Contributor: John Lister

The NHS was set up to be a universal health service, covering the whole population, providing care according to clinical need, not ability to pay, and funded from general taxation. 

Resources have never matched the level of demand for care, and there has always been a waiting list for some forms of treatment. This has fed the illusion that by paying for private treatment those with the fattest wallets can somehow ease the burden on the NHS and reduce the waiting lists; in reality this approach does not reflect how the resources available are shared between the NHS and the private sector.

A finite pool of staff

The majority of private hospitals employ doctors, surgeons and anaesthetists who also hold NHS posts.  So if surgery increases in the private sector, it reduces staff availability for NHS work. In the case of other staff, such as nurses and allied health professionals, any increase in the scale and scope of the private sector means it makes a greater call upon the limited pool of staff available, and if the staff go to the private sector the capacity of the NHS is then restricted.

It should be noted that this pool of staff has, in the main, had its training organised and paid for by the NHS. For example, consultants are employed by private hospitals on a self-employed basis and the companies contribute nothing to their training.

Of course the very separation of richer people from poorer also immediately undermines the universality of the NHS, creating a two-tier system.

Two tier service

With a two-tier system comes a more fundamental long-term threat, that the NHS might increasingly be left as the health care system for the poor, with wealthier people pressing for tax relief on private health insurance, or other ways of compensating for their additional outlay – deepening the inequality.  

And if the NHS became primarily a service for the poor, we can expect that it would gradually become a poorer service. Few wealthier, influential people would be willing to demand it be properly funded – as has become the case with education and social care. 

NHS: the main provider

It is important to note that only a handful of the largest private hospitals have Intensive Treatment Units (ITUs) and can offer more complex treatment or react to emergencies within their own hospitals.

The average private hospital has just over 40 beds and, with some exceptions, can offer only the simplest and least complex operations. They rely on the NHS for staff and as back-up for their own services. When things go wrong in these small hospitals, they send patients by ambulance to the NHS for emergency care: there were 706 such cases in England and Wales in 12 months from 1 July 2021.  

In most cases private hospitals take the uncomplicated, routine NHS cases, leaving the NHS to cope with all of the emergencies. the most complex cases requiring beds and longer stays in hospital, and all the Covid cases. All of which are inevitably more costly.

The NHS also has to deal with all the patients facing delayed discharge for lack of social care or community health services. 

Loss in funding? 

The NHS loses out financially each time a patient goes private as the system for funding NHS hospitals works on a  ‘payment by results’ basis, which pays a fixed tariff rate per patient treated.

Wealthier patients paying for private care effectively deprive an NHS hospital of the tariff fee for their treatment, while NHS patients who opt to use private hospitals also unwittingly siphon the tariff fee out of the NHS – a system introduced by Tony Blair’s government in the mid 2000s, with the right for NHS elective patients to choose to have their operations from “any qualified provider”.  

Taking routine cases out of the NHS also undermines the training of medical and nursing staff, which requires experience of a mixed caseload: the vast majority of training of staff is done by the NHS, and can’t be done in a-typical tiny private hospital. 

Going private does not help the NHS

The current record waiting list in England (7.3 million at last count) and extended waiting times for many treatments have grown as a result of 13 years of real-terms cuts in government spending on health. NHS funding has fallen behind the rising costs of drugs, supplies and equipment, behind the growth in the population and in particular the increasing proportion of older people who on average make more use of the NHS. 

Rich or poor, the harsh reality is that if you have an emergency, or need a whole range of complex treatments, there is no alternative to the NHS.  Going private, instead of taking the pressure off the NHS, hampers it from providing its services.

Wealthier people can sometimes run from this by opting for private care, but they can’t hide from the fact that all the main emergency and specialist care is provided by the NHS. Rich and poor alike have an interest in demanding it is properly funded, with sufficient capacity, safely staffed and, as it was in 1948,  properly accessible to all those who need it, without recent racist exclusions or charges – free at point of use. 


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