still significant uncertainty around exactly how claims will develop and ‘catch up’ in the coming months as there are many variables that will influence this.

 

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