The Competition and Markets Authority (CMA) has rebuked the private healthcare sector for its slow compliance with requirements to publish transparency data about fees and outcomes to help inform patients.
It also warned the sector about further delays to implementing its 2014 order and revealed it will be watching the sector closely with quarterly oversight meetings.
The regulator also highlighted its desire to work with the Private Healthcare Information Network (PHIN) to enforce data compliance among practitioners and providers.
The private healthcare sector has also been told to up its game on data quality as it is a “long way” off full compliance with the Competition and Markets Authority (CMA) private healthcare market investigation order issued in 2014.
The details were revealed alongside the PHIN 2022-2026 plan to deliver the remaining requirements of the CMA’s Private Healthcare Investigation Order which was published in 2014.
The regulator’s comments followed its approval of the PHIN strategy last week while CMA nominees Claire Whyley and Keith Richards have both been appointed non-executive directors on the PHIN board.
‘Ready to enforcement action’
Sarah Cardell, interim chief executive at the CMA noted the regulator had approved the new plan that PHIN and its members agreed, but issued a warning about further delays.
“It has taken longer than it should have to reach this position and all involved will need to learn from this experience,” she said.
“However, the new plan represents an important step forward to ensure that the private healthcare sector complies with the CMA’s order and patients feel the benefit of high-quality information on the performance of hospitals and consultants.
“We now expect to see PHIN and its members apply a relentless focus on achieving the plan and improving the quality of data that is provided.
“We will monitor progress closely and stand ready to take enforcement action if hospitals or consultants fail to meet the standards and timescales set out.”
Quarterly oversight meetings
The strategy comes as PHIN’s latest analysis shows that more patients are opting to self-fund common procedures such as cataract surgery, hip and knee replacements, with NHS waiting lists reaching record levels.
PHIN admitted full delivery of the CMA order has been slower than anticipated, but there was more information available to patients considering private healthcare services than ever before.
On the regulator’s oversight demands, it said: “PHIN and key partners in the sector will monitor delivery against the agreed plan at quarterly meetings with the CMA. The CMA will continue to monitor progress against the plan and agreed milestones.”
PHIN and the sector agreed they will work with the CMA to identify alternative options if any existing metrics prove unable to be published.
The body added it will work with the regulator to ensure participation of non-compliant providers in the UK.
“The CMA is committed to undertaking such action as is required to ensure that the order is delivered by mid-2026,” PHIN added.
Clarifications required
Work will also be conducted with the CMA to clarify the boundaries set out in the order that determine when providers are required to participate. For example:
The order only focuses on ‘admitted’ patients and not the grey area of procedures delivered on both an admitted and outpatient basis.
This means that PHIN does not have the complete picture of all admitted activity for many procedures and therefore there is not a level playing field on data submitted nor information to publish for these types of procedure.
Greater clarity is needed on the definitions of what is construed as admitted activity in the sector and this must be consistently applied.
Similarly, much oncology, gynaecology, ophthalmology, dermatological surgery, interventional cardiology and radiology activity falls largely into the area of either outpatients or admitted activity depending on which organisation is performing the treatment.
Without a level playing field for these specialties, the information PHIN receives and can publish is not as helpful for patients.
The strategy document also points out that clarification is required from the CMA on whether consultants not registered with the General Medical Council (those registered with the General Dental Council, or allied professions’ regulators) are included under the order.
This would mean PHIN needs to publish information about their practices and that they need to submit fee information.
Clarification is also required about certain treatments and care being included in the scope of the order.
For example, certain legally restricted codes relating to sensitive diagnoses and treatments, as well as patients who opt-out of having their data published or used.
‘Hard work starts now’
Jack Griffin, acting chief executive of PHIN, said: “We are really pleased to have worked across the sector to develop a realistic, workable delivery plan which we are all committed to.
“Of course, the real hard work starts now, but we approach this with renewed energy.”
David Hare, CEO of the Independent Healthcare Providers Network, added: “With increasing numbers of patients paying privately for healthcare, PHIN’s role has never been more important in helping to improve transparency in the sector and to support patients to make the best possible decisions about their treatment.
“We welcome the strong engagement from PHIN in developing its important new strategy which will be key in ensuring patients can navigate the privately-funded care which is available to them in the UK, as well as delivering the CMA’s order.”
For more on the roadmap: Insurers demand faster delivery of fee and outcome data from healthcare providers – Health & Protection (healthcareandprotection.com), ‘Step-change’ needed as private healthcare ‘long way’ off data compliance – PHIN – Health & Protection (healthcareandprotection.com)
