For decades, the National Health Service has driven the UK's reputation for world-leading medical care, drawing patients from overseas who sought private treatment from its consultants and the highly specialised equipment available at its teaching hospitals.
But today, it is NHS patients themselves who are moving away from the UK’s public system, to be treated at private hospitals.
As part of a new series on global health care, The National spent months speaking to doctors, hospital managers and patients from the UK and overseas, to track shifts in how people are treated.
Across the world, patients are becoming health nomads, either crossing borders to seek treatment or moving from public to private healthcare systems.
With the public NHS under the most pressure it has seen as it nears its 75th anniversary, more people are resorting to buying health, revealing the challenges and changes to the UK's healthcare system.
As the public health service experiences record waiting times, growing number of patients are paying out of their own pockets for care they would have previously had through the NHS, while others are being transferred for NHS-funded care at private hospitals.
NHS treatment in a private setting
Among these patients was Alexander Seale, 35, who spoke to The National about the pioneering neurosurgery he received earlier this year as an NHS patient at the Cleveland Clinic London, one of the capital’s largest new private hospitals for complex care, which opened last year.
NHS work accounted for 8 per cent of private hospital revenue in Central London in 2021, having grown by 272 per cent since 2019, according to a report by LaingBuisson, a healthcare business intelligence firm.
The figures reveal how London’s private healthcare industry, which took a hit during the Covid-19 pandemic, was bolstered by NHS work in 2021.
Hospital revenue in Central London from private patients that year was up by only 0.6 per cent since 2020, “with the rest of the growth being made up of NHS work,” said the LaingBuisson report.
US-owned HCA Healthcare, London’s biggest group of private hospitals, may have had its revenue bolstered by NHS work worth £74 million ($91 million) in 2021, according to LaingBuisson – that is 11 per cent of its total revenue – while its private patient revenue fell by 7 per cent.
Clap for heroes
The NHS is one of the UK’s most revered institutions, with Britons standing on their doorsteps to applaud the efforts of doctors and nurses during the pandemic. Yet in recent years it has been plagued by staff shortages, delays to care, and ongoing strikes by nurses and junior doctors protesting against poor pay and deteriorating standards.
Prime Minister Rishi Sunak has backed the private sector in his efforts to curb NHS waiting lists, with a record 7.3 million patients currently waiting for treatment in England.
The government announced that patients seeking referrals from their GPs would be given the choice of five hospitals for treatment in May – including nearby independent providers where waiting times may be shorter.
Opposition Labour leader Keir Starmer, who has accused the government of neglecting the NHS, has said that the private sector could help reduce waiting lists if it is used “effectively.”
“The context in the UK is largely dominated by significant challenges within the NHS, and how these challenges impact patients, and their decisions,” David Hare, chief executive of the Independent Healthcare Providers Network, told The National.
“There’s a clear cross-party consensus now emerging that the NHS should be ensuring more patients are treated in the independent sector,” he said.
Paul Manning, Chief Medical Officer at Circle Health Group, said private hospitals had redundant capacity which could be used to accommodate NHS patients.
“The independent sector is quite heavily used in terms of its infrastructure between Monday and Friday nine-to-five, but not particularly in the evenings and not particularly the weekends because it is planned care,” he told The National.
Critics of the strategy view it as yet another attempt to privatise the health service.
“The ‘plan’ effectively institutionalises NHS dependence on costly and inefficient private sector hospitals and beds while recognising that the real problem is in fact lack of adequate NHS capacity,” said Dr John Puntis, of the campaign group Keep Our NHS Public, in a statement.
A growing market in London
Hospitals in Central London make up 81 per cent of the capital’s private sector revenue, according to LaingBuisson.
The top three largest hospitals are the Wellington Hospital with 196 beds, the Cleveland Clinic with 184 beds and the London Bridge Hospital with 181 beds.
The city has an estimated 3,000 private consultants, who typically work for several private hospitals outside of their NHS commitments. Of these, about 600 consultants are believed to bring in 80 per cent of the shared consultant revenue.
New hospitals are expanding the city’s treatment capacity and bringing in new models of private care.
The Fortius Clinic, which opened as the Schoen Clinic in 2018, specialises in orthopaedics, while One Welbeck, which opened in 2019, has leading day-case facilities for digestive health and women’s health, among others.
Pay as you go health care
Yet a record number of patients are also paying out of pocket for private care in the UK – in what Mr Manning has described as a “sea change”.
“There's always been a small cohort of private patients. I've never known a time when so many patients are prepared to take at least some financial accountability – it may only be for the initial consultation, it may only be for a diagnostic, or it might be for the whole pathway,” said Mr Manning.
He also noted a “material increase” in corporate-funded private medical insurance.“We're seeing a material increase in numbers of patients come in through corporately-funded private medical insurance,” he said, “As an employer there’s a desire to make sure your staff can return to work after planned care as quickly as possible, and that you are seen to support your staff.”
Damian Watson, a retired car sales professional from Manchester, told The National how he paid £14,000 for a one-off, robotic arm-assisted knee replacement surgery using money from his pension.
A long-time sufferer of osteoarthritis, Mr Watson opted for surgery after he found himself struggling to walk while caring for his grandchildren.
Last year, 272,000 patients paid for their own treatment, which is 27 per cent more than in 2019 and the highest on record, according to the Private Healthcare Information Network (PHIN).
There were more private inpatient and day-case admissions (820,000) last year than in any previous year, according to PHIN, which began collecting data in 2013.
LaingBuisson estimates that self-paying revenue in the independent sector in London grew by 18.6% from 2019 to 2021.
“We are seeing a shift to people having a clearer understanding of the healthcare system and the choice they have within that,” Ian Gargan, PHIN’s chief executive told The National.
“More and more people are looking to find out about the hospitals and doctors who could treat them,” he added, referring to the growing numbers of users searching treatments and providers on their website.
“We predict there will be over 1 million private admissions in the coming years, driven by an increase in private health insurance, but there could well be even higher growth.”
These changes indicate that health care in the UK, which historically has been driven by the NHS, could be changing for the long term.
“We could be seeing the beginning of a significant behavioural shift with people feeling it’s perfectly normal and sensible to use private health care when they need it, in addition to, or separate from, their NHS care,” said Hare.
Private health care, he added, is proving to be “more affordable” than people assume.
“Recent research highlights a relatively modest average spend. This demonstrates that private health care is an option for smaller procedures, consultations, scans or diagnostics,” he said.
“After experiencing private health care for the first time many people say they will go straight to that option again should they need treatment, reporting both a speedy and high quality service.”
Nonetheless, the private sector is still recovering from setbacks linked to the pandemic.
From 2019 to 2021, London’s private hospitals saw a drop of 34 per cent in overseas patients who are funded by their embassies, according to LaingBuisson.
Private patient units at NHS hospitals, whose profits go back into the NHS, were still about 9 per cent lower in 2021 than they were in 2019, according to the report.
Due to a lack of data, LaingBuisson could not comment beyond 2021, but it believes that London's private sector's pre-pandemic private patient and overseas patient figures will have recovered this year.
There are also signs that pressure on the NHS could be spilling into private hospitals.
“Consultants being exhausted from their NHS work lead them to take extended and sometimes sporadic holidays,” said the LaingBuisson report.
Junior doctor strikes this year posed a risk to private hospitals, whose consultants were called back into their NHS commitments to make up for staff shortages.
But even with these concerns, it appears Britain's shift to accepting private health care is set to expand.