Could the NHS lose its halo as waitlists push people towards private practice?
Since the outbreak of the Covid-19 pandemic, NHS waiting times have increased sharply. In early 2020, there were about 4.4 million people on some kind of NHS waiting list. In early 2022, that figure had soared to 6.1 million.
In early 2020, fewer than one in five patients waited for longer than 18 weeks. Now, more than one in three patients do. Waiting times of more than a year used to be vanishingly rare. Today, there are nearly a third of a million people who have been waiting for this long.
As a reflection of that, public satisfaction with the NHS has fallen drastically, according to the British Social Attitudes (BSA) survey. Between 2007 and 2020, the share of respondents who said they were satisfied with the NHS always exceeded 50 per cent, and could go as high as 70 per cent. Meanwhile, the share of respondents who expressed dissatisfaction never exceeded 30 per cent, and could go as low as 15 per cent.
In 2021, only 36 per cent were satisfied, while 41 per cent were dissatisfied, which means that we are now in net dissatisfaction territory. When those who were dissatisfied were asked for the reason(s), the most common response was “It takes too long to get a GP or hospital appointment”.
So it’s unsurprising this has turned into an increasing willingness to turn to private sector alternatives to the NHS. According to a YouGov survey, nearly one in four people say they would consider going private. Younger adults (who generally need less healthcare) are more likely (29 per cent) to consider this option than older generations. Though this sounds counterintuitive – young people tend to need less healthcare – this is a generation not as heavily enamoured with the NHS as many older adults. They appreciate its importance, sure, but have been least likely to benefit from it and much of their support on it rests on the knowledge they will need it in the future.
In addition, a survey by the Institute for Policy Research (IPPR) specifically asked those who had recently experienced difficulties in accessing NHS care whether they had considered using a private alternative. 12 per cent of them said they had not just considered it, but actually done so, while another 26 per cent said they had at least thought about it.
Some private healthcare providers report an increase in fee-paying patients, although it is too early to say whether this is a sector-wide trend (or, indeed, whether it is a trend at all, rather than just a one-off uptick).
Still, this is quite a contrast to 2020, the year of the weekly “Clap for Carers” or “Clap for the NHS” ritual. Is the NHS finally losing its halo? The use of private healthcare could be a one-off exception, explained by the Covid-19 backlog. But it could also be a psychological dam-breaker. Once people get into the habit: could private healthcare become “normalised” in Britain? Could this, indirectly, lead to greater acceptance for market-based reforms of the healthcare system, of the type that would currently be decried as “privatisation”?
It likely won’t be a massive swell which upturns the NHS. The BSA survey also shows that there is still near-universal approval of the health service as a general model of healthcare provision, even if there is dissatisfaction with its current performance. People like the idea of the NHS – if not its actual practice.
In addition, the survey shows that those who are dissatisfied with the NHS tend not to blame the NHS itself for their dissatisfaction. They are more likely to blame underfunding, and unspecified “government reforms”. In other words: it’s not their GPs fault they can’t get an appointment – it’s the Prime Minister’s. This is the ultimate ring of protection for the enduring love of the health service, allowing them to escape any culpability for delays.
Even if we do see a lasting increase in the size of the private healthcare sector (which is by no means guaranteed; it may well be just a flash in the pan), it will not necessarily translate into a more general change in attitudes.
It is more likely to lead to a situation where people love the NHS in the abstract, even if they try to avoid using it.