Exclusive:NHS Scotland crisis: Patients seeking private healthcare set to reach record levels as unions warn of 'two-tier NHS'

Paid-for treatment for some medical procedures has soared by up to 74 per cent, amid a spike in those seeking endoscopies, colonoscopies and blood diagnostic tests, figures collated by the Private Healthcare Information Network (PHIN) have shown. It comes as private admissions to hospitals in Scotland have risen by 5 per cent overall.

The figures prompted the British Medical Association (BMA) to warn excessive NHS Scotland waiting lists were “threatening the founding principle of the NHS”. Dr Iain Kennedy, chair of BMA Scotland, said the nation had “sleepwalked” into creating a two-tier healthcare system as the “inevitable consequence of ducking the hard decisions”.

Between quarter three (July-September) of 2022 and quarter three of 2023, paid-for diagnostic blood tests increased by up to 74 per cent across Scotland and the rest of the UK. The number of diagnostic upper gastro-intestinal endoscopies – a scan of the oesophagus and stomach – rose six per cent, reaching 10,000. Private endoscopies cost around £2,000 in Scotland, but can cost as much as £4,000.

The latest figures for upper endoscopies in NHS Scotland show that as of December last year, there were 11,044 patients on a waiting list, with nearly half (5,052) having waited more than six weeks.

Contrary to the immediate post-pandemic period, most Scottish private hospital admissions are now funded via health insurance, rather than self pay, with 6,200 admissions paid for by insurance and 5,165 paid in full. Compared to quarter three of 2019, before the pandemic, there has been a 22 per cent increase in private procedures. The total of 11,365 private admissions does not include cosmetic procedures.

Richard Wells, the director of Healthcare Informatics, which manages PHIN’s data team, said private admissions were expected to hit record levels when 2023’s quarter four (October-December) statistics are published.

“Given the level of admissions in the first three quarters of the year, it would be very unexpected if hospital admissions in the private healthcare sector don’t hit record levels in 2023 when all the data is collected and analysed,” he said.

“However, the way people are paying for their treatment does seem to be changing again. After a rapid growth in self-pay following the pandemic, private medical insurance has been firmly re-established as the primary method of payment for private healthcare and, indeed, is now more popular than before the pandemic.”

Mr Wells said this was due to “several factors”, including the increased availability of workplace-based insurance schemes and “a better understanding of the costs and benefits of medical insurance”.

Dr Kennedy said the union had “long warned that in Scotland a two-tier system is rapidly developing”.

“Those who can afford to pay to access timely care do so, while those who can’t are left languishing – often in pain – on lengthening waiting lists,” he said.

“We have sleepwalked into this, by continually ignoring the warning signs that Scotland’s NHS is desperately struggling to meet growing demand. It threatens the founding principle of the NHS – namely that it should be free at the point of need and is the inevitable consequence of ducking the hard decisions and being honest and having the open conversation on the future of the NHS that we all know needs to happen.”

Dr Kennedy said doctors “see the implications of an underfunded, under-staffed system on a daily basis”, and medics are “forced to apologise to patients” and inform them of the long waits they are likely to face for treatment.

“That is primarily, of course, bad for patients, but it takes its toll on staff who know – through no fault of their own – that they aren’t able to provide the best possible care for their patients,” he said.

“We need to finally grasp the nettle on this, and acknowledge that the way this two-tier system is developing is neither equitable or fair and will simply widen the deeply embedded health inequalities that already exist in Scotland.

“And we need to get on with the national conversation we have called for, which can then lead to a clear consensus around a plan for the future of the NHS that puts it on sustainable footing for generations to come and protects that treasured principle that it must remain free at the point of use.”

Scottish Labour health spokesperson Jackie Baillie said “the very future” of the NHS was at risk “after years of mismanagement and neglect under the SNP”.

“With almost one in six Scots stuck on record-high waiting lists, it is no wonder more and more Scots are resorting to private healthcare,” she said.

“It is shameful that families are being forced to empty their savings or go into debt simply to get the healthcare they need. Our NHS is on life support – the SNP must act now to bring down waiting lists and restore the founding principles of our NHS and ensure Scots can access free healthcare at the point of need.”

Scottish Conservative deputy health spokesperson Tess White said the “shocking revelations” were “a damning indictment of the SNP’s failure to get a grip of the backlogs in our NHS”.

“Too many suffering patients have been left with little option, but to go private in order to get treatment,” she said.

“During a global cost-of-living crisis in particular, this should be a source of shame for SNP ministers who have left frontline services dangerously understaffed and under resourced.

“Neil Gray, as the latest SNP health secretary, needs to produce a proper vision for our NHS to stop patients taking desperate measures. If he is looking for somewhere to start, he should adopt the bold measures in our health paper which would deliver a modern, efficient, and local health service.”

Colin Poolman, director of the Royal College of Nursing Scotland, said Scotland’s NHS is facing “unprecedented demand”.

“Too many people are waiting too long,” Mr Poolman said.

"Too long for diagnosis, too long for treatment and many are waiting too long in hospital when they should be being cared for in their communities.

“The staffing crisis is a key factor in these record A&E waits, delays in discharges and backlogs for treatment, compounded by increasingly complex clinical care needs, declining public health and the impact of Covid-19.

“It is no surprise that those who can afford it are looking to the private sector for their health care needs. But it is important to remember that funding our health and social care services is a political decision. Y

"Yes, budgets are tight but the cost of not investing in nursing is significant, both in terms of the long-term impact on service delivery, and the very real risk of harm to patients and residents being cared for today.”

A Scottish Government spokesperson said: “We are committed to eradicating long waits, which have been exacerbated by the pandemic, to ensure all people receive the treatment they need as soon as possible.“Our £1 billion NHS Recovery Plan has delivered a significant reduction for the longest waits and continues to support an increase in activity through the implementation of sustainable improvements and new models of care. Our continued partnership with NHS Scotland’s Centre for Sustainable Delivery (CfSD) plays a central role in this.“To increase capacity for orthopaedic, ophthalmic and diagnostic activity, we have opened two National Treatment Centres, with a further two centres opening this year. These centres will provide capacity for more than 20,000 additional surgeries each year.”