I am one of the people Prof Rafael Bengoa is referring to.
Speaking on Radio Ulster last weekend, the author of the 2016 Bengoa report on reforming Northern Ireland’s health service warned more and more people here are turning to private care. This is creating “a system that nobody wants, a system which introduces even more inequalities”.
Earlier this year I took out private medical insurance, at £50 per month for a family of five. I am only too aware this bargain is an illusion. The policy has a large excess and covers acute care only, such as cancer. Anything ‘pre-existing’ is excluded, which from the small print appears to rule out making any claim for the first two years. My premiums will rise steadily with age and jump sharply if I make a claim and of course they would be at American levels if our private sector was not completely dependent on hidden subsidies from the NHS.
Private care in Northern Ireland is performed almost exclusively by NHS employees on their time off. NHS facilities may be hired; the NHS may even be paying via waiting list initiatives. If something goes wrong the patient can be whisked back into the NHS as a priority by their moonlighting consultant.
I cannot pretend my £50 is funding more healthcare capacity for Northern Ireland to any meaningful extent. Although the private sector does build some facilities and create some jobs, it is not training any new doctors or nurses or even providing the training places NHS staff use to learn on the job. None of our private hospitals have intensive care beds, rendering them glorified clinics. All I am doing is paying de facto NHS overtime to clamber up a queue that remains the same length overall. The private sector moves me up the queue by cannibalising the public sector, creating a vicious circle.
But what is my alternative? While I disagree with academic selection, it would be grotesque to make my children go to schools where they cannot take separate sciences or maths beyond GCSE, just so I could congratulate myself on my social solidarity. I am certainly not going to make anyone in my family, myself included, wait years for serious medical attention on point of principle. I realise I am in a vicious circle, contributing to the very problem I am trying to escape, and that I will eventually be priced out of insurance. However, as NHS waiting lists are now of life-threatening length, I am afraid the trap has fully sprung.
The insurance industry does not compile statistics on how many people have private health cover in Northern Ireland but a small 2017 consumer survey put the figure at 18 per cent, higher than any UK region outside London. It can only have risen since - a quarter of the population would be a fair estimate.
That does not include those paying directly, or ‘self-financing’ to use the industry term. Reports suggest this has driven significant growth in private care, especially since the pandemic boosted personal savings. Elective procedures such as cataract removal at £3,000 or hip replacement at £15,000 are within the range some working families can fund or at least borrow in desperation - for now. But prices will inevitably soar with demand. Northern Ireland only has a handful of private hospitals, where waiting times have also begun to stretch, although only to months rather than years. As more people acquire insurance, a phenomenon will occur familiar to anyone who has tried repairing a car at their own expense: hospitals will demand the same high fee insurers pay; and insurers have little incentive to keep fees down.
Private healthcare coped here while it was a small-scale, middle-class queue-jumping secret. It cannot take on the work of a collapsing NHS - in fact, it needs the NHS.
In 2017, Bupa effectively withdrew from Northern Ireland by announcing it would no longer hire facilities at our NHS hospitals. The initial cause was a row over medical negligence cover at the Belfast trust but the company went on to claim every NHS hospital here is unable to provide the service paying customers require. Policy-holders now have to go to Britain for many treatments. That includes Stormont civil servants, as Bupa administers their mutual insurance scheme.
Private healthcare has been a safety valve and lifeboat for those in the know in Northern Ireland for quite some time.
Perhaps the prospect of it being overwhelmed as well might finally concentrate minds.
