The NHS Waiting List Reduction Framework Agreement: what is it and how does it work?

Throughout the coronavirus pandemic, many have raised concerns over the ability of the NHS to cope with acute ICU admissions and having capacity for respiratory beds. This, rightly, has been at the forefront of governmental agendas to address the most urgent public health issue experienced in generations. Anyone who has tried to use healthcare services during this time will be familiar with the letters, automated messages and disclaimers that many health services are running on reduced staff and following protocols to reduce patient contact. Whilst a large stockpile of COVID related equipment has amassed across the country, those requiring elective surgery have been given uncertainty as to their chances of having their procedure, at least until the pandemic is under control.  For those with orthopaedic issues and chronic pain which may be having a drastic effect on the patient’s life and wellbeing, an indefinite extension to their waiting times would have been a heavy, hopeless toll.

Many organisations have used private healthcare companies to streamline their processes, as seen with independent diagnostics for x-ray, MRI and CT scans. NHS England has published a new open opportunity contract notice valued at £10bn ahead of an intention in September to establish a framework agreement of service providers capable of helping NHS trusts and services reduce waiting times impacted by coronavirus. The notice, which was runs until August 27, 2020, will allow potential suppliers to engage with NHS England about involvement on the Waiting List Reduction Framework Agreement. Once established, according to the contract notice, the outsourced framework is expected to run from November 2020 through until December 2022.

Normally, patients who are referred for surgery or treatment have a statutory right to expect a procedure within 18 weeks, yet those times have ballooned in the face of the pandemic. Several large private healthcare suppliers including organisations like BMI, Spire and Nuffield are expected to tender for diagnostics, cancer treatments, surgery and other services. Earlier in the summer, NHS England discussed the rationale behind the tender, “Tens of thousands more people will be able to benefit from quicker access to surgery and other procedures, as well as vital tests and checks over the coming weeks, as a result of this deal, which is good news for patients”.

It emerged in mid September that some NHS patients had waited 37 weeks for their procedure, tests and diagnostics, with over 50,000 patients waiting a minimum of a year without treatment. Not only is there the primary issues of a reduced quality of life, pain and uncertainty over patients future, this waiting time also produces secondary implications like sedentary lifestyles, mental health problems and reduced productivity, potentially all further worsening the initial condition. For those who cannot afford private healthcare, the enforced wait times currently imposed by NHS services are sure to increase reliance on other services such as physiotherapists and mental health departments. By the end of this year, it is expected that 1 in 6 people in the UK will be on an NHS waiting list for some form of healthcare. An interesting aspect of this tender is that NHS emergency and urgent patients could also be triaged from intensive care and A&E departments to reduce demand on those services which are overrun during high usage (and the complications of COVID and non-COVID wards).

The companies completed their bids at the end of September, and are now expected to be awarded the contracts starting in November, bringing hope and optimism to those who have long waited for treatment. The merging of private and public healthcare is an interesting proposition, exposing patients to potentially higher levels of care and diagnostic equipment which is just not available on NHS services which feel the stretch – regardless of the pandemic. These outpatient and inpatient services which often afford higher quality equipment, scanners and the latest medicine, are funded predominantly by patient insurance and, in this case, the government tender. Many healthcare departments in the NHS have been running at 60% capacity since March, with physical distancing and room restrictions posing even more asterisks over the ability of the NHS to satisfy routine and elective procedures. Although a national health service is imperative in this country, the access to potentially higher levels of care (and treatment and diagnostics not available on the NHS) will serve to further improve the quality of life of these patients, and reduce their reliance on other NHS services. In any case, the £10 billion figure is a predicted number, and is dependant on the demand over a four to five year period.