Could the private sector help fix the NHS backlog?

The Conservative plan to tackle the NHS backlog has, so far, run roughly along the lines of the New Labour approach to the hefty waiting lists in the health service at the turn of the century. More money, more flexibility when using the private sector and greater ‘patient choice’ (which in this context translates as patients who’ve been waiting a very long time being able to get treatment in another part of the country where waiting lists aren’t quite so bad). So far, the main difference is that ministers are just shouting a bit less at hospitals (though GPs might argue they are bearing the brunt this time instead) than the Labour government did.

But as I say in the i paper this week, some Conservatives are urging a markedly different approach where those who can afford to opt out of the NHS and get treatment in the private sector are rewarded through things like more sympathetic tax treatment for private medical insurance and so on. Their logic is that this frees up space for others who can’t pay and therefore helps the overall waiting list. The policy problem with this is that the Tories would have to justify spending money on a tax break which it could be spending on the NHS itself or on other drivers of demand such as the social care sector. The political problem is that having spent the past decade and a bit trying to reassure voters that they are totally committed to the NHS, the Conservatives would then look as though they were trying to undermine it and as though they were in favour of privatisation after all.

Privatisation is generally an ill-defined spectre in the health service which can refer to anything from the foundation hospitals that the Blair government set up all the way to contracting out services to private companies (but never to the way GPs are contracted by the NHS because to acknowledge that the health service isn’t and has never been a perfect monolith would be to make the spectre a bit less scary). But whether or not the Conservatives do engage with these suggestions from their backbenches to use individuals seeking private treatment (as opposed to commissioning the private sector through the NHS) as a means of driving down the waiting list, there is currently an erosion of one of the key principles of the health service. Many of those who are stuck waiting for a long time (and there are more than 300,000 who’ve been waiting for over a year) are scraping together cash or going into debt in order to seek treatment because they can’t bear the pain any more or are worried about their illness progressing to an untreatable state. They are having to take part in a two-tier health system.

Now, anyone with a mental health problem reading this might be thinking rather wryly ‘welcome to the club’ given it has long been the case that even with a serious condition you can end up parked on a list for more than a year – and that’s often just to get a diagnosis. The NHS has been part of a two-tier system for mental health for a very long time: if you have money to pay for counselling, you’ll opt out. We have – unfortunately – come to accept this state of affairs over many years. But the spectacle of patients who are not rich and who still believe in the NHS having to go private for physical problems is new. It’s also not something a Conservative government can easily bear. These patients don’t want to have to pay for their treatment, and it won’t be the NHS they blame for being put in this position either.