What does the next generation of voters, clinicians, politicians or service users think about the future of the NHS, and particularly its ongoing relationship with private health providers? Tazine Shiraz is a 6th year student at a secondary school in Newton Mearns, Glasgow. Here is the broadly discursive essay she submitted this year as part of her Higher English portfolio.

To pay, or not to pay? That is indeed the question facing Britain’s healthcare system.  For decades, healthcare has been administered by private and public sectors – but should something as fundamental as healthcare have any tiers at all? In a society that claims to value equality, the availability of private care establishes a system where wealth influences the standard and speed of treatment. The stark contrast between public and private healthcare – from waiting times to quality of facilities to availability of specialists – raises important questions: Why should timely access to quality healthcare depend on financial status rather than degree of need? Is the system as sick as its patients? Today, the concept of private healthcare is overshadowing and detracting from the NHS, as it diminishes the original focus on patient well-being and equality of service.

Private healthcare deepens ethical and social divides and raises significant moral implications, since it is only accessible to those with the financial means to afford it. Although private healthcare has grown increasingly popular among a public worried by NHS delays, a study conducted by ‘IHPN’ (Independent Healthcare Providers Network) found that of those who dismissed private healthcare, 63% stated it was simply not an option as they ‘could never afford it’. The cost of private treatment can range from perhaps £2,000 for a simple gastroscopy to nearly £15,000 for complicated knee replacement surgery; figures totally unreasonable to many. In addition, another 27% of the IHPN sample claimed they ‘don’t approve of private healthcare in principle’. Why should wealth play any role, let alone such a significant one, when it comes to healthcare? Although some health conditions are deemed to be self-inflicted (socio-economic factors often play a part), on the whole people have very little to no control over the illnesses they suffer. In general, private healthcare is associated with greater comfort, luxury, and exclusivity, undoubtedly making it seem to many like the superior option. However, for those on lower incomes, private treatment remains entirely out of reach, creating a harmful divide in society. Furthermore, the King’s Fund observed that during the pandemic waiting lists were greater by 14% in poverty-stricken areas compared to well-off areas. This reinforces the idea that private healthcare systems are damaging, divisive and detrimental when it  comes to treating those suffering the most.

It is crucial that we understand that both healthcare services rely on medical professionals who are highly trained, many of whom work across both sectors; this implies a consistent level of expertise. The only difference is that being treated in a private hospital would cost an arm and a leg, while in the NHS it would be free of charge. According to IHPN, 34% of those who opted out of using private healthcare justified it by saying that ‘you can get access to the same medical professionals in the NHS’. Choosing to go private for an elective procedure (which will cost you months' worth of your salary) might be convenient. But when the professionals delivering those services are no better qualified than those working in the NHS, it seems utterly absurd. The average monthly cost of private health insurance can range from £80-£166 (depending on the number of people using it within a family), while a single procedure can cost over ten times that amount. Private care is essentially the ‘first-class’ version of healthcare; you arrive at the same destination as everyone in Economy, but with comfier seats, a four-course meal, and more leg room. But you have paid for the cost of ten economy tickets! Realistically, if two specialists in the same field were working on your case, one from private and one from public healthcare, would you be able to distinguish between them? Highly unlikely. This undermines the notion that private care guarantees higher quality, emphasised further by the fact that many specialists work in both public and private institutions. You are basically spending a fortune just to jump the NHS queue.

In addition, another often forgotten factor is that private healthcare facilities are not as well-resourced or equipped to handle severe or emergency cases as the NHS is. Studies conducted on the performance of private healthcare have proved that there have been avoidable deaths, due to a lack of staff and extra resources not being immediately available to treat dangerous, problematic cases. As a disturbing example, the ‘Centre for Health and Public Interest’ discovered that between 2010 and 2014, 800 patients (including some referred by the NHS) died unexpectedly in private hospitals across the UK. Colin Leys, author of BBC’s ‘London Inside Out’ programme, claimed that “In the NHS, you have a national reporting and learning system...all hospitals must report all serious incidents and if they see a pattern building up they intervene, and that doesn’t happen for private hospitals”. This statement highlights not only the inability to ensure patient safety but also a lack of transparency within private sectors. This is both troubling and more importantly, dangerous to healthcare. What is more, further studies have observed that 72% of private hospitals do not operate a Critical Care Unit that is permanently staffed throughout the week, and in addition, only 45% of private hospitals had an emergency anaesthetist on call. These startling statistics suggest there is some risk for patients treated in private hospitals that would not exist in a large NHS hospital. In addition, private hospitals tend to ‘cherry-pick' low-risk patients and only provide planned, elective procedures. Meanwhile, the NHS has total responsibility for providing 24/7 services and has plenty of experience in dealing with severe and complex cases. This evidence reinforces that the perception of private healthcare being safer or superior is misleading.

On the other hand, however, it can be argued that private healthcare does in fact provide certain advantages over NHS care. The greatest of these, of course, is the shorter waiting times, which provide much quicker access to specialists, tests, and treatments. This has spared many patients prolonged suffering, and in some cases, even saved their lives. Private treatment also offers more personalised care, as patients are often able to choose a preferred specialist or consultant, along with flexible visiting hours and comfortable private rooms. Furthermore, private healthcare is in general more adaptable due to the ability to choose timings and hospitals, and some even claim that it releases pressure off the NHS by freeing up space in public hospitals. All these factors are appealing and comforting.

So yes, at first glance, private healthcare appears highly attractive. However, as tempting as private suites and ‘picking’ your specialists seem, this ultimately reinforces the appalling inequality within healthcare systems. Suitable waiting times and personalised treatment should in fact be regarded as the standard across healthcare facilities, not privileges reserved for those who can afford them.

In the US, a recent study found that between 2000 and 2018, privatisation of 258 hospitals led to a decrease in low-income patients being treated because they provided ‘less profit’ due to low public reimbursement rates. These disturbing but real situations should make you wonder, has healthcare been reduced to nothing more than a money-making business? Why is profit now its prime purpose?

Hence, the question is not whether reform is needed, but how it can be achieved. Adversely long waiting times have dire, sometimes fatal, consequences and must be shortened without adding pressure on an already overworked NHS. While temporary public-private partnerships have reduced waiting lists, long-term dependence on private facilities is unfeasible. One possible solution would be to reinvest funding currently directed towards private facilities into expanding NHS capacity, as well as utilise private spaces and staff to provide free healthcare. Scaling up privatisation only drains workers and resources from the NHS, while further driving a wedge between the rich and poor.

The goal to work towards is for all patients, regardless of wealth and status, to receive timely, high-quality care – free at the point of use.

The views of columnists and people who write guest insight articles are their own.        

Bibliography:

https://www.ihpn.org.uk/why-dont-people-use-private-healthcare/

https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsbull.2023.95

https://www.theguardian.com/commentisfree/2020/jan/08/private-healthcare-sector-nhs-staff

https://www.ox.ac.uk/news/2024-02-29-new-study-links-hospital-privatisation-worse-patient-care

https://www.theguardian.com/society/2020/jan/13/the-impact-of-private-healthcare-on-the-nhs

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https://www.independent.co.uk/news/uk/home-news/private-hospitals-lack-facilities-to-deal-with-emergencies-study-finds-10078928.html 

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https://medmentor.co.uk/blog/what-is-the-difference-between-public-and-private-healthcare-services-in-the-uk