Healthcare is an evergreen topic in the UK; even more so after parliamentary change, when expectations are high.
Expectations that will weigh heavily on Keir Starmer, as his government’s first winter in Downing Street coincides with the NHS’s ‘worst winter yet’.
Despite the mammoth task ahead, Starmer has promised an ambitious and proactive approach to the NHS. A landmark vote on 29 November 2024 passed the Terminally Ill Adults (End of Life) Bill in the House of Commons by 330 votes to 275. Women’s health has also been under the spotlight, with Starmer promising to address misogyny in medicine after a report, presented by the Westminster’s Women and Equalities Committee, gained public support in December. And we patiently await Labour’s ten-year plan to save the NHS, which is set to be published this Spring.
It’s a plan that is desperately needed, as the NHS creaks under the weight of pressure. Lack of access to referrals for specialist consultants, three-year waiting lists for clinics and therapeutic services, cancelled surgical procedures, staff shortages and budget constraints have been an increasing issue for a quarter of a century. The NHS is harder to access than ever.
In September 2022, leaked minutes revealed that leaders of Scotland’s NHS had been supportive of a healthcare system where “those who can afford to, pay” to ease pressure on resources. Nicola Sturgeon dismissed the idea as “not up for debate”, but the minutes highlight the troubling misnomer that more people using private services is a positive, simply freeing up space in state healthcare.
In Sleepwalking into a two-tiered healthcare system, Nada Khan argues that this way of thinking is counterintuitive and overshadows the siphoning of staff and resources from the NHS to the private sector. In the report published in the British Journal of General Practice, Khan highlights the dangers of a rise in out-of-pocket payments, and the impacts of two-tier healthcare on the poorest in society.
For some Brits, accessing private healthcare can be reasonably smooth. If you are young and healthy you can get basic healthcare coverage for as little as £15 per month. By age 70 it rockets to over £140 a month. Cover is increasingly being offered as an employment benefit – although this is typically not an option for low-paid or gig-economy workers. And no matter who you are, pre-existing and chronic conditions are seldom covered – making health insurance a largely unattainable prospect for millions of Britain’s elderly, poor, and disabled.
Mark Dayan, Policy Analyst and Head of Public Affairs for the Nuffield Trust, cautions that the rising trend in out-of-pocket healthcare, where patients pay for treatment themselves, is solidifying a disadvantage which has been cultivated in desperation:
“While the vast majority of care remains NHS funded and delivered, there has been a definitive shift in all four UK countries towards private healthcare either funded out of pocket or to a lesser extent through private healthcare plans.
“The fact that more people are paying out of pocket at a time when the economy is tight and difficult, not a time of plenty, suggests they are turning to the private sector out of desperation as NHS provision flatlines. That means that the balance of care is very slowly shifting from care based on need, to care based on willingness and ability to pay.”
Popular out-of-pocket healthcare services and their average costs
• Hip replacements: Nearly 30,000 privately funded in 2022, with an average cost of £10,761.
• Knee replacements: £11,434 per procedure.
• Cataract surgery: £2,425.
• Hernia repair: £2,695.
• Specialist consultations: Ranging from £99 to £350, depending on the expertise.
• Neurodivergence assessment: £1267.
• Medical cannabis: £150-£250 per month.
• Psychotherapy: £50-£80 per session.
Out-of-pocket costs are a constant battle for single mother of two and NHS nurse Danni Smith, who not only manages multiple conditions of her own including myalgic encephalomyelitis (ME), complex PTSD, autism and avoidant resistant food intake disorder (ARFID), but also the additional needs of her thirteen-year-old son who has autism and ARFID.
Danni – who has spent thousands for private weight loss treatment abroad in a bid to improve her overall health – has ARFID, an eating disorder which limits the types of food a person can eat. ARFID can cause overwhelming physical and psychological symptoms as well as difficulty managing a healthy weight. Hoping to maintain her self-funded surgical weight loss with ongoing support through the NHS, Danni discovered that it wasn’t necessarily a lack of help available, more a lack of the right help:
“ARFID just wasn’t recognised in the NHS dietician services that I was able to access, so I had to pay privately. It cost me £395 for 45 minutes with a psychologist in London.”
Acutely aware of the damage that a lifetime’s silent battle with ARFID had caused her, Danni was keen to ensure support for her thirteen-year-old son who displayed many similar struggles with food. She paid privately for a full report by Dr Gillian Harris of the Birmingham Food Refusal Service hoping to improve her son’s overall wellbeing, particularly in school, but was left angry and disappointed by the lack of response.
“The report cost £390, it was a comprehensive assessment which was delivered to the paediatrician, the GP, and the schools. However, nothing was implemented as recommended, there just wasn’t enough support. I’ve had to manage it the best I can on my own. Honestly, the report was amazing, I got what I paid for, yet it was worthless.”
Danni’s income consists of her part-time employment as a lead nurse and some income-related and disability benefits. As a homeowner, she receives no Housing Benefit or housing-related Universal Credit toward her mortgage payments, leaving her housing in a precarious position every time she is forced to go private.
A 2023 report by the King’s Fund has also highlighted the capitalisation of autonomy in healthcare. Author Jonathon Holmes wrote, “Those with lower disposable incomes may well still choose to self-fund in order to ensure more timely access to health care but will run the risk of greater financial hardship if they do so.”
While the report signals a choice to self-fund, many disabled Brits do not feel they have any choices left.
Katherine Rowe, 53, from Hertfordshire, has spent the past two decades navigating healthcare, with a heavy engagement in private care funded solely through state benefits after being forced to stop working due to ill health.
Katherine lives with multiple conditions, including ankylosing spondylitis, fibromyalgia, Crohn’s disease, and long-term mental health challenges. Persistent pain, reduced mobility, and socially isolating symptoms dominate her daily life. Yet, despite it all, she faces these challenges with remarkable tenacity.
“You’ve got to keep rolling with it; otherwise, it rolls over you,” she says.
Like many disabled people in Britain, Katherine struggled for years before receiving her first diagnosis. A process Katherine feels was prolonged by misogyny in healthcare.
“As a woman, I don’t get listened to. As soon as they see, ‘oh, female,’ it’s either a hypochondriac or health anxiety, and they don’t want to know. I’ve been gaslighted a lot!”
Her experience echoes findings from the Westminster’s Women and Equalities Committee report, presented by MP Sarah Owen. The report highlights how women’s health concerns—particularly with conditions like endometriosis and adenomyosis—are often dismissed or overlooked. While the government has promised to ‘overhaul women’s healthcare,’ it remains unclear whether these changes will address women’s place in all health, or just gynaecological health.
After years of feeling unheard, Katherine turned to private healthcare. Without the option of medical insurance due to her pre-existing conditions, she faced difficult decisions about how to fund her care on incapacity benefits.
“You’ve got to invest in yourself,” she says. “I get frustrated with those who expect everything to be done for them but won’t help themselves.”
Yet even her best efforts often led to painful setbacks.
“At one point, I was living on about £30 a week, and £15 of that went on healthcare. I couldn’t, and still don’t go out for dinner or get my hair cut—it’s all luxuries. Basically roof, food, healthcare, that’s it.
“I even tried growing vegetables to save money and be healthy, but then I was diagnosed with Crohn’s, and they told me I shouldn’t eat fibre. All I’ve ever done is try to help myself, and it just backfires.”
Over the years, Katherine has learned to prioritise her needs. For a long time, private mental health services took precedence, but worsening joint pain and mobility issues forced her to change her approach.
“My first focus was counselling, as I’d struggled with my mental health for so long. But when things got harder physically, I had to shift with it. You can’t have it all, unfortunately.”
Katherine began sessions with a former NHS physiotherapist who offered a person-centred approach to managing her ankylosing spondylitis and fibromyalgia.
“It wasn’t standard physio like you get with the NHS. It was tailored, which was much better. Finding the money isn’t easy but I made it work and went for about six or seven years.”
But once again, tough choices arose. An administrative mistake left Katherine without a gastroenterologist when hers retired.
“My gastro consultant retired before Covid and I got lost in the ether, I wasn’t assigned to anybody, then the global pandemic and there was no chance.”
To avoid further delays as her symptoms worsened, she paid £250 for a private consultation — a cost that represents nearly two weeks of her Employment Support Allowance (ESA) payment. ESA is a primary income benefit for people with long-term sickness and disability. Claimants go through lengthy applications and procedures which have often come under public scrutiny.
Katherine shared that she has been encouraged to continue accessing private care by an NHS pain management consultant.
“He told me he advises all his patients to go private. He knows my financial situation, but he didn’t seem bothered.”
More recently, she spent another £400 on Botox for bruxism, a condition causing severe teeth grinding, forcing her to give up physiotherapy altogether.
“I’ve worn a guard since 2010 because without it I’d have no teeth left, it’s really severe. The NHS just told me to stop grinding, but I do it in my sleep—how do you stop that?
“So, I went through the dentist for Botox, and it was £400. I can’t afford to go back to physio now either. I’ve been looking into medical cannabis as it could help everything.”
Despite her proactivity and resilience, Katherine has faced periods of instability and homelessness. She takes joy in the small, free moments of connection with others, and she co-runs an online support group for people with Raynaud’s & Erythromelalgia.
One of her greatest hopes for the future of healthcare is that it doesn’t rely too heavily on technology, she said, “I don’t have a new phone, my fingers can’t work touch screens, and I can’t bloody afford one.”
The government’s plan – which is expected to lean heavily on technology – must account for intersectionality and complex barriers, whilst strategically investing in the NHS to avoid a continuance of diverted patients, siphoned resources, and working-class patients in financial hardship and health deficit.
Katherine and Dani are just two of millions in this country who are forced into making the toughest decisions for marginal (if any) improvement in their healthcare. Financial hardship, homelessness, pain, and hopelessness reflect the desperate reality of two-tier healthcare.
Continue reading...
Expectations that will weigh heavily on Keir Starmer, as his government’s first winter in Downing Street coincides with the NHS’s ‘worst winter yet’.
Despite the mammoth task ahead, Starmer has promised an ambitious and proactive approach to the NHS. A landmark vote on 29 November 2024 passed the Terminally Ill Adults (End of Life) Bill in the House of Commons by 330 votes to 275. Women’s health has also been under the spotlight, with Starmer promising to address misogyny in medicine after a report, presented by the Westminster’s Women and Equalities Committee, gained public support in December. And we patiently await Labour’s ten-year plan to save the NHS, which is set to be published this Spring.
It’s a plan that is desperately needed, as the NHS creaks under the weight of pressure. Lack of access to referrals for specialist consultants, three-year waiting lists for clinics and therapeutic services, cancelled surgical procedures, staff shortages and budget constraints have been an increasing issue for a quarter of a century. The NHS is harder to access than ever.
In September 2022, leaked minutes revealed that leaders of Scotland’s NHS had been supportive of a healthcare system where “those who can afford to, pay” to ease pressure on resources. Nicola Sturgeon dismissed the idea as “not up for debate”, but the minutes highlight the troubling misnomer that more people using private services is a positive, simply freeing up space in state healthcare.
In Sleepwalking into a two-tiered healthcare system, Nada Khan argues that this way of thinking is counterintuitive and overshadows the siphoning of staff and resources from the NHS to the private sector. In the report published in the British Journal of General Practice, Khan highlights the dangers of a rise in out-of-pocket payments, and the impacts of two-tier healthcare on the poorest in society.
For some Brits, accessing private healthcare can be reasonably smooth. If you are young and healthy you can get basic healthcare coverage for as little as £15 per month. By age 70 it rockets to over £140 a month. Cover is increasingly being offered as an employment benefit – although this is typically not an option for low-paid or gig-economy workers. And no matter who you are, pre-existing and chronic conditions are seldom covered – making health insurance a largely unattainable prospect for millions of Britain’s elderly, poor, and disabled.
the balance of care is very slowly shifting from care based on need, to care based on willingness and ability to pay
Mark Dayan, Policy Analyst and Head of Public Affairs for the Nuffield Trust, cautions that the rising trend in out-of-pocket healthcare, where patients pay for treatment themselves, is solidifying a disadvantage which has been cultivated in desperation:
“While the vast majority of care remains NHS funded and delivered, there has been a definitive shift in all four UK countries towards private healthcare either funded out of pocket or to a lesser extent through private healthcare plans.
“The fact that more people are paying out of pocket at a time when the economy is tight and difficult, not a time of plenty, suggests they are turning to the private sector out of desperation as NHS provision flatlines. That means that the balance of care is very slowly shifting from care based on need, to care based on willingness and ability to pay.”
Popular out-of-pocket healthcare services and their average costs
• Hip replacements: Nearly 30,000 privately funded in 2022, with an average cost of £10,761.
• Knee replacements: £11,434 per procedure.
• Cataract surgery: £2,425.
• Hernia repair: £2,695.
• Specialist consultations: Ranging from £99 to £350, depending on the expertise.
• Neurodivergence assessment: £1267.
• Medical cannabis: £150-£250 per month.
• Psychotherapy: £50-£80 per session.
Out-of-pocket costs are a constant battle for single mother of two and NHS nurse Danni Smith, who not only manages multiple conditions of her own including myalgic encephalomyelitis (ME), complex PTSD, autism and avoidant resistant food intake disorder (ARFID), but also the additional needs of her thirteen-year-old son who has autism and ARFID.
Danni – who has spent thousands for private weight loss treatment abroad in a bid to improve her overall health – has ARFID, an eating disorder which limits the types of food a person can eat. ARFID can cause overwhelming physical and psychological symptoms as well as difficulty managing a healthy weight. Hoping to maintain her self-funded surgical weight loss with ongoing support through the NHS, Danni discovered that it wasn’t necessarily a lack of help available, more a lack of the right help:
“ARFID just wasn’t recognised in the NHS dietician services that I was able to access, so I had to pay privately. It cost me £395 for 45 minutes with a psychologist in London.”
Acutely aware of the damage that a lifetime’s silent battle with ARFID had caused her, Danni was keen to ensure support for her thirteen-year-old son who displayed many similar struggles with food. She paid privately for a full report by Dr Gillian Harris of the Birmingham Food Refusal Service hoping to improve her son’s overall wellbeing, particularly in school, but was left angry and disappointed by the lack of response.
“The report cost £390, it was a comprehensive assessment which was delivered to the paediatrician, the GP, and the schools. However, nothing was implemented as recommended, there just wasn’t enough support. I’ve had to manage it the best I can on my own. Honestly, the report was amazing, I got what I paid for, yet it was worthless.”
Danni’s income consists of her part-time employment as a lead nurse and some income-related and disability benefits. As a homeowner, she receives no Housing Benefit or housing-related Universal Credit toward her mortgage payments, leaving her housing in a precarious position every time she is forced to go private.
Health and hardship
A 2023 report by the King’s Fund has also highlighted the capitalisation of autonomy in healthcare. Author Jonathon Holmes wrote, “Those with lower disposable incomes may well still choose to self-fund in order to ensure more timely access to health care but will run the risk of greater financial hardship if they do so.”
While the report signals a choice to self-fund, many disabled Brits do not feel they have any choices left.
Katherine Rowe, 53, from Hertfordshire, has spent the past two decades navigating healthcare, with a heavy engagement in private care funded solely through state benefits after being forced to stop working due to ill health.
Katherine lives with multiple conditions, including ankylosing spondylitis, fibromyalgia, Crohn’s disease, and long-term mental health challenges. Persistent pain, reduced mobility, and socially isolating symptoms dominate her daily life. Yet, despite it all, she faces these challenges with remarkable tenacity.
“You’ve got to keep rolling with it; otherwise, it rolls over you,” she says.
Like many disabled people in Britain, Katherine struggled for years before receiving her first diagnosis. A process Katherine feels was prolonged by misogyny in healthcare.
“As a woman, I don’t get listened to. As soon as they see, ‘oh, female,’ it’s either a hypochondriac or health anxiety, and they don’t want to know. I’ve been gaslighted a lot!”
Her experience echoes findings from the Westminster’s Women and Equalities Committee report, presented by MP Sarah Owen. The report highlights how women’s health concerns—particularly with conditions like endometriosis and adenomyosis—are often dismissed or overlooked. While the government has promised to ‘overhaul women’s healthcare,’ it remains unclear whether these changes will address women’s place in all health, or just gynaecological health.
At one point, I was living on about £30 a week, and £15 of that went on healthcare
After years of feeling unheard, Katherine turned to private healthcare. Without the option of medical insurance due to her pre-existing conditions, she faced difficult decisions about how to fund her care on incapacity benefits.
“You’ve got to invest in yourself,” she says. “I get frustrated with those who expect everything to be done for them but won’t help themselves.”
Yet even her best efforts often led to painful setbacks.
“At one point, I was living on about £30 a week, and £15 of that went on healthcare. I couldn’t, and still don’t go out for dinner or get my hair cut—it’s all luxuries. Basically roof, food, healthcare, that’s it.
“I even tried growing vegetables to save money and be healthy, but then I was diagnosed with Crohn’s, and they told me I shouldn’t eat fibre. All I’ve ever done is try to help myself, and it just backfires.”
Over the years, Katherine has learned to prioritise her needs. For a long time, private mental health services took precedence, but worsening joint pain and mobility issues forced her to change her approach.
“My first focus was counselling, as I’d struggled with my mental health for so long. But when things got harder physically, I had to shift with it. You can’t have it all, unfortunately.”
Katherine began sessions with a former NHS physiotherapist who offered a person-centred approach to managing her ankylosing spondylitis and fibromyalgia.
“It wasn’t standard physio like you get with the NHS. It was tailored, which was much better. Finding the money isn’t easy but I made it work and went for about six or seven years.”
But once again, tough choices arose. An administrative mistake left Katherine without a gastroenterologist when hers retired.
“My gastro consultant retired before Covid and I got lost in the ether, I wasn’t assigned to anybody, then the global pandemic and there was no chance.”
To avoid further delays as her symptoms worsened, she paid £250 for a private consultation — a cost that represents nearly two weeks of her Employment Support Allowance (ESA) payment. ESA is a primary income benefit for people with long-term sickness and disability. Claimants go through lengthy applications and procedures which have often come under public scrutiny.
Katherine shared that she has been encouraged to continue accessing private care by an NHS pain management consultant.
“He told me he advises all his patients to go private. He knows my financial situation, but he didn’t seem bothered.”
More recently, she spent another £400 on Botox for bruxism, a condition causing severe teeth grinding, forcing her to give up physiotherapy altogether.
“I’ve worn a guard since 2010 because without it I’d have no teeth left, it’s really severe. The NHS just told me to stop grinding, but I do it in my sleep—how do you stop that?
“So, I went through the dentist for Botox, and it was £400. I can’t afford to go back to physio now either. I’ve been looking into medical cannabis as it could help everything.”
Despite her proactivity and resilience, Katherine has faced periods of instability and homelessness. She takes joy in the small, free moments of connection with others, and she co-runs an online support group for people with Raynaud’s & Erythromelalgia.
One of her greatest hopes for the future of healthcare is that it doesn’t rely too heavily on technology, she said, “I don’t have a new phone, my fingers can’t work touch screens, and I can’t bloody afford one.”
The government’s plan – which is expected to lean heavily on technology – must account for intersectionality and complex barriers, whilst strategically investing in the NHS to avoid a continuance of diverted patients, siphoned resources, and working-class patients in financial hardship and health deficit.
Katherine and Dani are just two of millions in this country who are forced into making the toughest decisions for marginal (if any) improvement in their healthcare. Financial hardship, homelessness, pain, and hopelessness reflect the desperate reality of two-tier healthcare.
Continue reading...
