Brits love the NHS, some will pay to avoid it.
For David Haselgrove, every day was a struggle to get out of bed, and then another struggle to put on his socks. Stairs were often impossible, and the pain made him irritable and difficult to live with.
But when he sought medical help for his arthritis, Mr Haselgrove was told the wait for a specialist consultation was more than two years. It may take another two years before the operation takes place.
“If I wasn’t the person I am, I would have lost the will to live because the pain takes over your life,” says Mr Haselgrove, 71, who is now fully mobile after a successful hip replacement.
His recovery has nothing to do with the British National Health Service.
Instead, Mr Haselgrove, who ran several small businesses during his working life, flew to a clinic in Lithuania to undergo surgery. He became one of a growing number of Britons who have dipped into their own pockets to pay for the procedures they are entitled to. free on the NHS
Free, universal healthcare – funded by general taxation and payroll deductions – is the founding principle of the National Health Service, one of Britain’s most respected institutions and the most enduring part of the welfare state the country sought to build after the suffering of the Second World War. .
But it is a promise that is taking longer and longer to fulfill.
After the financial crisis, the Conservative-led coalition government elected in 2010 entered a period of austerity, during which healthcare spending failed to keep pace with the needs of an aging population.
In the decade leading up to the coronavirus pandemic, spending rose in real terms by just 0.4 percent per person per year – including four years when spending per person actually fell. according to the Nuffield Trust, a research institute specialized in health. Investments have been made in buildings and equipment, including essential diagnostic tools such as CT and MRI scanners significantly lagged behind medical systems in other advanced economies, according to the King’s Fund, a healthcare-focused think tank.
That already contributed to a backlog of 4.6 million procedures before the pandemic, a number that rose to six million when scheduled procedures gave way to emergency care during the Covid crisis. The treatment line has only grown since then. This now concerns approximately 7.7 million procedures, which amounts to approximately one tenth of the population. Thousands have waited more than two yearsoften pain.
It’s no wonder that many Britons who can afford to lower the border are doing so, while some with more limited resources are dipping into savings or taking on debt. Yet that trend, some critics say, could undermine a health care system that has been the bedrock of British life for three-quarters of a century.
Private health insurance is expensive in Britain and taxable if offered as a benefit by employers. So the shift is most visible when people pay out of pocket for surgeries and other medical care.
According to the Private Healthcare Information Network, which publishes data on the sectorthere were about 50,000 “self-pay” medical admissions in a typical quarter before the pandemic. That figure is now steadily rising significantly; in the first quarter of this year there were 71,000, almost a record.
This does not apply to patients who go abroad, such as Mr Haselgrove. At 7,000 euros, about $7,500, a hip replacement at the Nord Clinic in Lithuania was significantly cheaper than at a private hospital in Britain.
Joint replacements like Mr Haselgrove’s “have the longest wait times in the country”, says Deborah Alsina, the chief executive of Versus Arthritis, a charity. “As a result, we are increasingly hearing from people paying to have their hip or knee replaced privately, in a fraction of the time it would take on the NHS”
Some critics of private involvement in British health care question whether for-profit providers are actually increasing the capacity of the system. Britain has a chronic shortage of healthcare workers, with more than 100,000 vacancies in the NHS. Most specialists working in both systems spend the vast majority of their time on NHS matters. suggest data. But private healthcare providers are dependent on bringing in extra work thousands of surgeons and other senior physicians whose main employer is the NHS
And when a routine private operation becomes an emergency, it is often the public system that must respond, as many private hospitals do not have emergency rooms or intensive care units.
But the biggest risk from the rise in self-pay patients, according to Chris Thomas, chief health officer at the Institute for Public Policy Research, a progressive think tank, lies not in the activities of the health care system but in its political underpinnings.
The British healthcare system, he said, is built around the idea of “universalizing the best” – creating a system “as good for a rich person” as for a poor person, Mr Thomas said.
If wealthier people increasingly opt out, Mr Thomas said, the NHS will become a second-tier system for those who cannot afford to do so, resulting in “a slow erosion of support”.
Some right-wing politicians have begun to call for a structural rethink – not a new idea, but one with previously limited support, even among free-market enthusiasts in the Conservative Party. The explosion in the number of waiting lists has fueled calls for change.
However, Mr Javid plans to leave Parliament at the next election, and the Conservatives who are still standing, along with the representatives of every other mainstream party in Britain, almost universally present themselves as champions of the NHS .
For now, even Britons who pay for care often do so reluctantly – sometimes feeling guilty about crossing the line – as they argue for a more generously funded public system.
Romy Cerratti, 43, a mental health campaigner who lives in Buckinghamshire, north London, has both paid for surgery – to remove painful breast implants she got 20 years ago as part of an NHS operation to treat a congenital abnormality of the breast to correct bone – and for psychotherapy. She fears she may need another operation and is still waiting for NHS group therapy after more than two years on a waiting list.
When she discusses healthcare with friends, she says, most tend to side with the NHS. “People say, ‘You don’t want to be like America; it’s a two-tiered system,” Ms. Cerratti said. She was able to afford the £7,000 surgery cost, about $8,800, due to an inheritance, but has had to cut back on private therapy for financial reasons.
“I always say we have a two-tier system here right now because those who can afford to go to the private sector are getting decent care,” she noted.
For those who can’t, she added, “It’s mostly a matter of luck.”