Olivia*, 27, began battling debilitating bowel issues more than seven years ago. The symptoms were mild at first, and her GP diagnosed her with irritable bowel syndrome (IBS). But her condition grew worse over the years, and life became a constant struggle.
“Going places became more difficult,” Olivia tells Spotlight. “I would get stuck at the pub or gym toilets for hours, and it would take a long time for the medication to work. I became terrified of being out and not making it to a bathroom in time.”
Despite the increased severity of her symptoms, Olivia faced an agonisingly long wait for a specialist consultation through the NHS. Because of a backlog for treatment, her GP couldn’t expedite an appointment with a gastroenterologist. The earliest scheduled slot was in 2024.
Faced with deteriorating health, Olivia chose to use the private sector. “In spring , I realised I [couldn’t] wait that long,” she recalls. “I want to be certain it’s IBS, and if it is, I want to figure out a treatment that works or at least improves my quality of life.”
Olivia is one of many individuals who have turned to private providers because of waiting times in the NHS. In January, Prime Minister Rishi Sunak pledged to cut waiting lists, but the number of people waiting for treatment has since soared to 7.7 million in September this year, up from 4.6 million in October 2019. As a result, the number of those seeking treatment and diagnostics privately has grown rapidly. One in eight Britons (12 per cent) had paid for private healthcare in the previous 12 months, according to a survey published in April.
Recent data from the Private Healthcare Information Network (PHIN) indicates a significant rise in private admissions across the UK, with 227,000 in the first quarter of this year – 17,000 more than in the same period in 2022. The top private procedures include cataract surgery, diagnostic colonoscopy, epidural injections – a common treatment for chronic back pain – and hip and knee replacements, though other conditions are also seeing rises in private provision. Rehabs UK, a charity, reports that more people are using the private sector to treat drug and alcohol issues as NHS admissions fall. The government itself is relying on privately run healthcare, recently launching 13 new community diagnostic centres, eight of which are independent, in order to cut NHS waiting lists.
Concerns persist, however, about the implications for the NHS of increased reliance on private healthcare. Experts warn against allowing the emergence of a two-tier system. Siva Anandaciva, chief analyst at The King’s Fund think tank, elaborated on this risk. The word “choice” is “incredibly important”, he tells Spotlight, “because it speaks to people who have the assets to pay for faster access to care for services that are important but still optional. The warning signs start to flash when people who can’t easily afford care feel like they have no other option than to try and pay for the treatment they need.”
For Olivia, and others, private healthcare is more a necessity than a choice. “I wish I didn’t have to,” she says. “It’s not like I have a lot of money for private healthcare. I changed jobs this year to get a better salary, and I’ve been saving, but it still makes me anxious about how much it will cost.” The expense of private healthcare can be a barrier to access. Though some appointments may be no more than the price of a haircut, routine procedures such as knee or hip operations can cost in the region of £10,000 to £15,000.
David Hare, the chief executive of the Independent Healthcare Providers Network, points out that people increasingly view their healthcare as a commodity: “If they need to purchase healthcare privately, they will prioritise that over lots of other things, like going on holiday or meals out.” But even a £30 GP appointment is too much for those who can’t afford it. As the cost-of-living crisis continues, a quarter of households in the UK now report having no savings.
And cost is not the only concern. With more money flowing into the private sector, some experts worry about widening disparities in standards between private and public healthcare. Olivia says that private healthcare made her feel that “someone is finally taking my concerns seriously[…] appointments are scheduled quickly, often within the same week. They respond to emails within hours. I get to see the same doctor.” In comparison, her experience with an NHS GP was fraught with frustration, delays, and a dearth of empathy. “It doesn’t inspire confidence that your health issues are being addressed,” she says.
The government and experts argue that those who can afford private healthcare help ease the burden on the NHS. “One fewer person on the NHS waiting list is one fewer person that the NHS has to treat,” Hare says. “If all of those people who were being treated privately now slipped into the NHS overnight you would be adding nearly a million people minimum to the NHS waiting list.”
But, as Anandaciva highlights, the increased demand for private healthcare may add to the strain in other ways. As of June 2023, there were 125,572 vacancies in secondary care in England, with 10,855 of these being medical positions – about 7.2 per cent of all medical posts in England. Since both sectors draw from the same pool of medical staff, as clinicians in the UK opt to work privately NHS services can become more stretched, with waiting times increasing, and patient experience worsening. In 2021/22, 38 per cent of nurses who left their NHS registered nursing job but stayed in work moved into roles in private hospitals, agencies, or charities. “I speak to clinicians all the time who are reducing their NHS commitments and offering more time through the independent sector,” Anandaciva explains. “There is clearly an impact on NHS resources, even if it is hard to quantify.”
The private sector can often offer shorter or more flexible hours, and both doctors and nurses earn more there than they do in the NHS. Given the real-terms pay cut faced by NHS staff over the past decade, some healthcare workers choose to supplement their income with private work or to leave the NHS altogether. Sarah Scobie, acting director of research at the Nuffield Trust, explains that “if a nurse has time to do a shift in a private hospital, then they might choose to do that rather than doing overtime in the hospital where their main job [is].”
Though the independent sector cannot fully act as a substitute for the NHS, it offers some overlapping services and complementary treatments, such as cosmetic procedures, osteopathy and ear cleaning. Some treatments are also not available in the private sector, in part because they are not profitable. Spotlight spoke to one individual, who preferred to remain nameless, with haemorrhagic telangiectasia, a rare hereditary bleeding condition. They explained that they could not access private healthcare for their condition, even if they wanted to.
“I could have had this sorted two years ago if it existed in the private sector, but I can’t go private as it’s such a rare condition it requires specialist equipment and nascent methods of operating, that only the NHS do,” they say. “It’s not profitable enough for the private sector to do it, and the equipment too expensive, the condition too rare, for it to ever be.”
This individual’s inability to access private treatment has caused them frustration and delays, but experts point out that this is the reason why the NHS exists as the primary health service in the UK. The public still relies on the NHS for a substantial portion of healthcare needs, and this keeps up the political pressure for resource allocation and improvement. Hare, as the representative of a network of independent health providers, is definitive that the NHS still has a vital part to play. The private sector is not only there as a complementary service, he says, but also to enhance NHS capabilities. “Nothing about the private sector’s role in the NHS means that patients will have to pay for NHS services or that anything is being sold off,” Hare says. “It retains a free-at-the-point-of-use, general taxation service, and we’re adding important capacity and capability.”
He also highlighted how the private sector provides important training for healthcare professionals. “The sector trains thousands of junior doctors every year and other medical professionals as well,” he says. “A number of providers have things like nurse apprentice schemes. Those nurses will often then go and work in the NHS, having been trained by the private sector.” For Hare, private and public healthcare are part of a single British system, with doctors working across both. “There is a one-healthcare mentality, with a symbiosis between the NHS and the private sector,” he adds.
Anandaciva remains confident that the NHS still has political will behind it and believes that the government should take a longer-term approach to ensuring its future. “We have an elective care strategy that is based around the next two to three years, rather than a broader strategy of what role we want the independent sector to play with the NHS over the next ten years, how that then affects everything from staffing to financing to planning decisions, and how you know if things are heading in the right direction or not,” he says. For the NHS to survive, he adds, the government needs to have a clear vision of where it wants the system to be, because “a lack of long-term strategy comes to bite you in the end.”
This piece first appeared in a Spotlight Healthcare print report on 13 October 2023. Read it here.