It’s another autumn, and the private healthcare sector is again attempting to convince journalists and the public that it is booming.
The publicists for the private hospitals are keen to take the stigma out of wealthy people paying up to jump lengthy NHS queues for elective treatment: David Hare, who runs the Independent Healthcare Providers Network (IHPN), has claimed to the Guardian that ‘going private’ is now the ‘new normal’.
But one look at the private sector’s own figures shows that it really isn’t normal at all.
The Private Healthcare Information Network (PHIN) claims the private hospital sector across the whole of the UK handled 904,000 private admissions in 2023, all of them elective cases, while the NHS in England alone treated over 11 million elective cases as well as 6.5 million emergencies (for which there is no private service available).
Another 445,000 NHS-funded patients further boosted private sector activity – at a cost of £3.5bn. This would give an average cost of £7,800 for each NHS patient treated in a private facility, which is astounding given that a very large proportion of the cases were relatively cheap cataract operations. (The NHS is now paying for more cataract surgery to be carried out by private eye clinics than it performs itself.)
Such high average costs cast even more severe doubts over the affordability of Wes Streeting’s relentlessly vaunted plan to make more use of the private sector to help cut waiting lists.
It is true to say that the latest quarterly figures (for Quarter 1 of 2024) show private patient numbers are at the highest ever and around 20% higher than they were before the pandemic. However, the overall numbers are so small that the apparently large 20% increase represents just 40,000 extra patients per quarter, which is 160,000 extra per year compared with 2019 – during a period when the waiting list has mushroomed by 3.2 million.
Clearly, the vast majority of people stuck on the waiting lists cannot afford the sky-high prices of being charged for ‘self-pay’ operations, which are even further from being ‘normal’.
Indeed – contrary to popular mythology – numbers of self-pay patients, which briefly surged after the pandemic’s peak, have stagnated for over 3 years, according to PHIN’s figures. Numbers are only being sustained by substantial growth (again from a small base) in Northern Ireland, where NHS waiting times have lengthened massively – while numbers in England and Scotland have begun to fall).
Plus, the location of private hospitals (heavily concentrated in London and the South East and a few prosperous centres) and their generally limited scope to undertake more complex treatments, for which many are stuck on NHS waiting lists, make it even more difficult for many patients to escape long delays by ‘going private’.
The expanding section of the market has been punters cashing in on their private health insurance – which again is not an option for patients already on NHS waiting lists since their pre-existing condition would not be covered.
Private hospitals are also far less keen on privately insured patients, whose costs and length of stay are likely to be tightly monitored, limiting the scope for the additional profits that come with self-pay patients. Private insurance premiums are also likely to rise with the increased number of claims, eroding insurers’ profit margins.
This is why we now have such mixed messages, with the latest claims of ‘boom times’ for private hospitals coming at the same time as they claim the NHS has no alternative but to use what Wes Streeting claims is “spare capacity” to treat even more NHS-funding patients.
And it’s why, according to an enthusiastic article in the Daily Telegraph the private sector itself has tried to jump-start action by Streeting, by drawing up its own new plan to invest £1 billion to build a string of diagnostic centres for NHS patients across the country, to help tackle delays in cancer diagnosis, and to develop new surgery units and even intensive care facilities.
The plans, promoted by the Independent Healthcare Providers Network (IHPN), are apparently being studied by the Treasury. The claim is that with the expanded capacity the independent sector could treat up to 2.5 million more patients, with “some treatment starting in weeks.”
But what the Telegraph does not point out is that the private sector would only go out on a limb and invest an extra £1 billion if there was a long-term government/NHS guarantee of sufficient NHS referrals to make sure of a hefty return on their capital.
This would in turn lock the NHS into a long-term dependence upon the private sector, and perpetuate the chronic capacity shortages that have impeded efforts to reduce the waiting lists.
The use of private finance (PFI) to build new hospitals from 1997 was a bad enough deal, costing many times more than the capital cost, with each PFI hospital providing a guaranteed profit stream for 25-30 years or more.
But the new private hospitals scheme would be even worse value. It would not even leave the NHS with any buildings or capacity – it would just be a long-term commitment to outsourcing NHS-funded treatment, alongside a long term drain of NHS-trained staff.
It would also create long term problems training new medical and nursing staff.
In the long run the private sector would not be paying for the new facilities and capacity: they would be turning the NHS into a permanent cash cow for private investors. The only sensible way to tackle capacity shortages is to invest in the NHS itself, where funding translates directly in to patient care with no private sector middle person creaming off a profit.
Now Rachel Reeves has announced an additional £22.6 billion is to be allocated to NHS “day to day spending” this year and next we have to hope any actual extra cash is invested in public provision and not wasted on the private sector’s latest attempt to fill its beds and bolster its profits with NHS-funded patients.
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