It was known as a mixed healthcare economy, and the NHS was supposed to have done away with it. But three generations on, are we sleepwalking back into a two-class system in which only those who can afford it – or are prepared to make sacrifices – can access the care they need?
The backlog caused by years of understaffing and compounded by the pandemic has led to more of us than ever paying for routine operations from our own pockets. The number has risen by a third in the last two years, and as of last week the Behrens family has been part of that statistic.
It was unreasonable, Mrs B decided, to have to endure another year of osteoarthritic pain while languishing on a waiting list when she could have her hip replaced almost immediately at a private hospital. So she did.
But it wasn’t as simple as that, because health insurance doesn’t cover pre-existing conditions. So she had to shop around and join the ranks of a new class of health tourist who instead of paying a little each month on the promise of preferential treatment for something that might never happen, is forced to raid the piggy bank to put right something that already has.
It turns out that the East Midlands is the cheapest place for private healthcare – possibly because shorter NHS queues there mean there is less demand – and we were able to save £4,000 by choosing a hospital near Chesterfield rather than one in Yorkshire. All the same, it cost probably as much as we will spend on holidays for the rest of our lives.
It’s not as if anyone has budgeted for this sort of thing. Some can borrow or otherwise scrape together the cash for private treatment but few can really afford it; it just causes penury further down the line.
It hasn’t previously been a consideration; we’ve taken for granted that healthcare will be there for us, free at the point of delivery, when we need it. But we seem now to be at the tipping point where that last part of the promise – ‘when we need it’ – is no longer deliverable.
This would already seem to be the case at Sheffield Children’s Hospital, where the queues have risen by 50 per cent in the last year, causing managers to write to parents asking if they want their children to remain on the waiting lists or to be discharged.
If there is a sadder indictment than this on the state of the NHS, I’ve yet to hear it. What parent would willingly turn down treatment for a sick child?
But it’s not the only sign of the way things are going. Last weekend a think-tank headed by the former chairman of a hospital trust recommended that patients be charged £8 for each day on the wards, and that those over 60 be made to start paying for their prescriptions.
The effect of that last threat will be to make medicines a luxury item for many pensioners, in the same way as pet food or heating fuel. They’ll have paid their national insurance for all those years only to find the rug pulled from under them when they are at their most vulnerable.
It is ultimately futile to compare any of this with what went on before the NHS was created. There were no routine operations then; only emergencies. But comparisons can’t be avoided.
Those lady almoners were the forebears of today’s health trusts – de facto rule makers who carried out means tests by any other name. We’ll find a less Victorian way of describing the practice, but make no mistake, that is the reality into which we’re heading.
And apparently the existing financial arrangements have failed doctors as much as patients, with the Royal College of GPs saying this week that it was no longer feasible to be a full-time family doctor. Most were spending a fifth of their time on paperwork instead of seeing patients.
But of all these shortcomings, it is the threat to pensioners, and the letter to the families of sick children, that most comprehensively travesties the 1940s vision of care from the cradle to the grave. When Winston Churchill coined the phrase he did not qualify it by warning that his successors would one day have to come after you for your life savings.