REPORT AUTHOR LIST OF TABLES LIST OF FIGURES EXECUTIVE SUMMARY 1

Transcription

1 TABLE OF CONTENTS REPORT AUTHOR FOREWORD LIST OF TABLES LIST OF FIGURES ii iii ix xi EXECUTIVE SUMMARY 1 1. MARKET Scope and definition Revisions Estimates for clinics Market shares Private acute medical care providers market size Private acute medical hospitals and clinics market Market size and growth trends Provider market shares Private patients only hospital market Market size and growth trends NHS Private Patients Market size and growth trends Regional trends Future trends and prospects Other private acute medical care components Screening Fertility treatments Pregnancy terminations Specialists private practice fee income Funding by payor type independent acute healthcare hospitals and clinics Self-pay spending non-cosmetic spending and cosmetic surgery revenues Private acute medical care market structure and activity overview Regional breakdown of capacity mainstream independent sector hospitals Sub-regional capacity in London, the South East and East of England Capacity trends over time independent sector hospitals and clinics Activity independent sector s patient admissions Mainstream hospitals (with inpatient/overnight bed capacity) activity data Independent sector s share of admissions Market structure of Private Patient Units and structural trends Regional structural trends Staffing Specialists 30 LaingBuisson Private Acute Healthcare, fifth edition v

2 Table of Contents Consultant supply and private practice Future supply of private practice Performance measures Profitability of the independent sector Quality CQC judgements POLITICS AND REGULATION Politics past, present and future Emergence and development of private acute medical care Philosophical opposition to private healthcare under Labour Engaging the independent sector to upscale NHS performance The Coalition government reforms in action, Political environment for the NHS under the Conservatives, 2015 onwards NHS performance under the Conservatives and future funding The development of choice for patients and use of the independent sector Commissioning and NHS outsourcing partnerships Labour Party policy for the NHS in Regulation of the independent acute medical care sector Overview Regulation of quality standards by the Care Quality Commission Scope of independent acute medical care regulation in England Outside the scope of regulation The essential standards in England Care Quality Commission developments for independent acute hospitals and clinics Monitor and NHS improvement Licensing Setting NHS prices Competition investigations Office of Fair Trading Competition and Markets Authority (previously Competition Commission) Remedies and author s view Remittal and appeals PHIN and performance data PAYORS Private medical cover Recent trends in private medical cover Private medical cover market structure Future prospects for private medical cover NHS purchasing Market value and trends Activity and provider shares hospital admissions 69 vi Private Acute Healthcare, fifth edition LaingBuisson

3 Table of Contents Admissions by specialty Activity and provider shares diagnostics Future prospects and trends Independent sector providers and patient choice Self-pay patients Market value, & growth trends Regional trends London versus the rest of UK Provider self-pay trends Historic trends NHS performance waiting and treatment restrictions Future prospects and trends Cosmetic surgery Cosmetic surgery future prospects and trends Overseas Market size and growth trends Projections and prospects MAJOR PROVIDERS Independent sector market concentration and shares Independent sector provider type New independent acute medical capacity and structural trends Capital investment by incumbents Full-service & specialist inpatient acute hospitals Day surgery only including specialist facilities Outpatient and diagnostic clinics Specialist outpatient clinics NHS acute services managed by independent sector NHS providers private income market shares Specialisation New PPUs including partnerships Other acute markets Screening Fertility Pregnancy Terminations Independent sector major provider profiles BMI Healthcare Spire Healthcare HCA Nuffield Health Ramsay Health Care Care UK The London Clinic 129 LaingBuisson Private Acute Healthcare, fifth edition vii

4 Table of Contents Aspen Healthcare Circle Bupa Cromwell INVESTORS Major investor review Netcare Mediclinic International HCA Healthcare Inc Tenet Healthcare Corporation Bridgepoint Capital Toscafund/Penta Capital Aurelius Fidelity International RCapital BlueGem Capital Partners Life Healthcare China Resources Group/Macquarie Group Apposite Capital CBPE Capital Recent acquisitions MARKET POTENTIAL Demand Supply 146 APPENDIX 1 GLOSSARY 149 APPENDIX 2 KEY LEGISLATION 153 APPENDIX 3 REGULATORS 155 APPENDIX 4 TRADE ASSOCIATIONS 157 APPENDIX 5 LIST OF PRIVATE PATIENT UNITS (WITH OVERNIGHT BEDS) 159 APPENDIX 6 FINAL CONCLUSIONS OF THE CMA S INVESTIGATION INTO PRIVATE HEALTHCARE 163 APPENDIX 7 FINANCIAL APPENDIX 167 viii Private Acute Healthcare, fifth edition LaingBuisson

5 LIST OF TABLES Table 1.1 Table 1.2 Table 1.3 Private acute medical care hospital market value (independent acute medical hospitals and clinics and NHS private patients) in the UK, & 2017 projections 7 Private patients only hospital market value (independent acute medical hospitals and clinics private patients and NHS private patients) in the UK, & 2017 projections 11 NHS private patient revenues in UK, private patient volumes in the NHS in England, and % of NHS finished consultant episodes in England, 1990/ /17 13 Table 1.4 NHS private patient revenues by UK region, and real growth, million, 2013/ /17 15 Table 1.5 Screening spending (market size) UK, real growth, and real index, Table 1.6 Trends in fertility treatment, all sectors UK, /17 18 Table 1.7 Table 1.8 Table 1.9 Number of independent sector abortions in England & Wales, and estimated UK independent sector clinic revenues, Independent acute medical hospitals and clinics UK market value, and revenues by purchaser, & 2017 projections 23 Regional share of UK mainstream independent acute medical care hospitals, share of overnight bed capacity, and share of operating theatres, January Table 1.10 Independent acute medical care hospitals and beds, UK Table 1.11 Patient admissions in mainstream hospitals (with overnight bed capacity), by type of admission and hospital type in the UK, calendar Table 1.12 Regional breakdown of PPUs with overnight bed capacity, UK, January Table 1.13 Table 1.14 Table 1.15 Table 2.1 EBITDAR margin and pre-tax profit/loss margin for major for-profit hospital operating companies latest accounting period, and previous year shown in brackets 34 Breakdown of (latest) CQC quality assessments of services provided by core independent hospitals in England (independent hospitals with inpatient facilities + day surgery hospitals of leading independent hospital groups), as at start of March 2018, covering 183 hospitals 36 Overall (latest) CQC quality assessments for core independent hospitals in England (independent hospitals with inpatient facilities + day surgery hospitals of leading independent hospital groups) by hospital provider, as at start of March 2018, covering 183 hospitals 36 CQC quality ratings for independent sector acute hospitals in England, 206 hospital locations as at 2 January Table 2.2 NHS tariff changes 2014/ /17 56 Table 3.1 Private medical cover persons covered, payouts (claims paid), and average price for private medical cover policy, LaingBuisson Private Acute Healthcare, fifth edition ix

6 List of Tables Table 3.2 NHS purchasing of UK independent acute medical care services, & 2017 Projections 68 Table 3.3 Table 3.4 Table 3.5 Table 3.6 NHS funded hospital admissions for acute medical care in the independent sector in England, 2004/ /17 & 2017/18 April to December 70 NHS funded admissions treated by independent sector (IS) providers by type of speciality in 2016/17 specialty share, proportion of all NHS admissions, and annual growth 73 NHS funded (provider based) diagnostic procedures carried out by the independent sector in England, 2009/ /17 74 Private self-pay spending on acute medical care services in independent sector hospitals and clinics in UK, including non-cosmetic and cosmetic split, & 2017 projections 78 Table 3.7 Proportion of self-financed treatment episodes in independent hospitals for /98 (England and Wales), (UK) 81 Table 4.1 Capacity of major acute medical care hospital operators by number of overnight hospitals, overnight (inpatient) beds, and total operating theatres (OTs) in all facilities, January Table 4.2 Top 20 independent acute medical care hospital providers by revenue, (calendar year unless otherwise stated), and 2016 market share 94 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Bed and revenue shares of the UK independent acute medical care hospital sector (excluding day only operators/facilities) by ownership group, 2016 & New independent acute medical care facilities in the UK by region, service type (fullservice or specialist) and treatment type (inpatient/day/outpatient), from 2014 onwards 97 Future new independent acute medical care facilities in the UK by region, service type (full-service or specialist) and treatment type (inpatient/day/outpatient), from 2018 onwards 99 Top 30 private patient Trust earners, annual growth and % share of UK NHS market, 2016/17 and 2015/ Table 4.6 Revenues of leading specialist IVF providers in the UK, Table 5.1 Main investors in the UK private acute medical care market, including source country, and investment start, at March Table 5.2 Significant acquisitions in the UK private acute medical care market, 2016 onwards 143 Table A5 List of dedicated NHS pay bed units, January 2018 by region, and management type 159 Table A6.1 Competition and Markets Authority Investigation into Private Healthcare Final Conclusions, April Table A6.2 Remedies Recommended by the Competition and Markets Authority, April x Private Acute Healthcare, fifth edition LaingBuisson

7 LIST OF FIGURES Figure 1.1 UK private acute medical care market value by component, Figure 1.2 Figure 1.3 Market shares (%) of the UK private acute medical care hospital market (independent sector hospitals and clinics + NHS private patient revenues) by provider, Real value index UK private acute medical care market, & private patient only (PPO) hospital market, Figure 1.4 Market shares of the UK PPO hospital market by provider, Figure 1.5 Legal abortions carried out in England and Wales Figure 1.6 Segmentation of public and private activity: abortions, England and Wales residents Figure 1.7 Figure 1.8 Capacity indicators (overnight hospitals (H), overnight beds (B) & operating theatres (OT)) by sub-region in London, the South East & East of England, January UK hospital (inpatient and day case) surgical activity breakdown by type of hospital supply (public NHS or private) and type of funding (public NHS or private), Figure 1.9 EBITDAR margin of leading independent sector hospital groups, Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 3.5 Figure 3.6 Market shares for total private medical cover market spending: insured premium income plus self-insured (Healthcare Trusts) derived spending combined, calendar Market shares (%) of NHS revenues generated by independent sector hospitals and clinics by provider, Monthly NHS funded elective surgery (provider based) admissions in independent sector in England, January 2013 December NHS funded acute medical care hospital admissions in independent sector in England in 2016/17 by provider (2015/16 in brackets) 71 NHS funded admissions treated by independent sector (IS) providers by type of specialty, 2016/17 72 NHS funded diagnostic procedures provider in the independent sector in England by provider group, 2016/17 (2015/16 in brackets) 74 Figure 3.7 London GVA (Gross Value Added) growth and Rest of UK GVA growth, Figure 3.8 Figure 3.9 Figure 3.10 Number of NHS patients waiting for start of treatment, and average (median) time waited in England, March 2008 December Waiting time from GP referral to hospital treatment for NHS admitted patients in England Average (median) number of weeks of waiting and percentage of patients waiting more than 18 weeks, March 2008 December Average (median), lowest and highest number of weeks of waiting from GP referral to treatment (admission) on NHS by region, October LaingBuisson Private Acute Healthcare, fifth edition xi

8 List of Figures Figure 3.11 Average (median) waiting time from GP referral to hospital treatment for NHS admitted patients in England at October 2017 by type of treatment, and percentage change in average waiting over the past 60 months (October 2012 to October 2017) 85 Figure 3.12 Annual growth in plastic surgery procedures reported by BAAPS members, Figure 3.13 Figure 4.1 Share of plastic surgery activity carried out by BAAPS members by type of procedure, 2011 and Market shares of Top ten hospital providers in private patient only independent acute medical care market, UK, xii Private Acute Healthcare, fifth edition LaingBuisson