Housing, heating, food – all these essentials have been subject to the whims of inflation over the past two years. While prices are now increasing less rapidly, they’re still rising, and interest rate hikes are expected to follow. Healthcare has, however, until recently remained the final life necessity that is affordable and accessible. Aneurin Bevan founded the NHS on the principle that care would be free at the point of service for everyone, whether that was a cancer diagnosis, a hip replacement, or an emergency caesarean section.
But NHS waiting lists have grown to unprecedented levels. In March 2023, there were 7.3 million people waiting for “non-urgent” elective care, such as knee replacements and cataract surgery, almost double the amount in May 2020. A recent report from the Public Accounts Committee found that waiting times for cancer treatment were “at their worst recorded level”, with severe workforce shortages at cancer centres causing life-threatening delays.
It is no surprise then that patients across the UK are being pushed into paying for private care out of desperation. Last year the charity Engage Britain found that one in ten adults in the UK had turned to private healthcare. Two thirds of them did so because they could not access timely treatment on the NHS.
Paying upfront is not an option for everyone. Recently it was revealed that many people are signing up for loans and “buy now, pay later” deals to cover the costs of tests, treatment and surgery. These allow people to spread payments over many months or years, often interest free, meaning costs do not build up over time. They’re not a new concept – instalment plans are used extensively by private hospitals and clinics to allow people to pay for cosmetic surgery and orthodontic work, for example. But encouraging the use of such deals for essential healthcare is an insidious shift that will push many people who are already struggling through the cost-of-living crisis further into poverty.
“Buy now, pay later” lenders have come under fire from campaigners and politicians who want to see the sector better regulated to detract people from committing to deals they cannot afford. Labour MP Stella Creasy has highlighted the dangers of these schemes being “aggressively marketed” to consumers “without any protection at all”, while Citizens Advice’s director of policy Matthew Upton recently described them as “like quicksand”.
Research shows us that poorer people already suffer from worse health outcomes – poverty impacts people’s health in many ways, including through increased stress levels, a lack of access to education on good lifestyle and diet choices, and inadequate housing. The Office for National Statistics has found that the life expectancy gap is nearly 20 years between the richest and poorest areas of England. Forcing people to stretch themselves financially will only exacerbate these inequalities. There is a known correlation between debt and poor health, with debt leading to stress, reduced income to spend on essential items, and contributing to behaviours such as smoking or drinking.
But private companies’ offers are being backed up by political rhetoric. Both the Conservatives and Labour have promoted the use of the private sector to clear the NHS backlog, saying it eases pressure on NHS services and helps individuals. “People… are being failed,” Dr Rosena Allin-Khan, the shadow mental health minister, recently told Spotlight. “If they can get the operations they need, while bringing waiting lists down and having their lives saved? Of course, there is a place for that.”
No one should be blamed for seeking a rapid cancer diagnosis or a hip replacement when they cannot on the NHS. But there is a danger in the belief that private healthcare should be the first port of call. Union chiefs have flagged how prioritising private healthcare creates a “two-tier” system, siphoning off valuable staff and resources to better-remunerated jobs in private clinics. When NHS doctors and nurses face appalling hours, pay and staffing levels, what are they going to choose?
While the government shouts about its pledges for the NHS, it is neglecting to fix the systemic issues that would enable it to achieve these. Take cancer care; last week NHS England announced that it was streamlining its waiting time targets, including a new aim to either diagnose or rule out cancer for three-quarters of patients within 28 days of a referral. But how will the NHS achieve this when 97 per cent of its cancer centres are understaffed?
Rather than relying on private care, efforts need to be made to improve the NHS’s capacity to treat people in the first place. This includes assessing staff working conditions and pay; improving recruitment and retention through vehicles such as bursaries and specialist training places; and reforming regulatory bodies like the General Medical Council (GMC), which has been found to cause doctors under investigation stress, mental health issues and to leave the profession.
Forcing people into private care is short-termist – it may help people now, but in the long run everyone will be worse off when a withered NHS is gasping for its last breaths.