Hip replacement operations highlight trend of NHS privatisation

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A report published by the Royal Society of Medicine highlights that NHS-funded private sector hip operations are worsening health inequality in the UK and follows the trend towards NHS privatisation.

The impact of outsourcing NHS hip operations to the private sector is highlighting the continuing trend towards NHS privatisation and reducing NHS provision. The new research examining the outsourcing of elective surgeries suggests that this is likely to result in risk selection and widening inequalities in the provision of elective hip operations in England.

The study was conducted by researchers from Newcastle University and Queen Mary University of London, and the findings were published in the Journal of the Royal Society of Medicine. The results show that NHS provision decreased by 8.6% and private provision increased 188% between the years 2007 to 2008 and 2012 to 2013.

From 2008 to 2013 hip operations for patients from the most affluent areas were increased by 288%, compared to 186% in patients from less affluent areas, and that females were much less likely to receive care relative to need.

NHS duties

Dr Shailen Sutaria, Queen Mary University of London, said: “While inequalities did not increase overall during the study period, this was due to the protective and buffering effects of NHS provision, which remained the dominant provider. The situation is likely to be worse now.”

Records of elective hip operations show that female and older patients, as well as those living in the most deprived areas, are much less likely to receive treatment relative to need. The researchers found that private providers favour less extremes of ages compared to NHS providers. These patients, the researchers say, may represent more complex operations or associated co-morbidities that are excluded by private providers.

Professor Allyson Pollock, Director of the Institute of Health and Society at Newcastle University, said: “In 2017, over one-third of NHS-funded elective hip operations were performed by the private sector. If the trends here continue, whereby private provision substitutes for NHS direct provision, with risk selection favouring less deprived patients, then widening inequalities are likely.”

Duties are placed on the NHS through the 2012 Health and Social Care Act that requires the NHS to ‘have regard to the need to reduce inequalities between patients with respect to their ability to access health services’.

NHS privatisation

The trend towards NHS privatisation has been ongoing for many years and private contractors have been used since the year 2000 to offer patients more choice and provide more competition within the health care sector. Since 2003, a number of privately-owned independent sector treatment centres were commissioned to treat NHS patients. These outsourced provisions focused on elective surgical procedures, raising many concerns regarding cost, quality and who receives treatment.

A third of contracts that provide clinical services were awarded to the private sector between the years 2013 and 2014 and by 2016, highlighting the trend towards NHS privatisation, and NHS England spent £8.7bn on private sector provision of secondary care services – a total of 7.7% of NHS expenditure for that year.

Elective hip arthroplasty is a common elective procedure that provides drastic improvements in quality of life for those who need the operation. In 2017, over one-third of NHS-funded elective hip operations were inline with the NHS privatisation trend as they performed by the private sector.

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