More evidence is emerging on the failure of the private hospital sector to make the expected gains from the chronic crisis of the NHS and its lengthening waiting lists.
- Far from booming, numbers of self-pay patients, those digging in to their savings or taking out loans to pay for private treatment, have remained stuck at around 70,000 per quarter since 2021.
- Almost half (46%) of people who have used private healthcare said being unable to get an NHS appointment was a factor in their decision
- Two thirds of people giving general support to the use of private providers did so with the provisos that it remained free of charge, and that the private provision was part of a drive to reduce waiting lists.
The latest is an opinion poll commissioned by “in-sourcing” company 18 Week Support, which provides staff who can use NHS facilities during evenings and weekends (when they are not being used by the NHS) to treat additional patients. This is precisely the spare capacity that has been utilised by the NHS itself in the past (notably the 2000s) to tackle ‘waiting list initiatives’, when sufficient funding was available to pay staff enhanced rates to work extra hours.
The YouGov poll they commissioned found that two-thirds (65%) of British adults who were asked “support the NHS using more independent health providers to perform operations or treatments, as long as they remain free at the point of use and cut down waiting times.”
But while 18 Week Support inform us that the survey was of just over 2000 people, they give no details on precisely what question they were asked, or what additional information they may have been given to explain “insourcing,” which is not a well-known aspect of private provision. But according to the same poll apparently “71% of Brits” support insourcing.
18 Week Support itself is far from typical of independent providers. Its website tells us that it originated in 2014 when “Dr Conal Perrett, an experienced consultant dermatologist with over 20 years’ NHS experience, realised there was a way to treat more patients on his waiting list without transferring them to a private hospital.” He spotted a gap in the healthcare market and “set about building a team of expert clinicians partnering with NHS trusts to manage elective pathways…”
So this “insourcing” – like the private hospital sector – depends for its workforce on NHS trained staff, but it does not divert them to working miles from NHS hospital sites in small and limited private hospitals. Its existence reflects the problems of the NHS recruiting and retaining sufficient suitably skilled staff to make full use of its capacity.
Greater use of this type of private sector provision is limited, of course, by the need for sufficient NHS beds to receive the additional patients needing to recover in hospital. And the shortage of beds, of course, is one of the greatest limitations on the NHS itself increasing the numbers of elective patients it can treat.
But there is no real correlation between supporting this particular use of private sector (effectively teams of agency staff working out of normal hours) and support for use of private hospitals, clinics and diagnostic hubs to treat NHS-funded patients.
It’s important that the two thirds of people giving general support to the use of private providers did so with the provisos that it remained free of charge, and that the private provision was part of a drive to reduce waiting lists.
Self pay
The numbers resorting to private self-pay and private health insurance funded private hospital care remain stubbornly and astonishingly low despite the soaring NHS waiting lists and often lengthy waiting times.
The most recent figures published by the Private Health Information Network (PHIN), the body set up in 2014 in response to demands from Competition and Markets Authority for accurate information on the performance of the private sector show a barely significant increase in the first quarter of 2023.
The PHIN figures showed a total increase of just 8,000 self-pay and insured patients, to 219,000 in the quarter, which is only fractionally up on the quarterly average for 2022, and only 12% up on the average for 2019 – when the NHS waiting list was around 4.5 million rather than 7 million plus.
Far from booming, numbers of self-pay patients, those digging in to their savings or taking out loans to pay for private treatment, have remained stuck at around 70,000 per quarter since 2021.
This is contrary to the widespread belief that the private sector is ‘making a fortune out of self-pay’ and therefore less interested in taking on more publicly-funded patients at NHS tariff.
Of course people on waiting lists for NHS care have already been diagnosed with pre-existing conditions which mean they cannot buy private health insurance. Many of them also have more complex needs, which mean small private hospitals with limited facilities cannot deliver the treatment they need, even if the NHS were to foot the bill.
But research commissioned and published last month by the private sector itself reveals that the major obstacle to widening the demand for self-pay private health care is the perceived – and actual – high cost of treatment. The focus is exclusively on acute services, with no mention of mental health care where the role of the private sector has expanded to fill gaps in the NHS.
A report by Bevan Brittan, published by PHIN, analysing the findings of a poll of “a nationally representative sample of 2,003 people” by Public First, found that the private sector has relatively few friends, and “Demand for private healthcare is being strongly driven by challenges within the NHS.”
Almost half (46%) of people who have used private healthcare said being unable to get an NHS appointment was a factor in their decision. “56% of people had tried to use the NHS before using private healthcare, while 42% had gone straight to the private system.”
But when asked about all the times they had used private healthcare, “only around one in five (21%) people say they usually or always go straight to the private system while 78% say that they usually or always try to go to the NHS first.”
Fractionally over half (51%) of the sample polled felt “very or quite positive” about private healthcare. However there are reasons to question this figure, since Bevan Brittan reveals that not all of the sample were asked all of the questions:
“We followed … up with a further survey of 1,771 people who said they were open to using private healthcare. This allowed us to delve deeper into the issues explored below.”
The report also confirms, as we might expect that “Given that private healthcare services are either funded through out of pocket expenditure or private medical insurance, it is not surprising that people with greater financial resources are more likely to have used private healthcare.”
However there is no reference in this report to the NHS commissioning of care in private hospitals and clinics, and it’s not clear whether some of the minority on lower incomes who had used private health care may have done so without paying themselves for the care.
It appears that only a minority “around 3 in 10 (29%)” of those who said they had used private health care had done so for operations and inpatient treatment, while one in eight (12%) had only had diagnostic tests and scans.
Perhaps most revealing are the answers when the pollsters asked about whether people could afford or “find a way to pay” for private care. For a GP appointment, when told they cost “between £40 and £200” it seems just over a third (36%) of people who initially thought they could not afford private healthcare said they might be able to afford it, leaving 64% sure they could not.
Far fewer when told the cost were persuaded they could afford private care for a cataract operation (£2,000 to £4,000) (12%) and fewer still (just 4%) felt they could afford a hip replacement (£9,000 to £15,000).
Bevan Brittan’s conclusion includes a frank admission, followed by a piece of wishful thinking:
“It is … clear that affordability is the biggest barrier to people accessing the system, although a lack of awareness and absence of information comes through – there could be an opportunity to empower patients by giving them much better information about the costs of private healthcare and how to navigate the system.”
Meanwhile the latest NHS statistics show that despite all of the government’s efforts to drum up more business for the private sector there has been only a small increase in the average numbers of NHS patients receiving in-patient care in the private sector, with fewer than 110,000 in patient cases a year and 700,000 day cases per year. This is trivial compared with the 8 million-plus planned and waiting list admissions and 7.4 million day cases handled by the NHS – in addition to 6 million emergency admissions.
The private sector is too expensive even for many of the people who might consider using it, and too small to make a significant difference to NHS waiting times. Moreover it can only expand by recruiting more of the limited pool of suitably qualified staff – at the expense of front-line NHS services.
Even its own research shows the limitations on the private market in health care: and that’s why the private sector bosses are still chivvying ministers to find them more NHS-funded patients to fill their otherwise empty beds.
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