John Humphrys - The NHS: Less Public… More Private?

May 26, 2023, 10:00 AM GMT+0

Fed up with not being able to get an appointment with your GP? Fed up with waiting to see a hospital consultant or having your operation postponed? Fed up with an NHS that seems no longer fit for purpose?

If your answer to any one of those questions is ‘yes’ let’s try one more. Are you so fed up that you’re seriously considering going private?

If your answer is another ‘yes’ you will have welcomed the news that you may be able to opt for medical treatment at a private hospital, with the costs borne by the health service. But perhaps you answered ‘no’ because the very concept is anathema to you. It represents what you might see as a serious step on the road to privatising our precious NHS. Rishi Sunak has assumed most of us will vote ‘yes’. It is part of his plan for cutting waiting lists, and that’s one of his five ‘pledges’ to the British public leading up to the next election.

Under the plan the role of the NHS app (with which most of us are meant to be familiar) would be enhanced so that patients stuck on the waiting-list could use it to check how long they would have to wait for surgery at NHS and private hospitals. They would then book their procedure at whichever best suited them. Crucially, it’s being reported by the Times, the number of people undergoing surgery would be increased “as far as possible” via the independent sector. “Patient choice – originally introduced by Labour under Tony Blair – should be “the default mechanism” for any patient who is referred by a GP for hospital care.

The proposal will be included in the forthcoming report of the “elective recovery taskforce”, which was set up by the prime minister last December to come up with new ways of dealing with serious backlogs. At the moment the NHS waiting list for various procedures across the country is estimated to be more than seven million. Under the new plan people on that list could check with the app to compare their NHS wait with having a comparable procedure at a private hospital. They would then be able to book in whichever suited them best. They would not be restricted (as most are at the moment) to using an NHS hospital in their immediate area.

The Times notes that the prime minister and the leader of the Labour Party are as one in identifying the crisis in the NHS as a critical issue in the upcoming general election. Sir Keir Starmer has made “building an NHS fit for the future” one of his five “missions” and the subject of a speech marking the publication of a policy document. Both Sunak and Starmer say new technology and patient choice are vital if the crisis of waiting lists is to be addressed.

Sir Keir’s plans include reducing ambulance waiting times to seven minutes for cardiac arrests and ensuring that all patients can be seen by a doctor within four hours of arriving at A&E. All planned hospital treatments would be carried out within 18 weeks. And the promise is that all this would be achieved within five years of a new Labour government being elected. Sir Keir admits that more money will be needed.

It's not difficult to find sceptics of Sunak’s approach. Charles Tallack, the director of data analytics at the Health Foundation think tank, has said that any steps to bring down the elective care waiting lists are welcome but “it is not immediately apparent how a new app would help achieve that, especially when patients are already able to book NHS treatment with a private provider via the NHS Choose and Book website.”

The latest figures suggest that fewer than one in ten of the operations paid for by the NHS are carried out in private hospitals or clinics and Tallack suggest it might not be easy to increase that figure substantially: “Key to the challenge of scaling up NHS-funded elective care in the independent sector are funding and staffing, both of which are severely constrained.”

Research published by the Health Foundation thinktank has warned that private hospitals were likely to be able to play only a limited role in busting the backlog. But there have been exceptions. Private providers have significantly increased the amount of eye surgery they carry out over recent years . They now do more than a third of all cataract operations.

The Centre for Health and the Public Interest, a thinktank that focuses on the NHS’s relationship with the private sector, has said that private hospitals employ very few doctors directly and rely for the most part on NHS medics working part-time for them on top of their main job.

The Times is sufficiently concerned about the state of the NHS to have set up its own “Health Commission” . It says there is “an unfortunate timidity in both parties’ approaches to the health system. Neither the Tories nor Labour will contemplate radical structural reforms to boost productivity or contemplate alternative funding models. Yet such is the scale of the crisis that new thinking is urgently needed.”

That new thinking, according to critics of our health system, must embrace a radical approach to dealing with the crisis in social care and the vast number of people in hospital beds who could and should be cared for in the community. It would deal with the incalculable health risks posed by the obesity epidemic which is threatening the health of millions of children. And it would also face up to what many regard as the sheer incompetence in the way the NHS itself is run.

One of the country’s most respected doctors is Professor Karol Sikora, who has worked in the NHS for 51 years and is a leading world authority on cancer. In an impassioned article in the Daily Mail he wrote that any criticism of our sacred NHS is “sacrilege, and anyone who dares propose reforms risks being denounced as a heretic.” In the eyes of “true believers” he wrote, the only failing of the health service is that there’s never enough money to pay for it. So the solution is to “fling more billions in the collection plate.”

That, says Sikora, will not deal with “the most insidious sickness” in the NHS: its bloated bureaucracy: “The fact is that our centralised, Soviet-style, state-run health service cannot deteriorate much further before it breaks down completely. It is already failing millions, leaving them to suffer and die.”

That, he believes, is what makes the Government’s “quietly radical new reforms” so significant. The introduction of a new feature in the NHS app that will enable patients to opt for medical treatment at private hospitals, with the costs borne by the health service, “represents a practical solution, and probably our best hope in the short-term of cutting waiting lists for procedures such as hip replacements, cataract surgery and even some heart work.”

But what of the risk that any departure from state funding will create a two-tier health service, where only the wealthy will be able to access life-saving surgery?

This, says Sikora, is pure dogma: “In most European countries, healthcare is also available free at the point of delivery. But the private sector works alongside public services. In France, for instance, you can go to a state-run hospital and have cancer treatment with a private provider — funded by the taxpayers. This is not only more efficient than the British system, it’s cheaper, too.”

So what do you think of the NHS? Have your own experiences of it made you despair and do you welcome the possibility of “going private” without having to pay an enormous bill? Or has your own treatment made you grateful for a system that is there when you need it without even having to think about the cost? Or perhaps you’re somewhere in the middle and believe the NHS is far from perfect but we mess about with it at our peril.

Let us know.

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