UK Edition
Numbers 'going private' for surgery soaring as NHS rationing deepens
The number of patients paying for operations privately is soaring amid rising waiting lists and deepening rationing across the NHS, new figures show.
Private companies have seen a 53 per cent rise in the “self-pay” market in four years, the data reveals.
Analysts said the market for operations such as hip surgery and cataract operations was being fuelled by “very high waits for NHS diagnosis and treatment”.
In the last four years, the numbers waiting more than six months for such operations has tripled, with 445,360 such cases by the end of last year.
Many areas have drawn up restrictions on access to treatment, refusing some operations entirely, with others only provided for those in extreme pain.
The President of the Royal College of Surgeons last night said it was “completely shameful” that patients left in misery, unable to work or go about their daily activities were being forced to resort to paying for operations the NHS should provide.
Two thirds of NHS trusts are home to private facilities which charge for treatment, with some advertising the chance to jump the queue as “an extension of our existing services”.
Typically, the clinics, and those run separately by private providers, charge between £9,000 and £14,000 for a hip replacement procedure, with prices of up to £5,000 for some type of cataract operations.
It comes amid deepening rationing across the NHS. In Sussex, proposals say patients should endure "uncontrolled, intense and persistent" pain for six months before being referred for hip surgery. Doctors say the restrictions proposed by seven clinical commissioning groups (CCGs) are so severe that patients could be left at risk of painkiller addiction. And hernia patients are being forced to prove they are in so much pain they cannot go to work before they are given an operation.
Most CCGs are now refusing to fund the surgery until patients are so debilitated their everyday life is affected, research has found, with just one in four following clinical guidelines. Meanwhile, two-thirds of areas are limiting cataract surgery to those with the worst vision.
And waiting times for cancer treatment are the worst they have been since data began being collected almost a decade ago, with more than one in five patients waiting more than two months for potentially life-saving procedures.
The report by market analysts LaingBuisson says patients are increasingly ending up paying for operations they might have expected to receive on the NHS.
The figures show that between 2012 and 2016, spending on the “self-pay” market for acute medical care rose from £454m to £701m - a rise of 53 per cent, including a 13 per cent rise in 2016.
The statistics exclude those paid via health insurance, and any cosmetic treatments.
The report says: “A consistent rise in waiting on the NHS is identified as a leading driver of increased interest in self-pay private healthcare.
“In particular, very high waiting times in many regions are likely to have encouraged more people to pay for care ‘out-of-pocket’.”
Experts said growth was particularly high among the over 50s, with restrictions on orthopaedics operations, hernia repair and on eye surgery such as cataract operations fuelling the rise in the numbers going private.
And Spire - the UK’s second largest private acute medical care provider - said its self-pay revenues have risen by 8 per cent in the first half of this year. However, the company was forced to issue a profits warning last week after the revenue received from the NHS fell by 9.5 per cent over the same period, as a result of growing rationing.
Professor Derek Alderson, President of the Royal College of Surgeons, said the evidence showed the private sector boom in self-pay treatment fell in exactly the areas the NHS was rationing - such as orthopaedics and cataract surgery.
“It is completely shameful that those in pain, and who may be unable to work or go about their daily activities, have to resort to self-fund their care in desperation.
“The recent decision by some commissioning groups to make patients effectively beg for a hip or knee replacement through an individual funding request will only increase the likelihood of more patients going private,” he warned.
The surgeon said it was “unacceptable” not to routinely fund effective treatments for individuals who had paid their taxes.
John Kell, head of policy at The Patients Association, said: “These figures are evidence of a serious and preventable failure of health policy, for which patients are paying either directly in financial terms or indirectly through avoidable suffering.
“As waiting times have lengthened and CCGs have imposed ever-higher bars on elective surgery in their scrabble to save cash due to underfunding, it’s only natural that people who are in pain and discomfort, but can afford to pay privately, will opt to jump the queue. Those who can’t afford to do this are left to suffer.”
Many of the major private firms advertising for “self-pay” treatment highlight the frustrations of long waiting times on the NHS. Promotional material from St Marys NHS treatment centre, in Portsmouth, highlights all operations which have a self-pay option, with links to the private provider, Care UK, which shares its site.
Caroline Abrahams, charity director at charity Age UK said: “It is extremely worrying that we seem to be sleepwalking towards a situation in which if you want a routine operation such as a hip replacement, cataract removal or hernia fix you either have to pay privately or wait a long time, often in chronic pain, on the NHS.”
"We recognise that NHS budgets are under huge pressure, but older people who need operations must be able to get them within a timescale based on their clinical need, not their bank balance. If this is no longer how things work we really are on a slippery slope when it comes to the idea of universal healthcare, free at the point of use - the founding principle of the NHS,” she said.
A Department of Health and Social Care spokesperson said: “The NHS is carrying out 2.2 million more operations compared to 2009/10. Decisions about when or whether treatment is carried out are rightly made by doctors based on what is best for their patient – and if such treatment is deemed necessary we expect patients to have access to it in a timely way.
“As part of our long-term plan for the NHS, we will increase funding by an average 3.4 per cent per year, meaning that by 2023/24 it will receive £20.5 billion a year more than it currently does.”