[00:00:00] Hello, I’m Suhail Mirza and welcome to this episode in season three of Voices of Care. I’m joined today by Dr Ian Gargan, CEO, and Pooja Rupalia-Seyani, Analytics Manager at the Private Healthcare Information Network, affectionately known to us as PHIN.

[00:00:15] Voices of Care, the healthcare podcast.

[00:00:20] Ian, Pooja, welcome and thanks for giving us your time today.

[00:00:23] Hi Suhail, delighted to be here as always.

[00:00:25] Thanks for having us.

[00:00:26] You’re very welcome. Ian. It must seem like a lifetime ago. September 2022, I think it was when you took the role.

[00:00:35] Time flies when you’re having fun, Suhail. So yeah, we’ve been busy, but it’s gone pretty quickly.

[00:00:38] It’s a busy time for the private acute sector. And I just thought we’d begin by just a reminder for people of the mission of PHIN. I know there’s a legal requirement, but I think it goes beyond that. It’s more about providing choice for patients, isn’t it?

[00:00:53] Correct. It is about patient choice. Our mission and our vision is to give choice for patients to select the best health care for them, best options so that they can get the optimum outcomes for their or after their health care intervention. So we’re legally mandated by the Competitions and Markets Authority, that’s a government department, to collect data from all the private providers around the country. We have 645 private providers that give us information. And from that then we put together reports and Pooja’s team does that, and we generate those reports that make contextualise that information, but make it useful for the doctors. They put all their information in, they have to. Useful for the providers, but mostly useful for patients, so that they can make the best choices about where they’re going to have their care. We also offer questions and insights. Even if you’re not going to select private health care, you can still ask those questions and have those insights that can help you choose or understand your care in the NHS, which we completely support as well, of course.

[00:01:51] And no pressure on you. But of course, data is the golden thread that runs through all of this, so I guess it’s super busy in terms of the timeline for the order and obviously the demand for people to know more about private health care.

[00:02:04] Yeah. So at the moment I guess we’re primarily focused on delivering the order. But there is obviously the insights that we can provide into what trends are going on in the market. So we try to spend and balance the time between doing a bit of kind of insights and providing trends and what we’re seeing in terms of the market. So recently we published a story on robotics assisted surgery, and we’re seeing kind of huge growth in the trends. So for us it’s the balance of both worlds.

[00:02:37] No. Absolutely. And I think Ian, since we last had the pleasure of your company, it’s a busy time. You’ve got a number of milestones. Tell us a little bit about what you’ve done, evidence backed assessments I think has been quite a big milestone.

[00:02:48] So we delivered a roadmap of exactly how we were going to deliver on our order that the government wanted us to deliver. And our providers are our main stakeholders with the hospitals and the consultants, like I mentioned. But this order had to be delivered by the end of June 2026, but we’re delivering it in three stages. So at the end of October 2024, so very imminently then in 2025 and 2026. However, really what we’re doing is we’re not delivering the order. The order will be delivered consistently forever, as long as the government want to do so and want the private sector to be more and more transparent, but we provide the architecture to facilitate that delivery. So that will be completed and it’s well on its way to completion, first stage of which, and the terrific team that we have, over 50 people work with us, done by the end of October. It’s actually what’s going to happen thereafter from 2026 to 2030 on increased usefulness so we can deliver more reports for like our colleagues who want to generate more data in our conference, colleagues who’ve spoken at LaingBuisson and other places, but also provide bespoke reporting for consultants and hospitals. And the UK is actually very unusual in that it has this mechanism to collect this data, which is, you know, fantastic. And increasingly there is more and more interest from our European colleagues and those in Dubai who want to be able to create the same type of internal architecture. So we’re hoping to do some more international work as well. So there’s lots of work and lots of exciting things going on.

[00:04:18] Yeah, which I think is evidence. I think from the latest stats there were, is it something like we’ve got 70,000 inquiries from 177 countries, countries, and visits onto the website. So definitely very international. Talking about trends, Pooja, you talked about this, Ian, can you give us a little bit of a picture because you’ve got, I guess, the bird’s eye as well as the close up view of private acute. It’s a transition period in many ways. We’ve got an election year, etc.. What’s the picture that you’re seeing in terms of activity? Because you produce these reports regularly in the private sector, whether it’s self-pay, private medical insurance, it’s quite a buoyant market with some mixtures in between.

[00:04:55] So private sector work is increasing all the time. Right. So there’s about 840,000 interventions last year. There’ll be close to a million this year. So private medical, general work is up 4% this year. We see that the self-pay market is levelling out. But private medical insurance and need for that is increasing as the products become more innovative and buoyant as well. Let’s not forget the principles of the NHS are still sacrosanct and we support the NHS, especially in its trauma and cancer care. But the waiting lists are long and people are increasingly frustrated. So the private sector is helping out with that and the government and the future government, if it is going to be a Labour government, has indicated that partnership with the private sector is something that they want to cultivate, more and more they’re already doing it, but while also maintaining the NHS, you know, the importance and the work that we do with them. And over a million people are employed there and take care of millions and millions of patients. I think with about 170 billion spent on that a year, and it was at most in the last year compared to the previous three years. And there will be increased spending but some more planning to go on there. But I think some of our other trends that Pooja can talk to would be with our website and our traffic there. It looks like there’s far more interest in what we’re doing.

[00:06:11] And you talked about the robotics. I want to just touch upon that because the evidence that’s quite interesting. It still seems like, we are in the 21st century, it seems so far in the future. But the numbers that you produced is that the incidence of robotics has been much more ubiquitous than we realised right across the board.

[00:06:29] Yeah. So we’re seeing roughly like 900% increase. So there’s various reasons for this. And all of the detail can be found in the stories that we’ve published. But more and more hospitals are purchasing the robots that are required for surgery. I can’t remember the names.

[00:06:47] Yeah. So there’s different manufacturers for the robot assistants, but we have Stryker and Mako and various others. Yeah, but they do the most interest, like the top procedures would be knee replacement.

[00:06:58] Yeah, knee replacement. And we saw a trend in prostate. So the analysis that we did, we looked at kind of private and NHS and where we’re seeing trends and what procedures we’re seeing in terms of where the robot assisted has been used. And we’ve also tried to look at kind of how this has affected outcomes. But at this stage, we don’t feel like we have enough information to provide kind of a solid story with the backing of the data to support that.

[00:07:30] So watch this space. Hopefully, the data will arise. Just quickly touching upon before we go into a bit more detail is obviously Ian talked about the NHS, how important it is, etc. now, this may be counterintuitive to people, but you obviously collaborate very closely with the NHS in terms of collecting data.

[00:07:44] So we get a quarterly feed from HES. So we collect that information and we also publish it in terms of whole practice. So obviously consultants they will work in private and NHS. So just providing part of a picture for example on our website doesn’t allow a patient to have enough information because it could show lower volumes just because that consultant doesn’t do as many private procedures as they do in the NHS. So we publish both the private and the NHS on the website to try and help patients understand kind of the journey of the consultant as well.

[00:08:24] No, absolutely.

[00:08:25] And really important. We’ve a new portal that’s launching in a couple of weeks for consultants, making it even more intuitive and easy for consultants. We are here to serve consultants needs, so the data is only as good as they provide and verify so that new portal will be. And they can use that portal to download an appraisal form for their yearly appraisals for the GMC and the revalidations. So that’s pretty exciting. And I think it’s important for your patient listenership to understand that while procedures for prostatectomies, total knee replacements, inguinal hernias, skin lesions and hip replacements are done with robots, it’s still the surgeon that does it. The robot just makes some of the work a little more precise, and uses previous CT scanning and other planning to be able to carry out those procedures. And we’re able to report on the outcomes of that. And I think Pooja and Pooja’s team, we show that while we mine a lot of data from the HES data, episodic data, and others for the report, for the EBA quality metrics that we publish on. There’s actually so much more information that PHIN gathered that is very useful to the marketplace.

[00:09:30] Well, sticking with the patient, I wanted to dig deeper about this is ultimately about patients choice and serving the patient. And how do you navigate the data? How do you put it? Because there’s so much of it. I mean, this is over to you here, Pooja. I mean, patients typically want to have information about is there a vegan dietary requirement to what’s the procedure going to cost. So in terms of getting gathering the data and putting it in one place, that’s a big exercise. But I guess you have your own team and procedure to make sure the user journey for the patient is as easy as possible.

[00:10:03] Yeah. So in terms of the user journey for the patient. So we’re working very closely. And Greg who’s the strategic projects lead, he is leading in terms of patient groups. So we are working with patient groups to understand what is useful from a patient perspective.

[00:10:20] That’s the feedback from the patient advisory groups that you’ve got.

[00:10:23] So we’re working with them to understand what is useful from a patient perspective. Obviously everyone has different needs when they’re going into private healthcare. So we try and liaise with the patient working groups as much as possible. And we might not be able to provide them with all the information that they need in terms of things like what meals are being offered. But in terms of the data that we collect, we try and translate it in a way that is meaningful to the end user, in this case, the patient. And sometimes it can get a bit complicated because some of the kind of terminology or just some of the detail behind the data might not be relevant to the patient. So we’re trying to work with them to understand what works for them and what data do we have that can help them.

[00:11:09] Well thank you. And I guess that leads us on nicely to the real window to the world for the patients is the website. And you’ve made some developments, new links. It’s a lot of data, 645 hospitals, 12,000 consultants, I think. And the numbers are going in the right direction in terms of the website, because that is your way of highlighting. I mean, from a personal anecdote, literally two days ago, a member of my wider family is trying to traverse the private acute healthcare market. I was able to help them a lot, but I did put them in touch with your website. So I don’t know if you want to expand just to how important that is for you.

[00:11:39] So the website is an ambassador for the work that we do. It’s our main product where we have the product for the consultant and other reports for the stakeholder. We are there for the patient and patient choice. So PHIN.org.uk puts together and simplifies that. And we’re doing more and more work on simplifying that information. Now while we can’t give specifically like consultant costs, length of stay for a typical. So say you’re having a hip done, say you live in Newcastle. You can go on to PHIN.org.uk and go “Hip Surgeon Newcastle” and you can find a list of surgeons, what the costs will be for that surgeon and then typically what the stats would be like the length of stay, or how likely is it that you get a complication. Some very big stuff but important information. And from that then and it’s important to note that Suhail, you’ll get the consultant price, not the package price. Package price for providers varies, but also it depends on how long you might be in hospital. Very good article though in the Daily Telegraph last year or a few months ago, which actually highlighted what you can expect to pay the spectrum of payments. But we had about 1.8 million people visited our website last year, and we’ve links to all the individual providers too. So if you did want to know what you can have for your tea, you can go to the website and see what they give you in a particular hospital, right. But we’re at about 578, 600,000 now already in the first quarter of this year. So we’re going to smash last year’s numbers, so it’s clearly becoming more useful. And that as Pooja says, is a lot to do with the feedback we’re getting from these patient groups that they consist of patients who have gone through gynae surgery and cancer and hip surgery. So a wide cross section of patients, but we’ll all be patients at some point, Suhail. So we’re trying to tune to the individual which is not an easy task. But we’re getting there.

[00:13:20] No absolutely. Now if we widen the lens a little bit, moving away from the patient, you talked about consultants as part of your stakeholder group together with insurers, of course, in the private hospitals. And my understanding is the richer the information that a consultant is able to provide, the greater engagement that you get from patients. I think 60% of the time that they look on a website is around a consultant. Can you walk me through in terms of how you’re doing that? Because that’s not an easy exercise in terms of data quality data clinics. There’s a whole program that you’ve got to support the consultant journey in terms of data provision.

[00:13:52] Yep. So we have a consultant engagement team, and they are always on hand to help the consultants in terms of filling out information on their specific profile. We also work very closely with the consultants. So as Ian mentioned in the new portal, we’ll be releasing a report which allows the consultant to download the information to help with the appraisals. But as part of our process of building that report, we worked very closely with the consultants. We took them on the journey with us to understand what their needs are, because they’re more involved and engaged. The consultant is with us, and the more that we can provide to them gets, the more invested they will be in making sure that their profile is up to date, that all of their relevant information on our website is correct and accurate, and that they’re looking at the data on a regular basis as well.

[00:14:44] Absolutely. And I think, again, sometimes people tend to think wrongly, that private acute hospitals are all in London. I mean, they’re all over the place. And you’ve been doing quite a lot of work. I just want to touch upon that with the devolved nations, with the likes of the IHPN, etc., across Wales, Scotland, so just be interesting to see this is very much a UK based focus.

[00:15:03] Yeah, we work very closely with the Independent Healthcare Provider Network, IHPN, and our colleagues there, and it’s totally for all of the nations, Northern Ireland, Scotland, Wales, and England. Our readership on our website, we’ve done our stats, come from Manchester, Bristol, Reading, Glasgow, and London. So very much a nationwide effort and we are seeing an increase. While the self-pay is still higher in the devolved nations, there’s equally an increase in the use of private sector medicine and a lot of the hospital groups that are in England are also in those devolved nations. So we’re absolutely obliged to do the same for every member of the population in Great Britain and Northern Ireland.

[00:15:46] And supporting consultants, the hospitals themselves. Is there a separate, dedicated team that works with them? Inbound APIs? We don’t want to get too technical, but, you know, it seems like a simple thing, data send process. But there’s a huge amount of work that goes around that.

[00:16:03] Yeah. So we also have a separate hospital engagement team and they have a similar process. They work very closely with the hospitals to ensure that the data that we’re getting is of good quality when we publish it on our website and within the portal, hospitals have access to various reports, and that lets them know if there’s any issues with their data. We provide them with kind of guides and information on how to improve the data quality, and we’re always working closely with them. So, the hospital engagement team, they have quarterly meetings where they go through just kind of general what’s going on at PHIN, give them updates, but then go into the detail in terms of what specific issues is that hospital having in terms of data quality? How can PHIN help them and what can they do to improve that data quality?

[00:16:52] And again, let’s step back a little bit here. The private acute sector is a significant sector in terms of the healthcare landscape. And you have a legal requirement, as you’ve talked about in terms of delivering the order. But I think what you’re at pains to emphasise, I think you had a plenary with the private medical insurers.

[00:17:12] And we have another one in May and another one in November. So we’re working closely with them.

[00:17:15] So I think the emphasis there for you is to say, well, look, we’re working with you, but this is something beyond the legal requirement that you’re trying to work with the insurers.

[00:17:22] We have to be useful, this is not just sustaining and adhering to an order. We have to be useful, and we want to be useful for patients. And the best way to be useful and private medical insurers, hospitals and consultants are all working for the same person, the patient. So the private medical insurers want to understand, you know, be able to get reports on what’s useful for patients and what the feedback is with the you know, we’re only as good as the data we get from the sites of the hospital. So we want to help them, as Pooja has described and the consultants. So yeah, it’s a much bigger picture of what we can do and what the opportunity is. We’re also gathering a lot of information at the moment, which is about admitted patient care, and that only accounts for about 30% of actual patient work. Much more work is done as day case and outpatient. And we do collect some data, patient work as well. A lot of work say cataract surgery. We look at their interventions and outcomes, but we are looking to expand what we collect in terms of information over the forthcoming 2 to 3 years and from 2026 to 2030, that we can include wider health network information, whether that’s all of day case outpatient work, more about diagnostic scoping and then, you know, potentially we could even work with other health areas and, you know, physiotherapists and dentists etc.. So this is endless in what we can do to provide. So as long as the sector and the patients feel that we’re useful, then we think we’ll be able to cultivate a bigger follow.

[00:18:49] And the feedback you’re getting from your teams with the consultants, hospitals, private medical insurance is there is a receptivity and a proactive desire to engage and support the sector in terms of its transparency.

[00:19:01] Yeah. That’s correct. So I guess because we’re working very closely with them, we’re bringing them along with us on this journey. And I’ve worked at PHIN for quite a while, so I’ve seen how the mindset has changed. Whereas when I first joined PHIN in 2016, the mindset was, we don’t want to do this, we don’t have to do this. But I think along the years we’ve kind of shown what value this brings. Yes, there’s a legal mandate, but the key thing to remember is the value that it brings for the individuals involved. So the hospitals, the consultants, but also for the patient. And at the end of the day, it’s the patient that does matter.

[00:19:37] Yes. Not just the letter of the legal requirement. I guess it’s the spirit that you’re talking about. And that’s interesting to see that change. So I want to pan the camera back a little bit more now and look at the broader healthcare picture, we’re in an election year, in case anybody hadn’t realised. And let’s look at private acute sector in the wider context. Now the NHS, the British Social Attitudes Survey in March of this year made for some sobering reading. I mean, record low levels of public satisfaction with the NHS for the first time, under 25%, 13% for social care, which is in a really poor state. Remaining committed to the principles of the NHS. Now the politicians, whether it’s Ed Davey, Wes Streeting, have been quite strident in talking about, as you said earlier, the role of the private sector. Can you sort of unpack that? Because it’s quite a transformative environment, but one full of opportunity potentially.

[00:20:33] Yeah, I think we need to get away from this independent public sector. We just need to talk about care. Right. So how do we have how do we get rid of the waiting lists, make it more efficient and make care available to all. And there’s a massive opportunity there. And some creative business planning needs to be done effectively rather than just saying same model, different money, same placement of resources or, you know, generally looking at the same topics, being a little more creative, and I would say Suhail being more myopic, like just look at 1 or 2 things that we can do. Unfortunately, as all of us who are interested in healthcare, when you start getting into that conversation, you feel like you want to do all things for everyone, and it’s just not possible in a lifetime. So what you should do is take bite sized challenges, you know, 1 or 2 picks. And look, I’m not running the NHS. It’s far more complicated than that, ultimately there is less than a quarter of the population that were surveyed said they were satisfied with the NHS, but nearly half of that population said they still would like the government to pay money towards the NHS because they love the principles of the NHS, as does the private sector want, and they have their own principles which are very similar, so how can we partner? There’s mixed messages coming from government, and I’m not going into a political debate.

[00:21:48] IHPN, my colleague, Mr. David Harewood, would have much more insight than me about this. But ultimately partnering and helping move public patients to private sector, which there are some mechanisms to do that and back is probably the way to go to be able to really hit hard on those wait lists. I actually think the private sector is here to stay. I think the manifesto of a Labour government and the Conservatives say, oh, we’ll help get the private sector to help out and then we’ll be fine. Because as a doctor and as a psychologist who’s worked in social care, that’s never going to happen. I can tell you that right now. So and I’m not afraid to absolutely, unambiguously say that, the private health care sector and the public sector are here to stay. All right. So how do you make them effective together and more productive and then not stress the population with this worry of not knowing where their care is coming from and have these long waiting lists. So I’ve seen the manifesto change and the governments over the last few years. And, you know, ultimately the politician wants to be able to say what people want to hear. But I think that there’s an opportunity there that’s missing. And if we’re able to help the NHS management as well as the private sector management to work closer together, we can provide an ideal solution.

[00:22:59] And I think on that spirit, I was just talking to Pooja earlier, people don’t realize you talked about the collaboration with the NHS. Part of this whole discussion is to ensure that actually data is available across the system, from each part of the system, so people can make informed choices, not just the patient but also the providers.

[00:23:18] Yeah. So I think obviously being an analyst, I think data is key and having access to the whole picture is key. And understanding what’s going on in the sector as a whole. As Ian mentioned, it’s a health care sector. Yes, there’s a private side, there’s an NHS side, but unless you have the full picture, it’s hard to understand what’s going on in terms of trends and patient outcomes. And I know you briefly touched on the politics, but from my perspective and from a data perspective, I just hope that data is used to help inform those decisions because decisions driven by data are much more effective from my perspective.

[00:23:57] And what a wonderful world that might be.

[00:23:59] But and the trends are important, just to even understand a very tangible example, when I started orthopaedic surgery, we would change a person’s hip and we’d tell them to stay in bed and they’d be in bed five days, and then we discharged them and they’d get physio and hopefully they get better. Now in, you know, 2024, we’re doing hips in a day. They’re straight out of bed. They’re running a marathon in three months. And the first bilateral hip replacement done as day surgery will be done this year. So those trends you know, that’s just a typical example of how medicine moves on really quickly. And patients have a right to that insight.

[00:24:31] Yeah I think you’re seeing the marrying of technology and data perhaps being the drivers of decision making, or at least a bigger role. One final thing to end with, we began with discussions of the order. Your annual progress report talks about your three priorities, and one of them, of course, is to deliver the order. And you’ve been on record to say you want to do that at pace. So you touched upon it now. So the milestones are set. You’re confident and looking beyond that period as well.

[00:24:56] So the sector has to deliver the order and their full compliance is definitely being held by the Competition and Market Authority encouraging the sector to comply. We talk daily, you know, very close to the CMA and we talk to the to our providers daily. And we have to make sure everyone’s aligned and going in the same direction. That’s no small task, and we’re 100% going to hit our milestones for the order in terms of the architecture. October 31st this year and then the subsequent 25 and June 2026, every faith the team are going to do that. No doubt in my mind, it’s actually what we’re going to do after that and beyond 26 for bespoke reporting, be able to create even more data and continue to do that work. That’s delivering the order and the legal mandate as we just talked to, but actually much more than that. So I think that’s what makes us really excited. And PHIN, are much bigger than an order and what we can do for patients.

[00:25:46] So a really busy future for you in terms of data beyond physiotherapists, new occupation groups that Ian’s talked about.

[00:25:53] I think it’s an exciting place to work at. I think having access to information that nobody else actually has access to, and being able to see the insights and actually work with data that has a positive outcome in the end and you’re helping other people. So I think, well, it does sound like a lot of work. I think it’s all exciting and good work.

[00:26:14] I think. On that positive note, Pooja, Ian, thank you very much for your time and insights. As always, I’m sure we’ll invite you back to see progress on the milestones and this bigger picture that you’re sharing. But thank you very much for your wisdom.

[00:26:25] Thank you Suhail.

[00:26:26] Thank you.

[00:26:26] My pleasure. If you’ve enjoyed this episode of Voices of Care, please like, follow, and subscribe wherever you receive your podcasts. And if you want to know more about how we are re-envisioning health and social care, please visit newcrosshealthcare.com/voicesofcare. In the meantime, it’s goodbye from Suhail Mirza and look forward to seeing you on the next episode.

[00:26:46] Voices of Care. The healthcare podcast.