Going Private: How political failure helped create a two-tier health service

Robert was in his early 40s when he began noticing stiffness in his joints and a slight tremor in his hands. Despite visits to his GP, it would not be until five years later that he was finally told he would be sent for an ‘urgent’ neurology referral. The wait was likely to be around six to eight months.

Now 47, Robert was given a Parkinson’s diagnosis after his wife Vonnie used private medical cover provided through her work to effectively jump the queue, paying £250 to allow her husband to see the same consultant he would have done in the NHS – just a lot sooner.

“Robert had been going to his GP with these symptoms for five years,” says Vonnie. “Somebody had not clocked on that things were not as they should be and yet we had to wait months to see a consultant. That’s intolerable. 

“When somebody says to you there’s a chance you have a progressive, degenerative neurological condition, you want all the answers straight away. We’re sitting at home with four kids who all fell apart as soon as they heard this news.”

Since the pandemic, the number of people paying for medical care has increased dramatically. Figures from the Private Healthcare Information Network, which monitors activity across the sector, show that 272,000 people paid for an operation or diagnostic procedure in the UK last year – up 37 per cent on 2019. Even for the most serious conditions, such as cancer, patients are funding their own treatment rather than be left at the mercy of NHS waiting lists. 

At a recent First Minister’s Questions, Scottish Labour leader Anas Sarwar said figures obtained by his party showed 1,000 rounds of chemotherapy were paid for privately in Scotland last year. “Why does the first minister believe people in Scotland should have to pay for their life-saving cancer treatment – 1,000 rounds – because of his party’s failure and incompetence,” he asked John Swinney.

While Scotland still sees a lower proportion of patients self-funding than elsewhere in the UK, there are nevertheless growing numbers of those who feel they have no option but to pay for treatment. In areas such as dentistry, physiotherapy and even mental health, private providers have increasingly begun to offer services to those who can afford to pay – even if it means sacrifices to be made elsewhere in their household budget – creating a two-tier system by stealth. 

Worried about any suggestion the NHS will not be safe in their hands, politicians of all parties regularly trot out lines about the health service being free at the point of use. But such rhetoric is already out of date, overtaken by the reality on the ground as more and more voters discover that for timely treatment in a range of areas, they’ll probably have to pay. 

A recent study by LangBuisson, which provides information on the independent healthcare sector to the Office for National Statistics (ONS), found the overall value of the health cover market in the UK at the end of 2022 was £6.7bn, up £385m on the previous year. It said demand for health insurance was being driven by companies putting in place schemes that offered their employees an alternative to NHS care and it also noted a rise in the number of individuals taking out their own private health cover. 

“There’s always been a correlation between the median waiting time for surgery on the NHS and the total volume of people covered by health insurance,” says report author Tim Read. 
“Our view is that the pandemic was not the cause of a sudden increase in private healthcare subscriptions, rather it was such a seismic event that it made more clear what was already a direction of travel. With the pandemic, people saw how important access and diagnosis is.”

Read says that as more people get comfortable using private health insurance, it becomes a “self-fulfilling prophecy”, with more people using it less as a last resort for major medical problems but also to speed up access to scans and diagnostics. 

Perhaps not surprisingly, the state of the NHS has featured heavily in general election campaigning. In one of the first live TV debates, Labour leader Keir Starmer ruled out using private medical care even if a family member was on a long waiting list, while Rishi Sunak said he would be willing to pay if it meant speeding up access to care. Labour, which will almost certainly form the next government, says it will spend an extra £1.8bn on the NHS to cut waiting times, meaning more money for Scotland in the form of Barnett consequentials. But on private healthcare, Starmer’s views appear to be out of step with the public. Recent polling by YouGov found three-quarters of those polled would pay for private treatment if a relative was waiting for surgery.

Figures published by Public Health Scotland at the end of May showed NHS waiting lists north of the border have reached record highs. PHS recorded more than 690,000 waits for appointments or treatment for non-urgent care. The number of waits for outpatient treatment was up 10 per cent on the previous year and more than double the size of the list before the pandemic. More than 8,000 people waited over two years for an appointment or to begin treatment. On cancer, where early detection is key, just 70.4 per cent of patients began treatment within 62 days, down from 83.7 per cent at the end of 2019 and well short of the 95 per cent target. 

Vonnie, whose husband is now on an NHS pathway after receiving his private referral, admits to feeling “guilt” that she managed to jump the queue by going private. 
“I hate that this is what we’ve had to do – it really goes against everything that morally and ethically I believe in,” she says. “I’m very proud of my values and Robert is as well. But the NHS wasn’t there for us when we were going through the worst thing that’s ever happened to us.”