Independent sector treatment of NHS patients is not a new phenomenon. NHS GPs, ophthalmic and pharmacy services have all largely been provided by independent contractors since the formation of the NHS in 1948. Today, independent providers deliver an even wider range and breadth of services to NHS patients.

Some of the achievements by the independent sector have been made by filling niches beyond traditional NHS provision, some through partnership working and others have arisen as the result of new policy developments. All services provided by the independent sector must comply with Healthcare Commission standards including quality of treatment, provision of information, management of complaints and facilities and equipment.

The rise of patient choice and the increased focus on public participation and the individualisation of health services have had, and will continue to have, a major impact on the future provision of NHS services. Similarly, the current political environment with the increased focus on a diversity of provision looks set to remain a cornerstone of policy irrespective of political control in the short-term.

I have long been impressed by the difference that independent providers make to the care of NHS patients and the NHS Confederation works very closely with the independent sector, alongside our ordinary NHS members, on all aspects of policy and influencing work.

The NHS Confederation's affiliate scheme, open to private, voluntary and not-for-profit providers of NHS services, was launched in 2004 to reflect the increasing diversity of the service providers in the modern NHS. Our affiliate members have the opportunity to connect with NHS leaders at events and join the voice of NHS leadership in influencing central policy and contributing to the public debate.

At this time of significant change in the health service, it's easy to forget that all providers of care are focused on improving the lives of patients. Like their NHS colleagues, the independent sector makes significant and wide-ranging improvements to the lives of NHS patients in their care.

NHS Confederation affiliate members are involved in providing services to the NHS in mental health, community provision and increasingly in diagnostics and elective surgery.

More than 80 per cent of those who use mental health services in the independent sector are NHS patients. There is a long history of charitable hospitals providing mental health care in the UK and the use of different services from a range of providers in the delivery of NHS mental health care has been common for many years. New services have been developed in partnership with the NHS, especially where it has not been viable for the NHS alone to provide enough capacity and specialised services.

The amount of mental health care provided by the independent sector is likely to increase as the government encourages more diversity. In many cases, the independent sector offers expertise, extra capacity in some very specialist areas and innovative ways of providing care. In addition, independent providers of mental health services can actually save the NHS money and free up NHS beds.

Independent mental health service providers are increasingly delivering niche services for specific groups of people - including secure services and substance misuse services. Many also provide community services especially appropriate for young people and black and minority ethnic communities, who may be less likely to engage with traditional NHS services. In the North West, one independent provider has developed a young person's service in partnership with NHS child and adolescent psychiatrists. The service ensures a fast assessment of young people with mental health problems and also makes sure they are discharged from hospital quickly and with the right support in place.

The recent government white paper Our health, our care, our say argues that more care should be provided in the community and promotes the need for a diversity of providers: 'We need innovative providers...who work together as part of a joined up system. We also need to support different approaches from non-traditional providers. We will encourage the independent and voluntary sectors to bring their capabilities much more into play in developing services that respond to need.' For many years, independent providers have worked locally to provide good and accessible care services on behalf of the NHS within the community.

Today, independent organisations are developing new community services, building innovative partnerships and complementing NHS services. They are providing services which help patients return home quicker after operations and treating people with long-term conditions in the community - reducing the number and duration of hospital admissions. In North Yorkshire, chemotherapy is being delivered to NHS cancer patients in their own homes by an independent provider.

Working in partnership with NHS ambulance services, independent providers are helping to deliver out-of-hours services in the community offering patients a single point of access and alleviating pressure on local accident and emergency departments. Examples of joint working are also emerging between independent providers and social care, housing and education services enabling patients to live independent lives back in the community.

The NHS Plan, published in 2000, recognised that there wasn't enough capacity to speed up patients' diagnoses and their treatment. The bottleneck in waiting times for diagnosis was identified as a particular problem area. In addition, the ambitious plan to bring waiting times down to six months by the end of 2005 and then to cut the time between GP referral and treatment to 18 weeks by the end of 2007 led the Department of Health to look beyond traditional NHS providers to help reduce waiting lists.

Increasingly the independent sector has become a partner in developing diagnostic services and non-emergency elective surgery on behalf of the NHS. Extra capacity has been introduced through the development of independent sector treatment centres (ISTCs). These centres are built and run by independent organisations to carry out diagnostic testing and operations on behalf of the NHS.

In 2003/04, 99,000 operations were provided to NHS patients by independent providers. And over 250,000 NHS patients have been treated by or received a diagnostic service from the independent sector with patient satisfaction running at over 94 per cent.

There has been much political and media interest in the development of ISTCs and some criticism that they have taken on work that could have been provided by the NHS. However, there is some evidence that suggests ISTCs have reduced waiting times and freed up NHS capacity for both diagnostics and elective surgery.

In the South West, an ISTC has developed a innovative blood conservation process that processes and cleans a patient's own blood during and after surgery and then re-transfuses it to the patient aiding the recovery process. Other independent providers assist NHS patients in different ways such as supporting early discharge of patients who have recently had operations. Not only does this help to save the NHS bed days, there is also evidence that patients' recovery and healing time is quicker in their own surroundings.

The NHS Confederation believes that there should be a fair and level playing field for all providers of care in the NHS - from the traditional NHS and foundation trusts to commercial and voluntary NHS providers. There are several key challenges to be met in the development of a level playing field which will enable providers from all sectors to provide high quality care on an equal footing. The Confederation has been working with our members to deliver a set of principles for fair and level playing field for all providers. We believe that the hallmarks of a successful, plural system working for all patients will be:

• Strong commissioning, with a local focus;
• Open and clearly accredited entry mechanisms for new providers;
• A single standard of licensing;
• Providers from all sectors within a dynamic market;
• An independent and fair payment mechanism, which balances quality and price pressures;
• Common regulation, working to better regulatory standards, underpinned by a meaningful and common dataset;
• Providers and commissioners successfully managing a variety of simultaneous multiple long-term relationships.

As we look forward, all providers of care to NHS patients face challenges as they respond to complex patient needs in a timely, cost-effective way using increasingly sophisticated ways of working in a variety of settings. These have to be achieved at the same time as responding to new organisational arrangements and policy initiatives. As we rise to these challenges, the delivery of high quality patient care is of course at the top of all our agendas.

For more information about the NHS Confederation's affiliate scheme, please go to: www.nhsconfed.org/affiliate

Dr Gill Morgan DBE
Chief Executive
NHS Confederation

Health Investor - September 2006