Privately funded hip replacements surge as patients shun NHS backlogs, study shows

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The proportion of NHS patients going private for hip surgery has surged since the Covid-19 pandemic, according to an analysis from a leading health think-tank.

The research by the Health Foundation showed the percentage of privately funded procedures overall had not risen significantly in recent years, despite waiting lists for treatment on the NHS standing at record highs.

Data from the National Joint Registry, analysed by the think-tank and shared with the Financial Times, indicated a big increase in privately paid for hip replacements in particular, where the total almost doubled from about 17,000 in 2019 to almost 30,000 in 2022. The registry’s data covers England, Wales and Northern Ireland.

The Health Foundation said this “will have had substantial financial implications for many of the patients who opted to fund their care privately”, even though “the large majority of elective hip replacements” are still funded by the NHS.

The findings scotch the notion that delays within the state health service — where 7.6mn are waiting for non-urgent care — have driven a structural shift in the number of patients opting for private treatment.

Privately funded elective inpatient activity in England grew by about 10.2 per cent between 2019-20 and 2022-23.

This represented a small increase in the overall proportion of inpatient elective care paid for privately — from 7.4 per cent in 2019-20 to 8.3 per cent in 2022-23 — the research found.

Josh Keith, assistant director of data analytics at the Health Foundation, said although there had only been a small increase in the proportion of elective inpatient care in England that was privately funded, this growth was “notably more pronounced for some procedures, such as hip replacements”.

“The trends we have observed do raise important questions about equity. Not everybody can afford to pay for care, and those who can afford to pay might not be those who are most in need,” he added.

David Hare, chief executive of the Independent Healthcare Providers Network, said: “Data shows that in the past few years record numbers of patients are choosing to ‘go private’ to get swift access to the care they need.”

He said this included “common paid-for procedures such as cataracts, hip and knee replacements as well as scans and GP appointments, but also more complex treatments with chemotherapy now the second most common private procedure”.

The researchers said “structural constraints on growth” in privately funded healthcare and workforce issues could partly explain why the tilt towards the independent sector had not been greater.

These constraints included “limited capacity” and the substantial amount of this being used to deliver NHS-funded care.

About 13 per cent of consultants delivered some privately funded healthcare in a given year, with estimates suggesting roughly 90 per cent of those also spent some of their time working in the NHS, the researchers said.

The study showed that fewer than one in four Britons said they would be likely to pay for private healthcare or insurance if they needed it — a proportion broadly unchanged since November 2021 when waiting lists were shorter compared with now.  

It quoted LaingBuisson, a market intelligence group specialising in private health services, that about one in 10 people in the UK was covered by private medical insurance in 2022.

“This is the highest level measured since 2020, but still below the peak of around 12 per cent in 2008, shortly before the global financial crisis. This suggests economic factors may influence the uptake of private health insurance as much as NHS waiting lists do,” the Health Foundation added.

Additional reporting by Amy Borrett