At lunch with a friend last week, I asked after her husband who has had a rough time with his health. He’s stable, thank whatever mercurial god is charged with keeping an eye on the National Health Service, but he needs treatment for a side-effect of radiotherapy and has just discovered that the waiting list is 80 weeks.
It was at this point I confessed. “I’m investigating private health insurance”, I said guiltily. She replied breezily that she and her husband have had it for years. It was the same story when I asked another friend. She wouldn’t be without it. I was, frankly, astonished.
It seems that while the NHS has creaked, strained and buckled over the past two decades, and politicians have decried private medicine and “the privatisation of the health service,” ordinary families — those who go on camper van holidays and send their kids to the local school — have worked out just what their health is worth and quietly done something about it.
They’ve watched relatives languish on waiting lists for treatment for non-urgent conditions, only to discover by the time they get the summons, the condition is critical. They’ve realised that their pets have better access to care and decided that their health is worth infinitely more than their computers, cars, the budgie, or all manner of other things they insure.
Even so, the fierce ideological battle around private medicine means that nobody is talking about it. In some ways, it’s the last great health taboo. Light entertainers make television programmes about the menopause. Women’s reproductive health has become a subject for employers. Remedies for erectile dysfunction are advertised on television. And quite right too. But private health insurance is rarely discussed.
I get it. The whole point of the NHS is its communitarianism. Collectively we all have a stake in it and a responsibility to it. It was designed to be the antithesis of every man for himself. But the NHS no longer does what it says on the tin. It’s not national in any meaningful way. The experience in Aberdeen is not the same as the experience in Aylesbury.
It is no longer about optimal health. As the system becomes more and more stretched, illness is the focus. Often patients cannot access the treatment they need because rationing dictates that they are not yet ill enough. And while there are pockets of excellence throughout the NHS, it is quite possible to spend time in the system and experience nothing remotely equivalent to service.
It sometimes seems that half the public sector is worn to an absolute frazzle while the other half is on a semi-permanent holiday.
But those perusing the Bupa website or contacting their broker should feel angry rather than guilty. It did not have to be like this. Every week there is a new crisis of a magnitude unimaginable pre-devolution.
Last week the Royal College of Emergency Medicine said that delivering safe care continues to be a challenge in every emergency department in Scotland. This came after August recorded the worst-ever waiting time figures for that month, with about a third of all patients waiting more than four hours to be seen.
The government target that 95 per cent of patients should be admitted, transferred or discharged from A&E within four hours has not been met for more than three years.
Had such a claim been made pre-devolution there would have been an outcry, but we’ve become inured to such news. If acute medicine cannot deliver prompt care anywhere in Scotland, the assumption must be that patients will suffer neglect, and could find themselves harmed or worse.
At the same time, the government’s flagship social care policy the National Care Service, hailed by then first minister Nicola Sturgeon as the most ambitious reform of the devolution era, is in crisis. The vision was for a service inspired by the NHS (ha!) with a network of care boards across Scotland which could provide consistent high-quality care and prevent elderly patients from blocking beds.
But with £28 million already spent, local authority leaders have pulled out of talks. They are facing a £585 million annual shortfall, predicted to rise to £780 million by 2026-27. The unions are calling for the National Care Service to be scrapped. At the same time, 18 per cent of care homes in Scotland have closed in the past decade.
The crisis in A&E and the struggles of the care sector bookend the troubles of the NHS. Bed-blocking in the NHS is at a record high. Some 2,000 patients ready for discharge were stuck in Scottish hospitals every day in August, the highest number since records began in 2016 and a rise of 11 per cent on the previous year.
Yet Scottish health spending per person has grown from £1,659 per person in 1999 to £3,073 last year in real terms, according to the Institute for Fiscal Studies. The number of clinicians employed by the Scottish NHS has increased since 2020, with 11 per cent more consultants, 16 per cent more junior doctors and 8 per cent more nurses than pre-pandemic.
Despite this emergency admissions, elective day-case patients and outpatient appointments are down by 8 per cent and elective inpatient admissions are down by 21 per cent. Five health boards were on the verge of bankruptcy before government bailouts.
If this were a business the CEO would be sacked, a turnaround specialist employed and measures to boost productivity introduced urgently. Everyone would be working flat out until the situation was resolved.
None of this should come as a surprise. Every year the auditor-general for Scotland reports on the state of the health service. If you read these reports over the past decade, they are the bureaucratic equivalent of a Hogarthian illustration of the handcart to hell in which the NHS is currently trundling.
They’ve stopped sugar-coating the pill for the Scottish government’s consumption. “[The NHS’s] longer-term affordability is at risk without reform. There is no overall vision,” the latest report stated.
Like Cassandra, these prophecies fall on deaf ears, despite the Scottish government having had 17 years to tackle the matter. The entire cabinet should be on their knees begging the forgiveness of voters. Instead, they seem as moribund as the worst hospital case.
As a journalist who has been writing about the health service since before devolution, married to an NHS hospital consultant of 30 years, I never thought health insurance would be something I would countenance. But I’ve seen too many patients pay too high a cost for our declining health service — some of them, sadly, the ultimate price.
