Private hospitals overtake NHS for hip and knee replacements

Private hospitals are delivering more hip and knee replacements than the NHS for the first time since the procedures were widely introduced in the 1960s and 1970s.

With the NHS still focused on Covid-19, independent hospital chains including Circle Health Group, Nuffield Health, HCA Healthcare and Spire Healthcare have doubled the numbers of privately paid patients, according to an analysis of official figures by healthcare consultancy Candesic for the Financial Times.

Although the overall numbers of hip and knee operations remain lower than in 2019, the research found that 56 per cent of the total surgeries performed in the first eight months of this year were performed in private hospitals, compared with 40 per cent over the same period two years ago.

Michelle Tempest, analyst at Candesic, said it was a “watershed” moment that showed more people were “choosing to go private”. “There is a shift going on and we are seeing the consumerisation of healthcare; people are starting to shop around and some are choosing to go private as waiting lists are ever increasing.”

Hip and knee operations have traditionally been the “bread and butter” of private hospitals, with outsourced work from the NHS a significant part of their business model. But the number of NHS patients treated in their facilities has fallen dramatically from 27 per cent of the total volume in 2019 to 18 per cent in 2021.

The switch from NHS work to privately paying patients comes despite long waiting lists for treatment and an agreement last year when the government paid all of the hospitals’ operating, interest, rental and staff costs in exchange for their help during the public emergency. The government has still not disclosed the cost.

David Rowland, director of independent think-tank the Centre for Health and the Public Interest, said the private hospital sector could not deliver this level of activity without the use of thousands of NHS consultants working in their spare time.

“It must be difficult for the 5.3m people on NHS waiting lists to know that NHS employees are choosing to dedicate their time treating fee-paying patients rather than helping to clear the NHS backlog,” he said.

Although most private operations are still paid for via insurance schemes, the biggest growth has been in patients paying an upfront fee for their operation, particularly in areas where the NHS hospitals have been slow to restore non-emergency surgeries. The price of a hip or knee replacement ranges between £8,000 and £15,000 depending on the provider and location.

Private hospital operators prefer self-pay patients as the margins are higher than for outsourced NHS work. “Everyone in the sector is having a bumper year for self-pay,” said one private hospital operator. “All the private hospitals are pretty full and looking at how they can increase productivity, for example by opening on weekend evenings. If you’re managing a private hospital for profitability, you want as much self pay as possible.”

Circle Health Group, which has merged with BMI to become Britain’s biggest private hospital operator, said it was using MRI scanners on the backs of lorries in hospital car parks to cope with the surge in demand. It is also expanding two of its hospitals with modular, factory-built theatres this autumn as part of a £100m investment programme.

Spire, the only UK-listed private hospital company, which has 40 hospitals nationwide, has already reported an 81 per cent surge in self-pay revenues in the second quarter of 2021 compared with the second quarter of 2019.

Private sector growth may be constrained by a dearth of operating theatre capacity, as well as staff, most of which work for the NHS. However, two of the US’s biggest hospital chains — the Mayo Clinic and the Cleveland Clinic — are planning to expand in the UK, with the Cleveland planning to hire its own doctors in a break with the model used by the rest of the private hospital sector.

The research shows that NHS hospitals have restarted elective surgery such as hips and knees at vastly different rates, with some regions such as south-west London performing just 10 per cent of the operations they were doing before the crisis.