BBC news programmes on July 22 included a prominent story on the increase in numbers of patients paying privately to secure health treatment last year, with numbers of “self pay” patients running up to 39% up on the last pre-pandemic year, 2019.
There’s no doubt that the ever-rising waiting list for access to an under-funded, under-staffed NHS, currently at 6.6 million, and expected by NHS Employers to top 9 million by 2024, is driving increased numbers of patients to desperate measures, including borrowing money, digging in to savings or even crowd-funding to pay for swifter private operations.
But by focusing on the large percentage increase rather than the actual numbers involved, and by giving no real context, the BBC reporting gives a false impression of large numbers of patients effectively giving up on the NHS.
This tends to reinforce the illusion that those that can afford private health care can escape the deepening crisis of the NHS. Both of these widely-held views are wrong.
The increase from the relatively low pre-pandemic base of 200,000 self-pay private patients in 2019 to the still modest recent level of 258,000 patients paying up front for operations in 2021 needs to be set against the increase in the NHS waiting list from 4.5 million in December 2020 to just over 6 million at the end of last year.
In that time over 1.5 million joined the NHS queue, many knowing they were in for a long wait, but only 58,000 additional people (less than 4%) paid to access private care – a tiny fraction even of the 300,000 or so patients waiting over a year.
For many the reason will be cost – with operations costing up to £15,000. But for many others there will be other factors, not least the concentration of most private hospitals in London and the south east, or the fact that their age and other complicating factors mean that the private sector is not geared up or willing to treat them at all.
It’s also interesting to note that the rise of self-pay numbers has run alongside a sharp reduction in numbers of operations paid for by private health insurance, which was 16% below 2019 levels last year.
This means that the total number of private operations were also down last year from 779,000 in 2019 to 747,000 in 2021. By comparison the NHS carried out 8.8 million elective operations in 2019-20, and 5.6 million even during 2020-21 at the peak of the pandemic.
The NHS has been reduced to 98,000 general and acute beds open overnight, which need to treat a mix of emergency, Covid and elective patients, plus 11,800 day only beds for elective work. By contrast the entire private acute hospital sector has only around 8,000 beds, mainly in small hospitals averaging just 40 beds.
And while there has been some investment in new, prestige buildings by major US hospital corporations (HCA, Mayo and Cleveland Clinic) these appear to be largely aimed at a reviving international market for private care rather than British punters or the cash-starved NHS. The main private hospital operators in England have not been expanding the bed base – and some have even been selling off hospitals to the NHS.
This limited size and patchy distribution of private hospitals has also limited their use by the NHS, as the HSJ and Lowdown have recently reported, and the numbers of patients treated in private beds are well short of the levels envisaged in the controversial “framework contracts” drawn up by NHS England in the hopes of getting waiting lists down.
In other words the NHS crisis is not necessarily a bonanza for the private sector. Indeed one problem for the private hospitals has been that since the peak of the pandemic fewer consultants are choosing to take private patients, limiting the private sector’s capacity to expand.
According to the Private Healthcare Information Network, whose press release triggered the BBC stories, there has been a 12% reduction in the number of consultants with a known private admission from July to December 2021 compared with the same period in 2019, from 12,473 to 10,976. The reduction is most dramatic in general medicine (44%) cardiology (21%) and medical oncology (21%) with a 15% drop in gastroenterologists, while ophthalmology, gynaecology, orthopaedics and general surgery have seen the smallest drop.
This pattern corresponds with the data showing that the growth in self-pay treatment has been concentrated on just three operations that have long been the staple fare of the private sector – cataract operations (day case treatment for which private hospitals and clinics are geared up, and which have increased by 56% from 8145 in 2019 to 12,700 last year), hip replacements (up by 141% from 2085 to 5015) and knee replacements (up 111% from 1240 to 2620).
As we have noted many times, the decision by patients who can afford it to go private for elective surgery widens health inequalities for the millions on waiting lists who cannot afford to do so or whose treatment is not available privately. It does not question the need for the NHS to treat the majority, and to deal with the emergencies that the private sector avoids like the plague.
The increased numbers paying for care is an indictment of the government’s record of underfunding of the NHS since 2010: but sadly there is no end in sight to this under-funding.
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