There is a chance the government will be swayed by a proposal put forward by the private healthcare lobby to invest massively in the private sector to ease waiting list pressures – to the tune of £1 billion, according to some news reports. We say beware.
There is a long tradition of using the private sector to ease temporary burden in the NHS. ‘Waiting list initiatives’ were one such scheme used during the Blair government days, and since, largely for elective surgery which lent itself to relatively straightforward processes and outcomes. With the caveat that if anything went wrong, patients were handed back to the NHS to treat. All the profit, none of the risk – but it addressed a need.
Now, however, the landscape is very different. Private-sector involvement with NHS treatment has increased dramatically – ophthalmic surgery is probably the worst example, but this is by no means on its own. More worryingly, the proportion of treatments carried out by private suppliers where people pay directly has increased alarmingly. One example: in 2014 the NHS funded 89% of all hip joint replacements, but by 2022 one in four of these operations were paid for privately. This at a time when NHS staff vacancies continue to rise and waiting lists continue to grow. Training places for many specialties are becoming increasingly scarce, sowing the seeds for massive problems in the future as doctors retire. And the vast bulk of healthcare medical training remains the responsibility of the NHS – not the private sector. Where will the much-vaunted private sector get its doctors from, if the NHS continues to fail to train enough? And who will pay for that?
What all this points to is the real possibility of a two-tier service, as a vibrant and growing private sector, drawing NHS money for years, is able to offer more treatments to more people – assuming they can pay for it – as the NHS struggles to cope and breaks down. If this sounds far fetched, look to dental services. Many areas of the country simply do not offer NHS dentistry, and more and more people suffer because they cannot afford to pay privately. The same fate can and will happen to other NHS services – unless the political will to fund the NHS directly, for NHS provision by the NHS, is found and acted upon. Which is why handing the private sector a billion-pound taxpayer handout to undertake massive investment and growth while the NHS continues to struggle could well be dining with the devil. Tempting – but at what cost? We urge caution – and a renewed will to fix the NHS itself.
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