How can the government prevent a ‘two-tier’ system over NHS care?

In a YouGov poll last year almost a third of respondents said they had had difficulties accessing NHS care during the Covid-19 pandemic – with a significant number of these saying they had used some form of paid-for alternative.

The figures are not surprising given the scale of challenges the NHS has faced in the last two years. With Covid all but shutting access to facets of routine care down during the first and second waves. The NHS now reportedly faces a care backlog of 9.2 million by 2024.

Given this climate, where some patients face waiting months and perhaps years for care, it is no surprise some are a looking towards more speedy diagnosis within private hospitals.

In a new report the Institute for Public Policy Research think tank has warned that this growing trend towards private healthcare risks creating a “two-tier” system as people look for diagnosis and treatment. The report references raising waiting times for community mental health services – particularly in children’s eating disorders – and within dementia diagnosis, long-term conditions and cancer.

The problem is not that the NHS will be privatised overnight, more that health inequalities will only widen if we move towards a “two-tier” healthcare system where the wealthy can access care more quickly than lose with lower incomes.

The movement towards this will be subtle, with people being able to access public health, sexual health services, mental health support more quickly than others for example. All of these things combining to make the overall health of one part of the population.

However, the gap may also become greater in cancer services and more specialist services, as people are able to pay for faster diagnosis.

Cancer and very specialist care has not traditionally been the bread-and-butter of the private sector, but Covid has meant providers have adapted to more readily provide these services.

If access to care is a key driver towards increased use of private providers, then how can the issue of a “two-tier” system be tackled? The answer has long been workforce.

Chris Hopson, chief of NHS Providers, warned on Tuesday that the NHS will not be able to tackle its backlog in care with the current staff shortages it faces. While things like new cancer hubs can be set up, this doesn’t increase the number of doctors, nurses and other clinicians available to do the actual work.

As with the problem of waiting lists, workforce shortages are not a creation of the Covid pandemic. They have been festering over the last decade.

NHS leaders have repeatedly called for a long-term workforce plan with funding, which has so far been ignored by the government.

Funding and a shiny new workforce plan won’t be a simple thing to put in place, but it is a vital place to start.