A LONG-TERM DECLINE in NHS access and quality, rapidly accelerated by the pandemic, has begun to supercharge a trend of people opting for private healthcare and products, especially in England, according to the annual Institute for Public Policy Research (IPPR) State of Health and Care 2022 report.

The IPPR warns that this growing ‘opt out’ is a symptom of the NHS being under resourced, and struggling to recruit and retain the workforce it needs to deliver truly universal care.

New IPPR/YouGov polling shows that 31 per cent of adults in Britain – the equivalent of 16 million people –
struggled to access the care they needed during the pandemic. Of these, almost one in eight (12 per cent) used some form of paid-for alternative and one in five considered doing so, with this proportion rising for wealthier people.

However, it should be noted that tends and practices in the separately run NHS Scotland are different to those in England, with Scotland’s NHS under pressure but showing a considerable commitment to public provision.

The report provides a snapshot of the declining access and quality of NHS care, heightened by the pandemic, which is driving more people towards private healthcare:

  • General practice: Over half of adults (54 per cent) believe it is harder to speak to a GP – whether by phone or in person – compared to before the pandemic, according to IPPR/YouGov polling.
  • Mental health: Hospital admissions for self-harm and assault among 5-15 year-olds was 25 per cent higher than expected (in Q3 2020). There is an even steeper rise in urgent referral rates for eating disorders, which have approximately doubled since the onset of the pandemic.
  • Cancer: The number of cancers diagnosed while still ‘highly curable’ fell three percentage points in the first year of the pandemic. On current trajectory, it will take around a decade to recover the cancer treatment backlog, according to IPPR and CF estimates.
  • Dementia: Only four in 10 people with dementia received a proper care plan, or care plan review, in 2021 compared with around seven in 10 in 2018-19.

New IPPR expenditure analysis shows that since the 1970s, the UK has seen the fastest rise in people paying for private healthcare and products in the G7. The report argues that this trend should alarm policymakers, as it signals that people are not receiving the quality and accessibility of NHS care that they deserve and expect.

The report argues that this move towards private healthcare by those who can afford it could be undermining the foundations of a universal health system and the spirit of the NHS. According to the report, the risk to the NHS isn’t so much of a sudden shift to an American-style health system, but of the emergence of an unequal two-tier system that comes to resemble the English education system, where a mediocre standard is available for everyone, but the best is only available to those who can and are willing to pay.”

Polling reveals that one in six Britons (17 per cent) say they would go private if they knew that they faced waiting longer than 18 weeks from referral to begin treatment on the NHS. A further 59 per cent say they wouldn’t opt for private healthcare because they couldn’t afford it, and just 10 per cent rejecting private healthcare on principle.

Researchers warn that if private healthcare becomes the ‘new normal’ for those who can afford it after the pandemic, it could further entrench and deepen health inequalities.

The report shows that people don’t want to see the emergence of a two-tier system. Despite the perception that private healthcare is better quality, the IPPR/YouGov polling found cross-party universal support for the core principles of an NHS free-at-the-point-of-delivery (88 per cent). Leaders should therefore draw on the public’s enduring support for NHS values as a clear mandate to invest in providing universal free access to the best possible care, according to IPPR.

The think tank argues that tackling long waiting times and poor outcomes is vital to ensuring the long-term survival of the NHS and arresting the trend towards an unequal two-tier system that increases health inequalities.

The report concludes that there is still time for decisive policy action to revitalise health and care and ‘build back better’. Part of IPPR’s plan to achieve this includes investing in new hospital beds and community care capacity, boosting staff pay and doubling investment in preventing ill health by 2030.

Chris Thomas, IPPR principal research fellow, said: “People aren’t opting-out the National Health Service because they’ve stopped believing in it as the best and fairest model of healthcare. Rather, those who can afford it are being forced to go private by the consequences of austerity and the pandemic on NHS access and quality – and those without the funds are left to ‘put up or shut up’.

“The risk is that, in the future, the idea you have to pay to get the best healthcare becomes normalised. This would erode public support and the electoral coalition that has underpinned the success and popularity of our NHS. In turn, this would further embed inequality, leave the NHS more liable to budget cuts, and to the poorly evidenced whims of politicians. Leaders should listen to what the public want and reinvigorate the NHS as a means to ‘universalise the best’ healthcare, for everyone, free at the point of delivery.”

The report proposes policies designed to live better with Covid, to help build back better, and to help prepare for the future.

On capacity: Allowing a yearly cycle of huge strain in summer and near collapse in the winter, in health and care, is not sustainable. The report recommends the government introduce a statutory definition of sustainability in health and care, with a target hospital occupancy rate of 85 per cent – with both new hospital beds and expanded community care capacity used to meet that level. To shore up staff retention in the short term IPPR calls for a CPI + five per cent pay bonus for staff, and improvements to workforce conditions, with more flexible working and progression.

On culture: To boost innovation, the IPPR recommends new ‘innovation adoption and spread mission statements’ to give national purpose and ensure the implementation of new technology and treatments. To boost healthcare integration, it calls for leaders to develop local ‘system leadership’ and a new multi-year community health building fund to help services work together better. And to ensure a greater focus on preventing illness, the report urges the government to double healthcare spend on prevention by 2030 – combined with bold action on obesity and tobacco outside the NHS.

On resources: The report says that while the Comprehensive Spending Review and Health and Social Care Levy provide a financial boost, funding remains a challenge. IPPR analysis suggests the NHS funding gap will threaten social care funding, which is reliant on money being transferred from the NHS. Elsewhere, local public health budgets remain below 2014/15 levels in real terms.

The IPPR recommends an additional increase in funding across health and care of £12.6 billion in 2022/3, £15.5 billion in 2023/4, and £20.2 billion in 2024/5.

* Read The State of Health and Care 2022 here.

* Source: Institute of Public Policy Research