As the squeeze on NHS finances tightens, some parts of the health service are looking to cut back on the amount of minor procedures being carried out. Sam Barrett asks what solutions are on the table to privately-funded treatment of “low clinical value” – and what providers’ plans are for the future.
Pressure on NHS budgets means some healthcare services are suffering. But, although there is still uncertainty over what is and what is not available on the NHS, the health insurance industry is ready to fill the gaps.
“We’re always watching what’s happening in the NHS and how our plans can adapt to address our customers’ healthcare requirements,” says Paul Shires, sales and marketing director at Westfield Health. “At the moment we’re seeing lots of media coverage of the rationing and withdrawal of some of the non-urgent procedures. This could affect our policyholders and we’re monitoring feedback to ensure we continue to meet their needs.”
There are plenty of examples of NHS services being affected. One of the more high profile cases dates back to October 2011, when a GP group in York sent out letters to around 30 of its NHS patients awaiting minor surgical procedures such as mole removal and ingrowing toenails, explaining that these procedures were no longer funded by the NHS. Instead it suggested they sought private treatment, recommending a number of clinics including its own.
And it is not the only instance of services being withdrawn. An investigation by the Daily Telegraph last December found that 20 of the 145 primary care trusts in England were cutting the services they provided. Examples of areas affected included NHS Warwickshire cutting low priority treatments such as injections for back pain; NHS Greater Manchester refusing surgery for mild varicose veins and limiting it for the removal of warts or tonsils; and cutbacks on eligibility for fertility treatment.
It also found evidence of the tightening of restrictions for treatment, with smoking and obesity being used to prevent more patients having procedures on the NHS. Some trusts had even taken the weight issue a step further, requiring overweight people to shed the excess before they’d be considered for treatment.
But while these moves are worrying, some of the healthcare cash plan providers are already signalling their interest in stepping into the breach.
“Where there is a squeeze on the NHS, a cash plan can fill the gap,” says Howard Hughes, head of employer marketing at Simplyhealth. “We’ve already seen this with dental, optical and therapies and we’re keeping a close eye on developments within the NHS. Given what’s happening, we may look to include minor surgery in the future.”
Some cash plan providers already include some cover for minor surgical procedures. Westfield Health has gone the furthest with its Surgery Choices option, which can be included on the individual scheme it offers through its online brand Health365 as well as on its corporate schemes.
This option gives policyholders access to 60 non-urgent surgical procedures such as treatment for gynaecological conditions, hernias, knee problems and varicose veins. On corporate schemes this costs an extra £1.24 a week per employee while on Health365, individuals pay a further £6 a month for cover.
Shires adds: “This has proved a popular option, especially in the corporate market. The top tier of an organisation might have medical insurance but management still wants the other employees to be treated quickly. Surgery Choices enables them to do this for these procedures without the expense of medical insurance.”
A contribution towards minor procedures is also included on Health Shield’s corporate scheme. While many of the other providers have streamlined their corporate schemes to focus on dental, optical and therapies, it has retained its hospital benefit, paying between £10 and £110 per day for day surgery as well as per night for inpatient stays, up to a maximum of 25 days and nights a year.
“We’ll pay the day surgery benefit whether the employee is treated in the NHS or privately,” explains Lara Rendell, marketing manager at Health Shield. “It also applies if they’re treated in a registered treatment centre rather than a hospital, as long as they have an anaesthetic.”
Simplyhealth customers can also access this benefit on its Simply Cash Plan. Although it is not an integral part of the benefits, employers can extend cover to hospital and accident for an additional 30p a week per employee. This would give them a hospital allowance of £20 per day or night up to a maximum of 20 days and nights a year. However it does restrict cover to treatment administered in hospitals, so operations carried out in a GP’s surgery or clinic would be excluded.
WPA, through its cash plan NHS Top-Up, also looks to provide financial assistance in areas where NHS provision is patchy. In addition to the standard trio of dental, optical and therapies, it provides between £50 and £150 a year towards GP services.
Charlie MacEwan, corporate communications director at WPA, explains what this covers: “Policyholders can claim for services their GP may charge for including consultations, inoculations, x-rays and completing claim forms and medical reports. This doesn’t extend to minor surgery but it would cover the cost of, for example, the flu jab, providing it is carried out by a GP.”
While the cash plan providers are all watching how NHS services shape up in the coming months, none are ready to release details of how their products will develop over the next few years.
“We don’t know how far the NHS cutbacks are going to go,” says Health Shield’s Rendell. “We’ll keep an eye on this and continue to survey our members to ensure we deliver what’s important to them.”
These observations may lead to new benefits being added to plans or tweaks on some of the existing areas, for instance extending day surgery benefits to pick up the cost of non-urgent treatments delivered in GP surgeries.
A more radical overhaul is expected from Westfield as it integrates PatientChoice into its business. Although it introduced Surgery Choices in 2007 through an arrangement with PatientChoice, it liked the idea so much it bought the company in 2011. It’s still offering the PatientChoice range of products, although it is not actively promoting them, while it works with PatientChoice’s chief executive Dominic Higham to explore the next phase of product development.
“We’re not going to rush this; we want a product that will suit customer requirements,” says Shires.
But while the cash plan providers are readying themselves to extend their cover as the services provided by the NHS are cut back, they are all keen that this doesn’t transform their plans into medical insurance.
“If we identify something the NHS isn’t doing and can price it we may look to add it to NHS Top-Up,” says MacEwan. “But the purpose of a cash plan is to supplement the NHS not replace it.”
The cash plan proposition is certainly very different to medical insurance, bringing a number of benefits policyholders and providers would be loathe to lose.
Simplyhealth’s Hughes explains: “Cash plans are very simple. There’s no underwriting, no excesses, no restricted networks and no need to get a referral for treatment from your GP. The policyholder is in control from day one. We wouldn’t want to change that.”
The importance of keeping cash plans distinct from medical insurance is a thought that is not far from Shires’s mind either.
“We’re looking very carefully at how we develop and don’t want to go into the medical insurance market,” Shires says. “Employers won’t entertain us as a medical insurance provider. They don’t want medical insurance and they certainly don’t want the same level of premium.”
As well as instances of the withdrawal of some procedures on the NHS, there is also evidence that people are finding it harder to be seen by a GP. According to Listening and Learning: the Ombudsman’s review of complaint handling by the NHS in England 2010-11, there has been an increase in the number of people complaining about being kicked off their GP’s list, with 6% more people complaining about this than did in the previous year.
Its investigations found that although British Medical Association guidance states that patients should not be removed just because they make a complaint or a family member had been removed, some GPs were taking a zero tolerance approach to who remains on their lists.
With removal from an NHS GP list becoming more common, more people may look to private GP practices. These have become more commonplace since they were given the green light in 2006 by then Health Secretary Patricia Hewitt. In response, some of the cash plan providers have incorporated cover for their services. For example WPA’s GP services cover, which gives up to £150 a year towards consultations and other minor procedures administered by a GP.
Other providers have added services such as GP helplines to support their policyholders rather than offer cover for consultations with private GPs. For example, Medicash offers access to Best Doctors for policyholders seeking a second opinion; BHSF has a 24-hour helpline staffed by a team of GPs; and Westfield has its DoctorLine, which gives telephone access to practising GPs and costs an additional 15p a week per employee on its Foresight Plan.