The United Kingdom is becoming a health service with a country attached. The National Health Service is on track to command almost half of all state spending. For all that, British healthcare outcomes come in at the bottom of the pack among comparable western European countries.
Waiting lists are the biggest issue facing the NHS, with a record 5.8 million patients currently waiting for treatment. This probably barely scratches the surface.
In response, record numbers are opting out of the NHS. Private hospitals are receiving unprecedented revenues for operations, diagnostic scans and cancer treatment. One provider, Spire Healthcare, has reported a record 81 per cent growth in self-pay revenues. Some patients are using their savings while others are taking out loans or borrowing money from friends and family.
Even then, only a small minority can afford private treatment. Millions of others are stuck, many in pain, waiting for the NHS to provide the service that they desperately need. Far from healthcare for all, the current system means only those who can afford it can get quick, effective treatment.
One solution would be to enable every patient to “Go Private” if the NHS fails to provide service within a reasonable time, paid for out of local health budgets. This would mean private healthcare could be accessed by everyone, not just the preserve of the most wealthy. It would result in greater patient choice, more equitable and better outcomes, and stronger incentives for speedy care in the NHS – if they can’t perform the treatment, they’ll have to pay for it.
This isn’t some wacky idea. It’s the successful approach taken by Denmark, a Scandinavian social democratic country with universal healthcare.
Since 2002, Denmark has had a maximum waiting time guarantee of two months for treatment, reduced to one month in 2007 with additional requirements for speedy diagnosis. If your waiting time exceeds the guarantee, you can select a private service in Denmark or abroad paid for by your region. The result of this has been a decline in waiting times in a range of areas. The median time for a hip replacement has fallen from around 70 days in the mid-2000s to around 45 days as of 2018.
After several attempts of throwing more money at the problem, Portugal took a similar approach in 2004. If waiting times exceed 75 per cent of the target, patients are issued with a voucher for a private provider. Between 2005 and 2010, surgery wait times plummeted 39 per cent.
It’s not without its risks. For example, private providers will need to be able to easily train more doctors and nurses and recruit from abroad, to ensure the system is not depriving the NHS of talent.
The oft refrain is that it would mean “privatising” the NHS. This is blatant nonsense. The NHS has been outsourcing treatment for decades and yet still remains true to its principles of free universal healthcare at the point of use. Tony Blair successfully reduced waiting times by establishing forty-six ‘Independent Sector Treatment Centre’ (ISTC). These were privately-owned centres that came to treat around 300,000 patients per a year.
The NHS is again expected to lean on the private sector, through bulk purchasing capacity, to get down waiting lists. The advantage of combining this with a set target, and a voucher system, would be greater patient choice and pressure to reduce waiting time.
Allowing people to suffer in agony or die while they wait for treatment rather than involve the NHS is not noble, it’s madly irresponsible. The central question should always be “will this deliver better healthcare outcomes?”