One in five patients is told by doctors or other NHS professionals that they must receive the required treatment or tests in private. This is just one of the shocking results of a survey of nearly 7,000 openDemocracy readers-supported by a separate poll commissioned by openDemocracy.

NHS staff responded to the patient’s statement. Nine-tenths (87%) of patient-facing staff stated that they simply cannot provide patients with treatment or procedures that can benefit from it.

The survey is one of the largest surveys of NHS patients and staff of its kind, and provides a detailed and worrying breakdown of what happened to these patients.

The government has repeatedly assured the public that the NHS will “keep it free when used.” But for many people who told openDemocracy that the NHS had scaled back the services it provided even before the pandemic, this language brought little comfort.

Patients and NHS staff also reported that although the Prime Minister has repeatedly promised that the NHS will “not sell,” they are increasingly relying on the private sector to fill the gap, whether it is funded by taxpayers or patients themselves.

Private payment

40% of the patients who responded to our survey were told that the NHS simply could not provide them with the treatment they needed. Half of these patients (one-fifth of all patients) said that a staff member of the NHS told them that they must privately pay for the required treatment:

“More and more people think that if you can’t afford private medical expenses, you will be treated worse than before.”

“My GP always urged me to seek private care, but never took steps to refer me to a specialist.”

The NHS staff themselves told us a similar story.

A general practitioner said: “I now often ask people if they have private insurance before referrals because I know the system is overwhelmed.”

A nurse added that recommending that patients pay “alleviates the anxiety of patients and caregivers/family members about delays in diagnostic tests”.

Many interviewees noticed that when NHS staff had to advise people to privatize, they felt “apologies” and “sadness”. One patient said that NHS staff “always be honest and show that they dislike this situation more than I do”. Another doctor added that their doctors were “fettered, and if they could, they would help.” Another said that their GP told them it was “due to funding problems.”

Another told us: “The doctor apologized for not being able to provide surgery for me. My condition is not bad enough. I prescribed tramadol for pain. My quality of life is very poor, so I am not sure if I can provide surgery before. How bad it will be. I am a widow, which means that my quality of life is worse because I can spend a few days without visitors, and rely on the Internet for shopping and have to pay for gardeners and cleaners. The savings are quickly disappearing.”

In recent years, NHS guidelines have become more and more stringent, ranging from ear syringes to hip surgery. Either in certain areas no more fees will be paid, or funding will only be provided in special circumstances or extreme pain. .

What else do you ask the patient to do?

Other advice given to those who have been denied NHS treatment includes the advice of “self-care” (one in five people accepted this advice), and they are directed to cheaper options such as voluntary services (one in ten) , And be directed to an online service (one in 20). Approximately 84-90% of patients reported being dissatisfied with these options, with the most dissatisfied (90%) among the patients who were directed to the online service.

“I had to take a meaningless group education course on female urinary problems. I live in a small town and this is an embarrassing topic-I wonder if they did it because of embarrassment. Diagnosis rate,” one patient said. “There is nothing in the educational curriculum that cannot be provided in the flyer.”

And there are real-world consequences. For many people—38% of people who have been rejected the ideal treatment or test and received a series of other options—means that their health has deteriorated as a result, and similar numbers (38%) have suffered anxiety. 12% said they missed the diagnosis.

Staff worries

Of the more than 500 NHS employees who responded to our survey, the majority (68%) stated that the problem has gotten worse in the past decade. Only 12% blamed it on the pandemic.

Almost all front-line NHS staff (98%) said they are worried that patients’ health will deteriorate due to the long waiting time for NHS treatment. About three-quarters said that waiting time has gotten worse in the past ten years. Approximately one in six (14%) said that the situation has gotten worse since the pandemic.

Approximately 48% of current NHS employees are considering leaving the service, and only 37% said they did not.

Public funding, private sector

Nearly two-fifths of patients (38%) said that NHS staff told them that if they accept the recommendation of NHS referral to a private hospital or clinic, they will get treatment faster. The staff confirmed this-nearly three-fifths of front-line NHS staff told us that they had to refer patients to private NHS-funded providers. Among those who do this, most (70%) have doubts about this approach, but many say they feel they have no choice.

‘patient [was] Seen faster. NHS Clinic [had] Waiting for a long time, so we were told to refer to.
Nurse

“In my ophthalmology (ophthalmology) field, the only way for older people to get the treatment they need is to turn to NHS-funded private care. It’s still the fine end of the wedge!
ophthalmologist

“I feel very painful because every time I use a private supplier, it means a decrease in NHS funds.”
Midwife

‘It makes me feel like an accomplice in secretly participating in privatization. By sending patients to them, I am pushing their profits and eroding the platform on which I stand.
Hospital doctor

Approximately half of the patients and nearly three-quarters (73%) of employees who have encountered this problem said that the situation has gotten worse in the past ten years, and only a smaller proportion said that this is mainly a COVID problem or has been a problem. . In the past ten years, no staff member said it has become better. Four-fifths (82%) of NHS employees said they saw evidence of privatization.

Both patients and staff explained how private companies working on NHS only want simple cases where they can “pick” NHS cash and profit from it-one patient commented that their private referrals are “usually a waste of time” I was eventually referred back to the NHS”.

The government recently set aside 10 billion pounds for the private sector to deal with the backlog of cases during the COVID period.

Enter-and be pushed out

Although most people have a positive attitude towards physical health, if they really accept it, even the difficulty of getting in is emphasized as a concern for many people.

One patient told us that making an appointment at his local GP was “more difficult than joining a Freemasonry.”

Mental health services were highlighted as a particular concern. Another patient said: “The local primary mental health classification will send you a list of phone numbers for other services. It took eight months, two attempts and six times. Go to the doctor for evaluation.”

Once through the gates of the NHS service, there is also the problem of being allowed to stay there long enough. Two-fifths (41%) of patients stated that they or the people they care for were discharged from hospitals or other NHS services prematurely, although some people are better at navigating the system than others.

One told us: “Mom yo-yo in and out of the hospital, her leg was broken, and she was infected. She was released many times during her illness.”

Another said: “I was discharged too early. But my senior social worker’s wife stepped in and I was detained for another 7 days until I was organized to provide care at home.”

Again, the NHS staff agreed. 56% of patient-facing staff told openDemocracy that they had to discharge patients prematurely.

Currently, hospitals and local authorities need to assess the care needs of patients before they are discharged-this is a requirement that many financially tight organizations cannot complete in time. This requirement was suspended during COVID, and the previous health and care bill is now completely cancelled in Parliament.

Not a pandemic issue

Most concerns were established long before the pandemic. More than half (56%) of patients who were refused NHS treatment and a similar proportion of patients discharged early (55%) said that the problems have gotten worse in the past ten years, and about a quarter said they believed these problems Mainly caused by COVID. Only 1% said that the situation has improved in the past ten years.

Perhaps unsurprisingly, the most common reported problem is the need to use telephone or online services to access the NHS, and most affected patients believe this is mainly something that has happened since the pandemic (86%). But even more worrying is that 64% of respondents said that when they feel that the NHS is not suitable for their needs, they have to use remote access to use the NHS.

The government recently responded to its backlash against online and phone appointments for general practitioners by promising to support more face-to-face appointments. But this move made many doctors angry because the government has been vigorously promoting primary and hospital healthcare services online and remotely over the years.

“My wife and I are both over 80 years old and we are not used to being diverted by strangers [the] Call and wait,” said one patient. “We want to see our general practitioners assess our health problems. Although these problems are small, they may worsen over time if they are not treated. We often rely on short and uncertain chats with pharmacists. “

Patient angry

However, respondents to the openDemocracy survey were deeply dissatisfied with the prospects for more private participation in healthcare. The most common reactions were “anger,” “disgust,” “worry,” panic, “shock,” or “worry.”

Many people emphasized that they considered the attack on the NHS to be deliberate and political, and some pointed to funding issues:

“There is no discussion. Be told [the NHS] I won’t pay for a lot of things anymore. Because I can self-manage to a large extent and have achieved success, I seem to be on a virtual “neglected list”. “

The NHS is very important to our readers-95% of people believe that the NHS is five-fifths of importance-with an average score of 4.92 points (out of five points).

But some people expressed despair, saying they “lost trust in the NHS” and felt “abandoned”.

One person said: “Since COVID, it no longer feels like providing medical services for everyone.”

“I feel that this country no longer has enough medical care. I have to take care of myself,” another person added.

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Note: The numbers in our survey mainly refer to the NHS in the United Kingdom, but early signs indicate significant differences in user experience in Scotland, Wales, and Northern Ireland, and we will report further.