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Analysis reveals ‘shift’ towards private healthcare

In the four years to September 2023, paid-for hospital admissions were up 218% in Northern Ireland, 124% in Wales, 80% in Scotland and 20% in England.

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There has been a “sharp increase” in people forking out for private health care, according to new analysis.

The Nuffield Trust said across the UK, there has been a rise in the number of people paying out of their own pocket for hospital care since the pandemic.

The think tank suggested people could be turning to private care “out of desperation as NHS provision flatlines”.

According to the analysis:

– The vast majority of planned hospital admissions in England – around 85% – are NHS patients in NHS hospitals, but this has fallen from 88% before the pandemic.

– Between September 2019 and September 2023, hospital admissions paid for out of pocket were up 218% in Northern Ireland, 124% in Wales, 80% in Scotland and 20% in England.

– Across the whole of the UK, this means a 32% increase in out-of-pocket admission and day cases between September 2019 to September 2023.

– There has also been a rise in people using private health insurance to get private healthcare – across the UK as a whole, hospital admissions through private health insurance are up 5%, with the Nuffield Trust saying the rise could be because people and employers “expect difficulty in accessing care to continue”.

The authors said the trends “may be being forced on the UK by a lack of NHS provision, and pressure from emergency demand, and serving as an alternative to the NHS being able to do more, rather than simply reflecting additional or better treatment being made available”.

They also warned the trend could risk exacerbating health inequalities.

Mark Dayan, one of the authors of the data briefing, said: “While the vast majority of care remains NHS funded and delivered, there has been a definitive shift in all four UK countries towards private healthcare, either funded out of pocket or to a lesser extent through private healthcare plans.

“Scotland, Wales and Northern Ireland have seen the starkest rises in those turning to private healthcare provision.

“In Northern Ireland, this more than tripled and could reflect patients grappling with the longest waiting times in any UK countries. At the same time, the English health service is once again starting to make more use of private providers itself, insofar as its budget can stretch.

“As more people shuttle from private care to NHS care and back, there is a risk that they will jump the queue, or fall through the cracks of disjointed information systems.

“The fact that more people are paying out of pocket at a time when the economy is tight and difficult, not a time of plenty, suggests they are turning to the private sector out of desperation as NHS provision flatlines. That means that the balance of care is very slowly shifting from care based on need, to care based on willingness and ability to pay.”

David Furness, from the Independent Healthcare Providers Network, said: “With NHS waiting lists at record levels, it’s not surprising that more people are choosing to use private healthcare, either paying by their own means, or through insurance.

“Independent providers are also continuing to play their role in the delivery of universal, high-quality NHS care, free at the point of use to patients all across the country, with independent providers delivering around one in five NHS admitted operations, and 10% of all elective activity, it’s clear that the sector is key to ensuring NHS patients can get the timely, high-quality care they need.”

“The Elective Care Framework sets out firm, timebound proposals for how the department is going to systemically tackle the backlog of patients.

“Huge efforts are being made across the entire system to maximise the current resource available.”

A Welsh Government spokesperson said: “NHS Wales works hard to deliver high-quality care to reduce waiting times, with the number of long waits continuing to fall in each of the last 23 months, the lowest since August 2021.

“We ask a lot of our health and care services, and everyone working in these services continues to work incredibly hard, providing care for all of us when we need it.”

A Scottish Government spokesperson said: “We are committed to eradicating long waits, which have been exacerbated by the pandemic, to ensure all people receive the treatment they need as soon as possible.

“An investment of £30 million is being targeted at a series of national and local plans to reduce to the national backlogs that built up throughout the pandemic by maximising the use of local and national resources across Scotland.

“This builds on our £1 billion NHS Recovery Plan which has delivered a significant reduction for the longest waits and continues to support an increase in activity through the implementation of sustainable improvements and new models of care.”

A Department of Health and Social Care spokesperson said: “We are taking the long-term decisions needed to make our health service in England faster, simpler and fairer, cutting waiting lists and ensuring people get the care they need.

“The overall NHS waiting list has fallen by around 200,000 over the past six months and we are continuing to make good progress, while delivering record numbers of diagnostic tests, record levels of investment and embracing the latest technology across the NHS to deliver care to people when and where they need it.”

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