We all know that waiting lists for operations, procedures such as endoscopy and investigations such as CT scans have increased and led to delays in treatment. However, unless you are suffering on one of these waiting lists, you may not realise it is driving some to private healthcare. So, how bad is this?
History of NHS waiting lists
When I started as a consultant in 1989, we had large waiting lists with people waiting for 12 to 18 months for routine surgery like knee and hip replacements. This started to change from 1997 onwards when the Labour government invested heavily in the NHS. Waiting times reduced, with the aim of treating everyone within 18 weeks. The waiting list remained stable at around 2.5 million people until 2013, when the Tory austerity programme started to bite; by the start of the pandemic in early 2020 it had reached over four million. Since the pandemic, it has grown drastically – the latest figures for July 2022 show:
- A record of over 6.84 million people waiting for treatment.
- 2.67 million patients waiting over 18 weeks for treatment, a further increase from last month.
- 377,689 patients waiting over one year for treatment – over 365 times the 1,032 people waiting over a year pre-pandemic in July 2019.
- A median waiting time for treatment of 13.3 weeks – significantly higher than the pre-Covid duration.
However, this issue could in reality be much worse than these reports suggest, as we know we have a hidden backlog resulting from the impact of Covid that has yet to reach the system.
What happens when waiting lists increase?
One of the worst features of increased waiting lists is the effect on waiting time for operations and procedures. This means we have considerable numbers of people suffering with hip and knee pain that severely affects their mobility, or with vision reduced to such an extent that this too affects their day-to-day lives.
This drives individuals without private health insurance towards using private healthcare by self-funding their operation. We have evidence that this is increasing markedly – figures show that when comparing the same period in 2019 and 2021
- self-funded hip replacement surgery increased by 165%
- self-funded knee replacement surgery increased by 122%
- self-funded cataract surgery increased by 64%
This is despite a typical private hip or knee replacement operation costing around £13,000 and cataract surgery just for one eye costing around £3,000.
Private healthcare: inequitable and destabilising
The cost for individuals obviously represents a considerable sacrifice and some will argue that by making it they are reducing waiting times for others on the NHS waiting list. However, there are several issues that we need to consider.
Firstly, this option is not open to all and not just because of the cost. Few private hospitals have intensive care units and so anyone who is higher risk due to their health is not suitable for having the more major procedures in such facilities. Then there is the issue about equity, as what we are now discussing is a two-tier system where access to shorter waiting times is controlled by wealth.
A large-scale move to private healthcare will also have the potential to destabilise the NHS further, particularly as we are competing for the same nursing, medical and other professions allied to medicine workforce. Currently there are over 46,000 vacancies in nursing and any expansion in private healthcare will add to this problem. It is a constant irritation that it is the NHS that provides most of the training for staff, while the private sector largely does not contribute to this. This is not about university training but, for example, providing the theatre scrub nurse training and experience that is needed for a nurse to be able to manage an operation.
Should I pay for my operation?
This is obviously a question for the individual. I know of elderly friends who do not have a lot of savings who have decided to get their cataract operations privately as their deteriorating vision had the potential to stop them driving.
If you do decide to pay for a private procedure, you will be well looked after. You will have more choice over the date for your procedure and it is unlikely to be cancelled due to a lack of beds in the hospital. The food will also be better than in most NHS hospitals.
It is important to realise, however, that most private hospitals are ill-equipped to deal with any emergency and so if a problem occurs you will most likely be moved to the nearest NHS hospital.
