A recent survey by the British Medical Journal of 134 acute hospital NHS trusts has found that 21 of those trusts have recently introduced private, or “self-funded” services alongside their NHS funded healthcare offering. 

The private offerings include treatments such as IVF treatment, varicose-vein removals and hernia repairs. It is probably unsurprising that these treatments are ones that cash-strapped NHS commissioners now restrict or for which there are long waiting times under the NHS funded routes. 

Critics argue that the infiltration of such “pay for” options has muddied the waters between private care and the NHS, creating what has been coined a “two tier system” of healthcare. However, this begs two questions: first and foremost, have the healthcare waters been “muddied”? And secondly, even if they are, is that really a problem? 

Turning to the first, with NHS acutes now able to raise up to 49 per cent of funds through non-NHS work, it would appear the ground is (or rather the waters are) ripe to be muddied. However, industry trends would appear to instead suggest a resilient preference for the provision of NHS funded work. Indeed, with independent healthcare providers leaning more and more in favour of providing NHS funded work, and private sector companies engaged in what the FT has rather dramatically and unhelpfully described as an “arms race” for the £5bn worth of NHS funded work, it seems the priority is NHS publically funded work. 

Nonetheless, considering the question as to whether a more mixed public/private healthcare system would in fact be a problem, from the perspective of independent healthcare providers, perhaps, but perhaps not. Chris Hopson, Head of the Foundation Trust Network has warned that the NHS will “keel over” unless change and (he suggests) competition is forthcoming in the NHS. Along the same lines, healthcare specialists for The Guardian allege that efficiency savings, new regulations encouraging competitive tendering and the government’s new “personal healthcare budgets” initiative are all pushing the UK healthcare system into a mixed (and some might allege, muddied) two tier system – with private companies and independents providing those services that can turn a profit – and the publically funded side of the NHS covering those services that do not create profit due to the risk, technical expertise, equipment and other such factors involved. 

Therefore, if independents are prepared to move with, or perhaps ahead of change, investing in and developing both public and private healthcare offerings where economies of scale and demand allow, they may more easily survive the wave of change inevitably heading towards the NHS.