Why NHS Trusts are putting their trust in 18 Week Support

Is outsourcing the solution?

Traditionally, ‘outsourcing’ (mainly to independent sector providers) has been a way to tackle such problems. Outsourcing can be flexible and permits Trusts to gain access to additional clinical capacity to reduce patient waiting times. These benefits often come with a heavy price tag and potential patient safety concerns. Moreover, research suggests that using private hospital providers who charge above the national tariff is simply a “quick fix” that adds to the Trust’s problems. Recent research by Centre for Health and Public Interest (CHPI) found that Trusts struggle to monitor such contracts and that it is difficult to know whether a provider is ‘cutting corners, or reducing quality in order to gain extra revenue.’

A new solution

Insourcing is a relatively new concept. It involves an independent provider carrying out services ‘in-house.’ Clinical teams are brought in to work directly with the Trust and in collaboration with existing in-house clinical teams. This has a number of benefits over outsourcing:

  • Reduced waiting times;
  • Improved patient care;
  • Reduced administrative burden of outsourcing;
  • Making better use of existing resources;
  • Real-time updates to PAS/patient records and clinic letters;
  • Safer care and Less adverse reputational risk.

By utilising any spare assets or capacity within a Trust, insourcing allows for a high volume of patients to be seen in a relatively short space of time. This can help a Trust clear backlogs, and simultaneously meet an increase in demand. Paradoxically, more activity leads to more income and reduced waiting times – whilst also reducing the threat of penalties being levied by Commissioners. Moreover, because insourcing may be delivered below the national tariff, any savings can be passed directly on to the Trust. By bringing in external expertise to work alongside a Trust’s own clinical and operational teams, there is the added bonus of creating a shared learning experience and boosting staff morale – another major NHS concern, and one which is inherently tied to performance.

Insourcing also enables the Trust to retain overall control over service delivery. By seeing patients within a hospital’s own setting, the Trust can monitor the safety and success of these services and any concerns or complaints can be dealt with quickly.

Better patient care

While outsourcing can be expensive and a burden to manage, insourcing makes better use of existing resources. There is a greater continuity of care and improved patient flow as patients are seen within the Trust’s own setting and managed from referral through to discharge. Moreover, research has indicated that patients prefer to be seen at an NHS Trust as opposed to a private setting, so there is less risk of patient non-compliance or high cancellation rates. DNA rates for an insourced solution are also consistently lower than for outsourcing.

Furthermore, because the Trust manages the back-office administrative support, there is no risk to patient confidentiality or issues of information governance. Administrative errors, such as duplicate bookings, can be avoided, meaning precious resources are not wasted.

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