ANNEXE 8

UNITED KINGDOM: Public Private Partnership in the NHS Gill Morgan DBE Chief Executive NHS Confederation

THE NHS Tax funded Historically –15% elective operations self pay/ insurance –Most expensive private sector in world –Significant use of independent sector in mental health and care of the elderly (20%) –Long waiting lists (numbers and times) –Increasing use of PFI (Public Finance initiative) for hospital building but not for services

“Wanless” Review Taxation best mechanism NHS underinvestment for 20 years –Buildings –Beds –staff Need for additional capacity Public health in parallel Tax funded system ; mixed provision

Actions Patient “Choice” Foundation Trusts Treatment centre programme –125,000 cases, further 250,000 planned –New staff and facilities –Centrally driven and purchased –Orthopaedics, ophthalmology Diagnostics Primary care Payment by results

Impact Reducing waiting lists –maximum 6 months –18 weeks referral to treatment 2008 traditional private practice declining Provider and doctor resistance Threat to existing providers –Public and private

Unanswered questions Failure regime –Closure? –Politics? Level playing field for NHS? Sustainability of strategic services ? Chronic disease management? –Incentives to admit Overcapacity?