A perfect match? The conditions for a functioning public and independent healthcare relationship

The relationship between the NHS and the independent healthcare sector has undergone a significant transformation since the onset of COVID-19. The rapid escalation of cases pushed the NHS to seek alternative ways to manage the crisis. In a historic move, the NHS entered into a £2bn agreement with independent healthcare providers (IHPs) to alleviate COVID-19 pressures, which required IHPs to postpone non-urgent elective surgeries and free up resources for use within the NHS.

While partnerships between the two sectors aren’t new, increased collaboration during the pandemic reignited conversations around how the NHS and independent health organisations should work together. Kier Starmer’s recent announcement indicates there will be closer ties between public and private providers. This is then a relationship that is still evolving, with many healthcare leaders working out the viability and long-term value of future collaboration, and how new frameworks will work in practice once implemented. There is significant untapped potential for deeper integration between the sectors, offering a pathway to a more resilient and efficient healthcare system and benefits to patients and the wider public.

A difficult relationship

Several factors have contributed to this becoming a difficult relationship for many providers. For one, the differing financial incentives and mechanisms for both the NHS and IHPs is a significant hurdle which can lead to clashes of culture. The NHS, publicly funded, is under significant pressure to balance its budget and prioritise internal capacity. Outsourcing activity and funding to independent providers can be perceived as taking funds and resources out of the NHS, creating a sense of competition and suspicion around the financial drivers of the IHPs rather than collaboration, even where there are strong personal relationships. 

Another factor is the skilled workforce shortage, which has affected both NHS and independent providers. The growing demand for healthcare services, coupled with limited resources in both clinical and administrative roles, places considerable strain on the ability of both sectors to operate efficiently. For example, the NHS and IHPs alike face difficulties in negotiating and managing contracts due to a shortage of clinical capacity. 

There are also political and regulatory obstacles that prevent smoother partnerships. The NHS, particularly in some quarters, has historically been reluctant to embrace independent sector involvement, driven in part by concerns over privatisation. This has created an ideological divide that, at times, manifests itself as mistrust between the two sectors.

Despite the challenges, there are signs that the relationship between the NHS and the independent healthcare sector can evolve into something more robust and mutually beneficial. There is increasing recognition from both sides that an integrated approach to healthcare is necessary to meet the growing and complex demands of the population.

Mutually beneficial rewards 

In moving forward, both sectors must work to align financial incentives, streamline administrative processes, and foster a culture of trust to utilise and deploy resources to the maximum effect for patients. This could be supported by creating a more transparent and flexible framework for procurement, contracting and a collaboration model that accommodates the diverse needs of both sectors. 

Only by overcoming these barriers can the NHS and independent healthcare providers work collaboratively to create a healthcare ecosystem that is more efficient, patient-centred, and resilient.

Collaboration between the sectors, while still evolving, represents an exciting area of opportunity to reimagine healthcare delivery in the NHS in England, making it more sustainable and responsive to the needs of patients.