The UK's population is ageing, with the number of people over 60 expected to rise by 25% between now and 2001. It's a worrying statistic, as these are the very people who absorb most of the nation's healthcare.
The UK currently spends around 7% of its gross domestic product on healthcare and, contrary to popular belief, we generally get good value for money.
Our life expectancy at birth, the infant mortality rate and overall mortality rates - the cardinal indicators of health - continue to improve. But the additional pressure that an ageing population will place on our public services, along with a continuing need to invest in complex technology and the best medical staff available, will start to take its toll. In this, the 50th anniversary year of the foundation of the National Health Service, the public and private sectors should be sinking their perceived differences and working to combine their separate strengths to meet changing - and ultimately infinite - public demand.
There are three misconceptions commonly held about the relationship between the public and private sectors. First, from its inception the NHS set public provision apart from pre-existing private healthcare, much of which was provided through charitable or mutual foundations. This allowed a myth to develop that the two sectors were in competition, and that private healthcare was a threat to the publicly funded health service. Yet the private and voluntary sectors actually share a common objective with the public sector, which could be pursued effectively in partnership.
Second, doctors and other medical staff frequently practise in both public and private sectors. This has created a belief that the private sector leeches on the public sector for its medical professionals.
The truth is that consultants have practised privately in addition to their NHS work for as long as the NHS has existed. By doing this they are able to supplement their income, which allows them to continue to work within the NHS at salary levels that the public purse can afford.
The third issue is the accusation of queue-jumping which is levelled against those who use private medicine. Even when the NHS was established, it was clear that it would not be able to meet the demand for free services at the point of use, and waiting lists developed. Patients who choose to be treated in the private sector should not therefore be criticised. By not taking up a place in the NHS queue, they allow the next patient in line to benefit from earlier treatment.
Unfortunately, these three issues have obstructed sensible discussion about an effective partnership between the NHS and the private sector.
The latter shares the NHS objective - to improve people's health - and its record in treating disease and tackling ill-health over the last 50 years stands up to any scrutiny. Currently, 11% of the UK population is covered by private medical insurance. The private sector carries out 20% of heart surgery, 30% of hip replacements and a total of 500,000 operations each year - all of them treatments that would otherwise be added to NHS waiting lists. It also provides and pays for a range of services that fall out-side NHS provision, such as preventative healthcare, in which the Government is now taking a more serious interest. BUPA has already taken a lead in developing and implementing a number of health promotion and screening programmes in the workplace. It has also pioneered comprehensive health screening in the UK and runs the country's largest network of screening centres.
No national strategy for public-private sector co-operation has ever been developed but there are local examples of joint ventures that have benefited the whole community. In Cambridge, BUPA has bought a heart laser machine that provides alternative treatment for people who are unable to undergo conventional heart surgery. In Hastings it has worked with the local NHS Trust to provide a new hospital. In both cases the facilities are available to NHS and private patients alike.
Since the election last year, the Government has had a clear mandate to defend and develop the NHS as a comprehensive service paid for out of our taxes, available to all and free at the point of use. Its comprehensive and thoughtful White Paper, The New NHS: Modern, Dependable, sets out the Government's plans for the NHS and recommends ways to improve performance management and overall service quality. BUPA was already piloting a number of these recommendations.
If the UK is to continue to improve health and reduce illness, there must be a significant shift in opinion about private care. There will always be constraints on the amount of public money available to fund healthcare. To my mind, it seems sensible to find other ways to maximise the limited public pool of resources. The independent sector already plays a major role in the provision of nursing home, residential and domiciliary care services. In dentistry, there is increasingly a mixed economy in which public and private provision exist comfortably side by side. Even in pensions, unemployment benefits and long-term care, the Government is exploring how private and mutual insurance might be used to relieve the burden on existing state cover.
It is time to stop regarding the private sector as a separate entity.
Closer working between public and private sectors in no way challenges the fundamental precept of the NHS, that everyone should have equal access to healthcare regardless of their ability to pay. People will increasingly need to provide for their own welfare needs and, if they are willing to pay for the flexibility of private healthcare to suit their social and employment circumstances, this should be encouraged. Some argue that this will lead to a two-tier system. Instead, it will mean that NHS resources can be focused on those who really need them, society's least advantaged.
Private healthcare helps to keep waiting lists to a minimum.
Sir Bryan Nicholson
Chairman of BUPA and companion of the IM
'Patients who choose to be treated in the private sector should not be criticised. Even when the NHS was established, it was clear that it would not be able to meet the demand for free services at the point of use, and waiting lists developed. By not taking up a place in the NHS queue, private-sector patients allow others to benefit from earlier treatment'.