On a recent Sunday afternoon, I was browsing an outdoor Christmas market and munching on a particularly crisp and crunchy apple. At one point, I bit down onto a hard piece of grit and, running my tongue along my teeth, realised the trusty old filling behind my front tooth had finally been dislodged.
A stalwart of my smile, it had been snugly in place since my front tooth was chipped for the first time when someone catapulted into me during an aggressive game of “it” in the primary school playground, and for the second time on the rim of a Cherry Lambrini bottle at a house party in my teens (ah, time’s cruel march).
Luckily surgical masks are having a bit of a renaissance at the moment, but the era of staring at my wonky grin on Zoom meant I’d need it filling in sharpish.
I discovered, however, that my NHS dentist had deregistered me last year. Apparently I should have made an unnecessary appointment during a deadly pandemic to keep my place on its books, which was promptly removed without warning.
Now, it seems impossible to find a dentist that will register me as an NHS patient. I’m not the only one. There is an enormous backlog at dentist surgeries after they closed in the first national lockdown, resulting in waiting times of up to three years for appointments.
Only 11 per cent of dentists listed on the NHS website say they would register adults as NHS patients (and I’ve spoken to at least one practice listed as available to register NHS patients that in reality is not), and less than a fifth would take on children, according to a recent Sunday Times report.
Anecdotally, this trend is being replicated across the health service. As NHS waiting lists reach record levels – the number now stands at six million in England – more and more patients are paying for procedures themselves.
While data for how many patients are using their own funds to pay for treatment is not available, recent polling and trends in the private health policy market suggest a shift.
Thirty per cent of people surveyed in November by Savanta ComRes for the Independent Healthcare Providers Network answered “yes” to the question “Would you be more likely to consider paying for private healthcare than before the pandemic?” – up from 22 per cent who were asked the same question in December 2020, according to results seen by the New Statesman.
More than one in five (21 per cent) say they have already gone private recently because they simply couldn’t get the treatment they urgently need, according to a July poll of over 4,000 people by Populus for the charity Engage Britain. A decade ago, just 13 per cent of all non-emergency surgery on UK residents was privately funded. (For context, roughly 13 per cent of people in the UK have some kind of private health insurance.)
Demand for private health policies rose 46 per cent in the first eight months of 2021 compared with the same period pre-pandemic in 2019, according to the health insurance comparison website, Quotezone.
A look into the 2021 half-year results of a publicly-listed healthcare company called Spire shows 46.7 per cent revenue growth on the first half of 2019 for “self-pay” patients – those who pay for private treatment themselves rather than claiming on insurance. That’s a “record” performance.
Industry insiders say the single biggest reason for this change is people stuck on NHS waiting lists and unable to access the treatment they need.
“Many more people are now looking to pay privately for their treatment. This reflects record level NHS waiting lists, with over a million patients now waiting more than six months for treatment and over 300,000 waiting for more than a year,” says David Hare, the chief executive of the Independent Healthcare Providers Network, which is calling for greater use of independent providers in helping the NHS tackle its backlog.
Private companies have always played a part in NHS provision, especially when trying to bring down waiting times. In 2014 I interviewed Andy Burnham, who was previously health secretary under Gordon Brown and is currently the mayor of Greater Manchester, and he said of New Labour:
“The last government worked with the private sector to bring down NHS waiting lists and they came right down. And that’s how I see it. I see a supporting role but not a replacement role [for private money in the NHS].”
But there is particular concern among some left-wing politicians and NHS frontline workers that the Conservative government is using the pandemic to advance marketisation of the health service.
One GP I spoke to recently, who has worked as an NHS doctor for over a decade, lamented that they had seen “no response from the government at all” to hospitals reaching full bed occupancy in England. “It’s like the government are completely oblivious to the current situation, or they’re completely complicit in it and it’s been their plan all along.”
This echoes the suspicion of the Vote Leave whistleblower Shahmir Sanni who, during the first lockdown in March 2020, wrote for the Byline Times that Boris Johnson and his cabinet “ideologically oppose” the NHS. Sanni’s perspective is similar to the view held by the Labour MP and former care worker Nadia Whittome who, in a debate on BBC Two’s Politics Live last month, argued that the government’s Health and Care Bill will “allow for greater privatisation of the NHS”.
In reality, the willingness of the Johnson government to expend political capital on putting taxes up to their highest level since the Fifties – going against many of their own MPs’ and members’ instincts – to pay for clearing the NHS waiting list suggests that a greater role for private healthcare is not currently a political priority.
The proportion of money spent by NHS commissioners on services delivered by the private sector has remained pretty level at around 7 per cent since before the pandemic, according to the King’s Fund health policy think tank.
But if you count outsourced elective operations, voluntary sector organisations, independent social care providers, GPs (which are mostly private partnerships), and pharmacy, optician and dental services, you reach a share of about 26 per cent of expenditure on private providers for 2018/19 – a 23 per cent increase on 2013/14 – according to research by David Rowland, the director of the Centre for Health and the Public Interest.
The coalition government’s controversial Health and Social Care Act of 2012 raised the number of contracts awarded to private providers, but the latest changes proposed in the new Health and Care Bill (currently being considered by the House of Lords) would actually reduce the role of market-based competition in NHS procurement processes.
“Overall, there is no evidence of a significant increase in spending on private providers or widespread privatisation of services in recent years,” concluded the King’s Fund, which has been robustly scrutinising the government’s pandemic response, in March this year.
However, as the booster programme takes precedence, routine GP appointments and elective procedures will again take a backseat. The waiting list will continue to grow. There is no plan yet to plug the chronic gaps in the NHS workforce, which some say are at the heart of its capacity issues.
Unless ministers are prepared to look the NHS crisis in the eye – and accept they must profoundly improve recruitment – desperate patients will have nowhere to turn to but their wallets.