Scots NHS for sale: Firms invited to bid for over 1,500 Scots medical procedures

Private hospitals and other health care firms are being asked to provide prices for more than 1500 procedures including a range of operations such as heart, cancer and brain surgery "to support the NHS in Scotland".

Would-be contractors have been told that health care support could even be provided outside of Scotland.

The details have raised concerns that it is setting a "pathway to the privatisation of the NHS".

According to details seen by the Herald on Sunday, £150m has been set aside that will cover five years of the system.

It will provide a "range of inpatient procedures, clinics and outpatient services to support the NHS in Scotland in delivering comprehensive and effective healthcare services".

READ MORE: Scots ministers 'break law' over award of new National Care Service contract

The 2015-16 programme for government, which set out the Scottish Government’s plans for the year ahead, pledged to "effectively eliminate use of the private sector for planned care" as part of a 20-year strategy.

And in 2017 Nicola Sturgeon told SNP conference delegates that “as long as the SNP is in office, the NHS will always be in public hands".

In July, the SNP pushed for a 'Protection Bill' at Westminster, to write into law that the NHS must be protected from privatisation.

In multiple statements on the state of the NHS, the SNP has stated: "The Tories simply cannot be trusted on privatisation."

In the summer of 2019, SNP ministers indicated that it would use private hospitals to cut waiting lists despite Nicola Surgeon vowing to push them to "the margins" of the NHS.

Waiting times were then revealed to have hit a new high with more than 23,000 patients, almost a third, waiting longer than the legally binding 12-week target for treatment.

Internal documents sent to health boards, seen by the Herald on Sunday reveal that some £10.7m was allocated for outsourcing as part of a Waiting Times Improvement Plan.  tien

Patients were sent to independent healthcare centres and private hospitals as as part of a programme overseen by the Golden Jubilee Hospital.

Letters from the Health Performance and Delivery Directorate to at least three health boards, NHS Greater Glasgow and Clyde, NHS Grampian and NHS Ayrshire and Arran, about the use of private providers, states: "We will continue to support this again next year, with no cessation of activity.

"There is an expectation that by March 2020, no patient will wait over 52 weeks for treatment and by September 2020, there will be no patient waiting longer than 26 weeks. Evidence of these objectives being achieved is required."

The letters added: “We would also envisage that there would be the potential to increase the activity allocation, and discussions are presently ongoing with providers."

Letters indicate that the orthopaedic services - which specialise in surgical treatments for bones and joints - were a large focus of the outsourcing support.

One letter to NHS Ayrshire and Arran's chief executive John Burns says the Golden Jubilee "will utilise all the available private sector capacity over the next few months".

The Scottish Government said in the summer of last year that no decision had been taken on whether any further private sector outsourcing would restart being paused due to Covid-19.

But soaring NHS waiting times during the pandemic have provided the background to the new move to step up private sector involvement.

In September, Nicola Sturgeon came under fire for the “tragedy” of “ever-lengthening” waiting lists, which left more than 600,000 people forced to wait for NHS treatment and diagnostics in June 2021.

Statistics from Public Health Scotland shows that waiting lists had soared from 450,000 in December 2019.

Leading care expert Nick Kempe, a former head of service for older people and adults in Glasgow and convenor of think tank Common Weal's Care Reform Group, said the private health procurement exercise was a "scandal".

"This just looks like the privatisation of the NHS," he said.

"They say the SNP are not privatising the NHS like in England. What is this tender if not about opening up the NHS in Scotland to 'market principles'."

A pre-qualification questionnaire (PQQ) has been circulated to firms by the NSS - which is responsible for buying and supplying items to keep hospitals and health centres running - as part of the new electronic private health care purchasing system for the NHS to check the suitability of suppliers.

A national procurement catalogue will be produced which will be available to all Scottish health boards. Suppliers are being asked to provide prices for some of healthcare's most complicated procedures including oesophagectomy, cancer surgery in the lower part of the oesophagus.

A range of other cancer surgery procedures are on the list including mastectomy for breast removal, lobectomy for the lung, colectomy for the bowel, prostatectomy for the prostate and cystectomy for the bladder.

Prices are also sought for heart bypass surgery, to improve blood flow to the heart and gastric bypass treatment, an obesity procedure aimed at restricting the amount of food that the stomach can hold.

Some of the most common surgical procedures are also on the list including knee and hip replacements and gall bladder surgery.

Private healthcare is even being asked to price up circumcision.

Suppliers have been told the system will provide "potential additional capacity in the provision of range of inpatient procedures, clinics and outpatient services to support the NHS in Scotland in delivering comprehensive and effective healthcare services".

They have to demonstrate experience in providing "safe, good quality services with appropriately qualified consultants, anaesthetists and clinical staff, including surgeons with relevant personal operating experience..."

Suppliers have to have a "proven track record of the delivery of high quality care by appropriately qualified medical and healthcare practitioners".

Firms are also asked to demonstrate capability to provide "surgical procedures for adults and children to be performed by named qualified and competent surgeons, with all appropriate and necessary steps taken to limit complications, minimise infection, and to provide where appropriate aftercare and follow-up".

Details have to be provided of operating, emergency, clinical care and post-operative facilities as well as resuscitation equipment.

They are asked to explain the facilities available in the post-operative care of patients in critical care beds with details of the levels of skilled nursing and intensive care staff, and the availability of supervision by surgical and anaesthetic staff.

All firms are expected to have been trading for a minimum of three years, but preferably five years with a turnover of more than £2m a year.

They will need criminal negligence insurance cover of up to £10m and £2m for public liability.

Providers are asked to detail all services offered with a breakdown of charges for all potential aspects of the services, including x-rays, scans, diagnostic tests, pre-operative assessments and post-operative care.

"It should be noted that all surgery and other treatment must be provided within a location as close as possible to the patients' health board, and within the United Kingdom, and comply with all relevant legislation and guidelines including the National Care Standards, which set out standards of care that people should be able to expect to receive from a care service," says information sent to would-be providers.

"Services must deliver high quality patient focussed care by trained and competent medical and healthcare practitioners in appropriate facilities that meet the standards for delivery of care expected by NHS Scotland and minimise risk to patients."

In an associated scoring methodology details, firms are told that depending on the nature of the services the primary NHS doctor responsible for the care of a patient may be a health board consultant or the patient’s general practitioner.

"Providers should take this into account and, depending on the services for which a PQQ is submitted, the potential provider should describe how effective communication with the patient’s consultant and/or GP is ensured, including communication about medication, post-operative care and approach to managing post operative complications," it says.

All would-be contractors have to confirm that training for consultant surgeons, anaesthetists and other clinical staff is up to date.

The information details continue: "The provider is to ensure that the patient and surgeon completes informed consent documents, in line with NHS Scotland national guidance, for each surgical intervention and received authorisation/order from the referring health board prior to commencement of any surgery.

"Providers must have processes in place to communicate effectively with the health board where the requirement for additional treatment is identified in the course of providing treatment ordered by the health board.

Services may be offered on a “see and treat” basis where providers give a patient assessment as well as treatment following assessment by a health board consultant and where the requirement for the surgical procedure or other care has already been established.

Providers have also been warned that they have a legal obligation to provide interpreters for patients with "preferred communication other than spoken English". Relatives were not to be routinely used as interpreters.

The Scottish Government said they "don't hold information" on the procurement exercise.

National Services Scotland, which is responsible for the procurement of services for NHS Scotland was approached for comment.

NSS manages over £1.4 billion in national contracts and is home to what it calls "the biggest public sector logistics operation in Scotland".

It says that from grounds maintenance to X-ray machines, bed linen to syringes, each year it procures and distributes "millions of vital supplies that support a patient's or visitor's interaction with our health service". From its Lanarkshire based National Distribution Centre, over 80,000 items are delivered every week to hospital wards, departments and community centres.

It says its mission is to "increase savings and maximise health impact while improving supply chain effectiveness and procurement capability".

One of its strategic objectives is to "define and introduce a tailored suite of services so that we can deliver efficiencies and savings across NHS Scotland".

Over five years it says it has yielded savings of £268m.

Its five year procurement strategy which runs to 2024 states the use of Dynamic Purchasing Systems (DPS) can "greatly reduce supplier administration burden and speed up tender procedures for individual contracts... and open up the opportunity to as wide a range of suppliers as possible."

The strategy says it will also ensure that they work within the national context under the Scottish Government Priorities for Scottish Public Procurement.