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, according to the annual IPPR ‘State of Health and Care 2022’ report. 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% 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%) used some form of paid-for alternative and one in five considered doing so, with this proportion rising for wealthier people.
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%) 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% 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%) 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% say they wouldn’t opt for private healthcare because they couldn’t afford it, and just 10% reject 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%). 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, says: “People aren’t opting-out of 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.”
