Feature

Figuring out private health care

Charting the size of the private health care sector in the UK isn’t easy as it should be, say the Radical Statistics Health Group

Statistics on the private health care sector are few and far between. Only limited aggregated data are collected from private hospitals and nursing homes,¹ which do not contribute data to the national systems on NHS in-patient and day case care in the four countries of the UK. Pay bed units should contribute to Hospital Episode Statistics in England, but there is considerable under-reporting.² Some data for England and Wales are collected through occasional surveys.^{3 4} Although the directories published by Laing and Buisson contain much more detailed data about the private health care market, they cost from £150 to £300, making their contents practically inaccessible, apart from the few extracts published on the company’s web site.⁵ Here, we use data from all these sources in an attempt to chart trends in private health care.

First, to set this in context, Figure 1 shows that the average numbers of NHS beds available daily in England – as in the other countries of the UK – decreased markedly during the last quarter of the twentieth century. Although the biggest fall resulted from the closure of the long stay psychiatric hospitals, bed availability in general and acute specialities and in maternity departments also decreased. The decline was greatest during the mid-1980s when the private acute sector was expanding, as Figure 2 shows.^{5 6} There was a major growth in the capacity of for-profit hospitals, while that of others declined.

But the private acute hospital sector is small compared with the numbers of beds in private nursing homes, as Figures 3 and 4 show. In Scotland data for private hospitals and clinics are not routinely published, perhaps because there were only 10 of them in 2000.⁷ Figures 3, 4 and 5 point to increases in numbers of nursing home beds in the early 1990s, before numbers levelled off later in the decade and dropped at the end. Earlier data for England are not shown because of changes in data collection. The total numbers of nursing home beds in England rose from 50,895 in 1985 to 176,392 in 1993/94, while numbers of private acute hospital beds rose from 8634 in 1985 to 11,371 in 1993/94.⁸

Figure 5 also shows increases in the numbers of Scottish nursing home places contracted for health board use. Analogous data are not available for England and Wales, although they do collect data about the increasing numbers of local authority supported residents in these and other homes.

Bed occupancy rates in nursing homes in England were around 80 per cent in the late 1990s, a similar level to the NHS.9 In contrast, the occupancy rates for private acute beds varied between 50 and 55 per cent, showing that the private sector in England has plenty of spare capacity. The pressure to use it will increase as a new generation of smaller NHS hospitals built under the PFI replaces larger, older hospitals.

In 1997/98, just over 10 per cent of operations in private hospitals were funded by the NHS and nearly half of these were terminations of pregnancy.³ Taken the other way round, 14.5 per cent of elective operations in England and Wales took place in the private sector, a level which had not changed since earlier surveys.⁴ These data underline the need to ensure that data about the activities of the private sector are collected routinely, especially if NHS funds are to be spent. The Care Standards Authority and its counterparts in other countries should use their powers to ensure that the private sector participates fully in national data collection systems.