London NHS hospitals struggling to cope with the Covid-19 pandemic bought £36m of cancer care, cardiology and other services directly from the UK’s largest private healthcare group, HCA, last year. Analysis of monthly public data from NHS trusts, published by the Centre for Health and the Public Interest (CHPI), reveals the extent to which London hospitals have become reliant on private providers, prompting concerns about creeping backdoor privatisation of the health service. “Covid has been very much used as a cover for shrinking NHS care and expanding private healthcare provision,” said Allyson Pollock, a clinical professor of public health at Newcastle University and an honorary professor at University College London. She said the money would be better used to invest in NHS staffing, equipment and expansion. This level of spending by individual NHS trusts was unprecedented for cancer care and cardiology, said CHPI. The spending is over and above the £2bn so far handed over from central NHS budgets to private hospitals during the pandemic. In recent years NHS hospitals have bought extra capacity from private providers for simple procedures such as hip and knee operations, but they have not previously spent large sums outsourcing more complex treatments. HCA said its support had allowed 14,000 complex cardiac and cancer NHS patients to receive the care they needed. Many of them were casualties of the widespread suspension of normal care during the pandemic, as resources were diverted away from many specialisms, including cancer, to treat Covid-19 patients. By outsourcing some of the most pressing cases on their backlog to HCA, trusts ensured that those most in need were cared for. Prior to the pandemic, HCA carried out virtually no work for the NHS. Founded in Nashville, Tennessee, in 1968, and listed on the New York stock exchange, HCA is the largest healthcare company in the world and has more than 30 hospitals and clinics in London and Manchester, with another one due to open in Birmingham this year. CHPI’s research shows the company was the biggest private beneficiary of funds spent on cancer care and cardiology direct from NHS hospital trusts in London between December 2020 and December 2021. The biggest spender was Guy’s and St Thomas’ NHS foundation trust, which bought more than £20m of services from HCA. Barts was the second largest spender, with £10m. University College London hospital (UCLH), Imperial College, Chelsea and Westminster, and the Royal Free also paid for HCA services. “The extent to which the private sector is now being used to deliver NHS cancer care services is unprecedented,” said David Rowland, the director of the CHPI. “We estimate it is only likely to grow as the NHS comes under more pressure over the next few months.” HCA said it had chosen not to take part in a deal struck between NHS England and private hospitals this month for up to £525m for reserve beds and staff in case of an Omicron admissions surge. A spokesperson for the firm’s UK arm said: “We can safely provide this level of complex care because of the deep clinical infrastructure we have in our hospitals, which includes the highest levels of intensive care and trained staffing support. We work with NHS trusts on an individual basis and in response to their requests for support.” The fees the London NHS trusts paid to HCA were covered either by NHS England, which has agreed to pay private hospitals £10bn over four years to help tackle its backlog, or from the Treasury-funded elective recovery fund, created last summer to help hospitals recover their levels of activity post pandemic. Guy’s and St Thomas’ said the money had been mainly spent on oncology and cardiology, as waiting lists had risen during the pandemic. A record 6 million people are on NHS waiting lists for routine hospital care in England. A trust spokesperson said: “We have worked with HCA to provide complex elective care from admission to discharge, including surgery and supporting diagnostic services, such as scans, while continuing to maintain urgent and emergency care to Covid and non-Covid patients on our NHS sites.” Barts Health NHS trust mainly bought cardiology and breast cancer surgery services from HCA. A Barts spokesperson said: “The trust has used HCA to enable staff to continue to provide planned care in a separate Covid-free environment while hospitals prioritised urgent and emergency care and Covid-19 patients.” He added that as the pandemic eased, it was likely that Barts would continue to use the private sector to assist with reducing waiting times. UCLH spent almost £3m with HCA last year, buying more than 500 procedures, most of them surgery for breast, head, neck, bladder and stomach cancers. Imperial College Healthcare NHS trust spent £2.6m. Chelsea and Westminster hospital bought nearly £900,000 of services from the company, while the Royal free hospital spent £2,000. Chelsea and Westminster said it used HCA mainly to provide colorectal and gynaecology cancer treatment to patients, primarily between December 2020 and March 2021. “This short-term measure must not become a long-term expediency to running down the NHS in favour of the private sector,” said Colin Hutchinson, the chair of the campaign group Doctors for the NHS. “The principal reason the NHS now needs to make use of the private sector is because of long-term underinvestment.”