The emerging consensus for greater choice in health care

9 Jan

For as long as I can remember, there has been a passionate argument over the morality of private health care. Critics characterise making use of it as “jumping the queue”. Defenders retort that getting out of the queue would be a better analogy. Those exercising the choice to “go private” are reducing the NHS waiting list and thus helping those who can’t afford such an option. Another emotive and controversial issue has been over the NHS itself using the private sector. Some feel it is justified if it offers value for money or eases particular pressures in the system – while treatment free at the point of delvery is still being provided. Others insist that it is just wrong on principle.

In the spirit of “only Nixon can go to China” perhaps it is easier for Labour Governments to take a pragmatic approach to the NHS making arrangements with independent providers. Alan Milburn is probably the Health Secretary who has been most unapologetic about making this case – he served in that post during the Blair Government between 1999 and 2003. But the trend has been quietly continuing for decades. In the financial year 2019/20, NHS spending on independent providers grew to £14.4 billion – and that was before the pandemic had a full impact.

Wes Streeting, the Shadow Health Secretary, has indicated he is thinking along the same lines as Milburn. He has told Nick Robinson, for a BBC podcast, that the Labour Government “showed using the private sector to bring down NHS waiting lists is effective and it’s popular with patients”. He added:

 “No doubt the government will turn to the private sector, no doubt the next Labour Government may have to use private sector capacity to bring down NHS waiting lists, and I won’t shirk that for a minute to get people better health outcomes.”

But should the potential for individual choice not also be enhanced? We have six million on the NHS waiting list and the figure is rising. Those diagnosed with cancer are supposed to get treatment within two months – but a third are having to wait longer. Should we not give those people a legal right to that treatment within the deadline? If the NHS does not have the capacity, then they would be entitled to use the private sector, with the NHS paying the bill.

Should we not provide tax relief for private health insurance – both for companies and private individuals? Employers already have a motive to help keep their workforce healthy – private health insurance is something trade unions have traditionally been keen to negotiate. But the efforts to provide good health care, including preventative measures, have wider benefits to society which should be recognised and encouraged.

Despite huge extra spending on the NHS, there has been a big increase in the number of people using the private sector. Before the pandemic, 13 per cent of us had private health insurance. That has risen sharply – by 46 per cent according to one estimate. But there has also been an increase in the number paying for a particular operation to be carried out privately. 21 per cent said in a poll for Populus that they had “gone private” in the past year.

What if you don’t have £13,000 for a knee replacement? Or £11,000 for a hip replacement? Or £3,000 for cataract surgery? Often waiting for months, while struggling to navigate the NHS bureaucracy is a frustrating and uncertain process. For many the delay is painful and prevents them from working. It is true that there is a divide.

But the answer is not to eliminate choice but to widen it. Those who spend money on the health of themselves and their families should be allowed to make that spending tax deductible. That change would make the option affordable for far more people. There should also be the security that, regardless of income, for certain treatments, if the NHS fails to provide care within a specific deadline, then the alternative of private provision can be undertaken with the cost fully met by the taxpayer.

Politically this approach would have some attractions for the Government. It would probably be popular with most voters. If Streeting supported it I suspect that would prompt a split in the Labour Party – with many keen not to compromise their ideological purity. But such policies would also have the merit of being right. It would mean applying the Conservative principle of individual choice in a way that is compassionate. It could avoid delays in getting necessary health treatment for the many and not just the few.