A continuing barrage of misinformation on the supposed boom in private medical treatment as a result of the soaring NHS waiting lists has continued into the summer ‘silly season’ for news, dragging in normally reliable commentators and news media.
A key problem in accurate reporting of trends in the use of private medicine is the long delay in publishing official statistics by the Private Healthcare Information Network (PHIN), whose most recent figures published in May only run up to the end of last year (2022). The figures are published quarterly, and are so small that even a modest increase in numbers of patients can result in a larger percentage change.
One figure that has generated a large number of misleading news reports was the increase in numbers of self-pay patients treated in private hospitals in 2022 compared with the last full pre-pandemic year, 2019. After the near-total collapse of private sector activity in Quarter 2 of 2020 and slow recovery in 2021 the quarterly total of self-pay patients rose from a steady 50,000 in 2019 to a peak of 72,000 in Quarter 2 of 2022, an increase of 42% – but only 22,000 extra patients, despite the massive increase in the NHS waiting list and long delays for many patients.
Subsequent quarters have fallen back from that peak, but the total of 272,000 self-pay patients in 2022 was 36% (73,000) higher than 2019.
This certainly appears to be a boom for the private hospitals, until we note the decline in numbers of insured patients getting treatment, which has still not recovered to 2019 levels.
Just 546,000 insured patients were treated as inpatients or day cases in 2022, 6 percent lower than 2019. In total the private sector treated just 9,000 more patients (4.5%) in 2022, even as waiting lists rocketed to more than 7 million, compared with 2019 when there were 4.5 million NHS patients waiting.
However some quite authoritative sources have published much more rosy accounts of the situation. Perhaps the most shocking is private sector analysts LaingBuisson, whose Private Healthcare Self-Pay UK Market Report, published in May (and retailing at a cool £1,000), appears focused on the “world beating growth” of the self-pay market “throughout 2021” – without noting that it was gradually recovering from the Covid-19 driven slump of 2020.
Despite the readily available (and free!) evidence that numbers of self-pay patients were tailing off throughout 2022, the LaingBuisson report argues: “… all indicators are that the self-pay market will continue to grow but providers must be prepared to effectively target varied patient needs to convert this interest into demand.”
The skewed figures from LaingBuisson have in turn led to misleading articles in the mainstream press that exaggerate the attractiveness and use of the private sector.
The Guardian, for example, in an article correctly highlighting the frustrations and delays of record NHS waiting lists, reported on August 6: “Buy now, pay later medical loans on rise as desperate patients go private amid NHS backlogs”. The article links back to an April 2022 Guardian article, which in turn was based on a previous (now unavailable) misleading LaingBuisson report, citing out of date information on the self-pay market. That Guardian article, relying on LaingBuisson’s information stated:
“Private hospital operators expect the boom in self-pay to continue for at least the next three to five years, with half of industry leaders expecting the market to grow by 10%-15% by 2025.”
Growth of 10-15% over three years may be significant, depending on the initial size of the market, but a 3-5% per year increase on a remarkably small number is certainly less than a “boom” – and we now know even that level of growth has not yet taken place.
David Furness of the Independent Healthcare Providers Network more or less confirms that the growth is nowhere near a boom when he claims in his quote to the Guardian only that “self pay grew really considerably after Covid.” In fact the figures show a mere handful of the extra millions now waiting for NHS care have opted for self-pay, raising numbers from about 50,000 admissions per quarter to a peak of 72,000.
The Guardian’s August 6 article (more of less copied wholesale by the Daily Mail the next day) exposes the scale of the loans and the potential rip-off interest rates involved as families struggle to pay for private operations while coping with the soaring cost of living.
But soaring inflation has run alongside private providers cashing in: Spire Healthcare reported its average revenue per case leapt by 21% from £2,642 in 2019 to £3,197 in the first half of 2022. The combined effect has been massive inflation in the cost of private operations, with sky high prices forcing people to consider various “buy now pay later” options if they are determined to go private.
Health insurers have also been keen to exaggerated the scale and growth of their market, with the chief executive of French owned insurance group AXA, followed by leading British insurer Aviva noth claiming the disastrously high NHS waiting lists open up “business opportunities” for those selling private health insurance. However the limitation on those business opportunities was revealed in the latest actual results of AXA’s private healthcare division, which showed that more customers can mean more claims. AXA’s half-year results showed “an increase in private medical claims had reduced the profits of its UK arm.”
Also claiming use of private healthcare has “soared” in the UK, PHIN statistics report a “record 820,000 inpatients and day cases” treated in private hospitals in 2022, even though this is just 41,000 (5.2%) higher than the pre-pandemic 2019 total.
A Guardian report on August 7, taking these exaggerated claims at face value, concluded that more people were “opting to pay for their own treatment, prompting ‘a new normal’ in the country despite a public health service.”
In fact private treatment is still far from normal, and the private sector is still very small and limited in scope compared with the NHS. Long delays in NHS treatment may mean that private care is no longer the preserve of the wealthy and the minority of workers with company health insurance plans, but the growing numbers paying for treatment are still dwarfed by the combined 14.7 million NHS patients treated as elective inpatients and day cases.
Sadly even the normally reliable Centre for Health and the Public Interest (CHPI) has echoed the misleading claims of a ‘booming’ private sector, with an August blog emphasising the increase in self-pay but ignoring the fall in privately insured patients. The blog also cites LaingBuisson figures showing private pay revenues “have soared, more than doubling since 2016 to £1.4 billion last year,” when the figures are in fact comparing 2016 with 2021, and do not adjust for sharply rising prices.
The main focus of the CHPI report of course is valid, exposing and challenging the increasing extent to which the universal and comprehensive NHS of 1948 – that delivered health care free at point of use on the basis of health need, not ability to pay – has been undermined by subsequent governments and by exclusion of services – including long term care of the elderly – that once were provided by the NHS.
But at a time when many on the left already appear to have a hugely exaggerated view of the size and scope of the private sector, it is important wherever possible to keep things in perspective.
The private sector’s own official figures show that despite the massive increase in numbers waiting for NHS treatment, many of them in pain and losing mobility, only a relative handful of patients have been able to access private treatment, whether because they cannot afford the hefty prices even if spread out over years, or because they live in areas with few private hospitals, or indeed because they have additional complicating issues that mean the private sector will not accept them and cannot cope with their needs.
The private hospital sector itself has tacitly admitted it has spare capacity it cannot fill, by lobbying hard for the government to divert more NHS-funded patients to fill their empty beds. Since patients funded on the NHS tariff are far less lucrative for the private sector than self-pay and privately insured patients, the only reason for this intense pressure must be that the private sector is failing to attract the extra private customers it expected to flow as the NHS crisis has worsened.
It seems that after the NHS bailed out a collapsing private hospital sector with hugely generous and unproductive contracts during the peak of the Covid pandemic, the so-called “independent sector” is once again desperate for a further hand-out of tax-payers’ money from the NHS to prop up its flagging business model.
As The Lowdown pointed out on August 9, the new NHS statistics on the role of the private sector also underline what a minor and insignificant role the private sector has played in delivering NHS patient care. They show that in the year to April 4 2023, private hospitals treated just 105,000 NHS-funded elective in-patients and 650,000 day cases, and delivered 665,000 diagnostic tests and procedures.
By contrast England’s NHS in the most recent statistics (2021-22) treated 7.9 million elective in-patients, 6.8 million day cases and 17million diagnostic tests – in addition to 6.2 million in-patient emergencies.
So small and limited is the private sector that any expansion of its role in treating NHS patients would add little capacity overall.
While private sector bosses understandably try to build and reinforce illusions in the potential, popularity and success of the private hospitals and clinics, campaigners and reporters need to see through the spin.
We need to bang home the real message, that this parasitic sector – which has become dependent on both NHS-funded patients and NHS-trained staff – is an obstacle rather than an asset in tackling the 7.6m waiting list.
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