Why the UK should embrace a blended healthcare system

During the pandemic, millions of people reassessed their priorities about many aspects of everyday life. One of those was private healthcare: pay-as-you go private treatments surged as the NHS buckled under the extraordinary strains put upon it by COVID. The backlog will take years to clear.

It’s time we faced into the challenges facing the NHS by accepting that making it easier for people to choose private healthcare at point of need is an essential step in bringing this beloved and critically important public service into balance.

Now I fully understand that many people feel passionately about the NHS and the principle that it is built on: that healthcare should be free for all. I fully agree that everyone should be entitled to excellent public healthcare and that should be funded adequately through taxes, but we have to recognise that the NHS is part of a public/private ecosystem and we can leverage that ecosystem to make the NHS’s service better.

Many thousands more people used private health care over the last couple of years. I spoke to a friend last year who was choosing to pay for a private surgery. She said she was going to “use the holiday money” – because she couldn’t use it for going on holiday. What was interesting was that she’s not someone I would ever have expected to go private, and more surprising still was the fact that when I spoke to her a few months later she said that now she’d done it she’d “do it again in a heartbeat”. Would she trade another holiday for a treatment in the future? “Absolutely”.

This sample of one is, Im sure, representative of what's going on more widely. We should recognise that the resetting of many such life priorities due to the pandemic is actually ok. Of course we want an NHS without a backlog. Of course we want speedy treatment when we need it. But it will never be so unless we accept that we need to actively spread the burden – through choice.

There’s nothing wrong with choosing a new knee over a new car. Or a new hip over a new kitchen. As long as it’s a choice that someone can make freely based on their own circumstances and priorities, and as long as they don’t have to make that choice if they don’t want to.

Given how many made that choice during lockdown and the backlog we now face, surely it’s time to stop pretending that one is good and the other is bad. Remember, every person who chooses to use a private service instead of a public one is freeing up capacity for someone who doesn’t want to, or can’t. Yes, that person is technically paying twice. Yes it favours people who can afford to make that choice. But is that really any different than taxing people at progressively higher rates based on what they earn? No, it’s just more targeted, more nuanced (because you can choose when to, and when not to, pay) and, crucially, it’s at point of need.

Some years ago we worked with the NHS on an ‘app store’ approach to third party services - the NHS would ‘bless’ relevant partners with official accreditation as long as they met certain standards. Extending this to private treatments in private facilities would be easy, and would encourage an even more highly competitive private sector, driving down costs and increasing accessibility.

If you set aside political principle, where is the downside? This type of choice must become acceptable, and it should be embraced by government and private sectors alike. To work, it has to originate from the NHS end. The NHS can even contribute towards private treatment where it needs to ease capacity or a procedure is expensive.

So imagine going to your NHS GP, being referred for specialist treatment and being sent something like this:

If you have private health insurance (individually or via employers) that could be exposed automatically as an option. And what about spread-payment services like Klarna? Are we saying it’s ok to offer an instant option to pay for a new sofa over time but not for a quality-of-life-limiting medical condition? Choice is critical.

The integrations needed to make this work are more than possible. We already have an anchor data point in NHS numbers: a unique identifier for every individual entitled to NHS treatment. This is more a philosophical question than a practical one: it can, and should, be done.

A tax-funded system like the NHS is brilliant. We all pay and we all benefit equally. But it’s not the only answer. The attitudinal changes triggered by the pandemic mean we have the opportunity to leverage the capacity available across the entire sector by better enabling one simple thing: our right to choose.