Thanks to the pandemic and budget cuts, waiting lists for access to NHS treatment continue to lengthen. And those who can afford it are increasingly choosing to access private treatment, inadvertently pushing the UK further into a two-tier healthcare system.
In September last year it was reported that the number of people waiting for hospital treatments in England was the highest since records began in 2007, having increased from 4.4 million in February 2020 to 5.6 million in September 2021. On top of that, 1.8 million people who were waiting for care in July had already been waiting for at least 18 months, and 7,980 people had been waiting for two years.
These waiting times are impacting everyone who needs to access the NHS but the backlog, according to The Guardian, is being "disproportionately shouldered by people in poorer areas". Additionally, analysis last year found that the impact is also affecting women more, with six times as many women waiting for treatment in the worst performing compared to the best performing Clinical Commissioning Groups (CCGs are groups of general practices (GPs) which come together in each area to commission the best services for their patients and population).
The pandemic has had several knock-on effects on waiting lists: the redeployment of staff to care for COVID patients as well as the need to cancel all non-urgent in-person care added significantly to waiting times. So too did the public’s heightened awareness of the health service’s frailties (stemming from repeated reminders that the NHS might be overwhelmed). This is thought to have led to many people delaying seeking treatment until further into the pandemic.
However, the problem of waiting times is not new. It has been a growing concern since the lists began lengthening in 2013 thanks to staff shortages, cuts to funding and a lack of equipment. According to the Financial Times, NHS waiting lists will continue to grow for another two years in England "and in some scenarios could more than double to 14mn, despite a tax rise designed to plough an additional £30bn into the service."
Consequently, more women than ever are seeking private healthcare either through insurance or self-funding in order to cut down on waiting time. According to health intelligence company LaingBuisson, self-pay healthcare is showing significant growth and is predicted to expand by another 10-15% over the next three years.
Alisha, 28, has been attempting to access osteopathic treatment since 2015. After being dismissed in various ways by NHS services and having records of NHS consultations lost, she became fed up and decided to go private. "I wouldn't have made this choice in the years before," she says, "mostly due to the price." In the end she spent up to £500 on consultations but says the private healthcare providers seem more concerned with payment and consultation than with the actual issues she’s seeking treatment for.
"I feel as though the private healthcare I received was similar, if not the same, as NHS services – but cost so much more. I've given up trying with both private and NHS services for now."
This is particularly pointed for gynaecological and sexual health services. Waiting lists in April 2021 were 60% higher than in April 2018 and while attendance of sexual health services dropped significantly during the pandemic, delays still plague the services.
Twenty-eight-year-old Olivia has been trying to get treatment since 2020 for long-term thrush, pain during her cycle and periods, intermenstrual bleeding and (recently discovered) ovarian cysts. "I waited nine months for a scan on the NHS after trying to get referred for a scan for about nine months on top of that." When her attempts to see a gynaecologist or sexual health expert through GP referrals were dismissed (she says she was told that as her pain isn’t urgent, she’s at the bottom of the list), she went to see a private gynaecologist last week – and paid £200 for the consultation. She adds: "Obviously I get they have zero resources and need to prioritise. I think the NHS is brilliant and I’ve had great experiences before now. But at this time it seems like everything is overwhelmed and the pain and discomfort I’m in is low-key exhausting all the time."
Similarly Hannah, 25, has been trying to access care for endometriosis since 2021. With doctors "running out of time" to treat her in A&E, she saw a doctor who said she was not in immediate danger and must wait for an outpatient call for an internal scan. "That was the end of July," she says. "In December they called to book an appointment."
In the end Hannah decided to pay £240 for a private scan, plus the £100 sign-up fee at a private GP. "After being unable to access the scan while knowing something wasn't right, my anxiety took over and I began to obsess about something growing inside me. I sought out a scan partially for the pain that was debilitating but also because the anxiety of not knowing, or knowing something could go wrong, began to take over my life."
In earlier years she says she would probably have waited out the NHS times. But she adds that while this is a privatisation of the NHS for many, the system is already privatised for people with conditions outside of the norm. "To access adequate care, experimental treatments or see certain specialists we have to pay out of pocket or set up funding pages. People in the UK love to believe in the sanctity of the NHS but it has been failing chronically ill people for years before this pandemic. We have a medical system that only understands the mainstream, and with budget cuts and austerity measures there is little hope for anything changing."
With so much strain already on NHS services, the move of individuals towards private care is absolutely understandable – especially when it comes to conditions affected by the gender health gap. However the development of a two-tier healthcare system will force those who are less well off to wait while those who can afford it pay for tests and treatments. It even has the potential to impact NHS patients as private hospitals often employ NHS doctors who spend their free time in private practice to supplement their income. As Tim Gardner, senior policy fellow at think tank The Health Foundation, told inews: "Staff [numbers] are going to be a critical constraint on the NHS being able to treat more patients and get rid of this backlog. If they are spending more time practicing in the private sector that might be taking away time from the NHS, which may have an impact on people who can’t afford to go private."
The government has already promised funding to help clear the backlog of NHS waiting lists but it is clear that far more needs to be done to stop a two-tier system emerging which will benefit only the few.