CQC warns of a two-tiered health service

By Olive Carterton

The Care Quality Commission (CQC) and the Parliamentary Health Service Ombudsman have both expressed concerns over a ‘two-tier health service’ increasingly favouring those who can pay privately for their treatment.

Responding to the watchdog’s annual State of Health and Social Care report, Ombudsman Rob Behrens said ‘Our healthcare system can’t keep up with the rising demand for care. 

‘With more and more people having to turn to private healthcare, a two-tiered health system has been created where, too often, only those who can afford it are able to be treated quickly.’

He said the report made for ‘extremely difficult reading’ and echoed widespread concerns about people’s access to and experience of healthcare, particularly in maternity and mental health.

CQC chief executive Ian Trenholm said: ‘The combination of the cost-of-living crisis and workforce challenges risks leading to unfair care, with those who can afford to pay for treatment doing so, and those who can’t facing longer waits and reduced access. 

‘And the impact of unresolved industrial action on people can’t be ignored. It’s crucial that both parties work towards an agreement so strikes do not continue into the winter, when disruption will have to be managed alongside increased demand for urgent care and staff sickness.’

Civica Medical Billing

CQC chairman Ian Dilks added that challenges described in the report were to some degree caused by a lack of joined-up planning, investment and delivery of care.

Now the opportunity needed to be grasped to ensure fairer care for everyone so that people got the care they needed, not just the care they could afford.

Salutary warning

Matthew Taylor, chief executive of the NHS Confederation, said the report laid bare the critical state of the NHS and should provide a salutary warning to political leaders about the abundance of issues facing the health service and the scale of the recovery task ahead.  

‘After a decade of underinvestment in staff, buildings and infrastructure, it is no surprise that we are in this position. We now need a credible plan that helps NHS leaders recover services and rebuild public confidence in what has always been one of the UK’s most valued institutions. 

‘The report is rightly at pains to point out that there is good work happening across all of the sectors in very tough conditions, particularly around mitigating the risks of staffing shortages, but health leaders will all too readily recognise the many intractable problems outlined within it.’  

He highlighted worsening health inequalities, with the report suggesting that those who could afford it were increasingly turning towards private care ‘creating the risk of widening access gaps towards a future two-tier healthcare system’.

The CQC said those who could afford it were increasingly turning to private healthcare. ‘Research by YouGov shows that eight in ten of those who used private health care last year would previously have used the NHS, with separate research showing that 56% of people had tried to use the NHS before using private healthcare.

‘This situation is likely to exacerbate existing heath inequalities and increase the risk of a two-tier system of health care, with people who cannot afford to pay waiting longer for care.’