|   Let integrity lead.

The dangers of a ‘two-tier’ health system

By Dr Ntuthuko Bhengu

This article highlights the complexities of healthcare service delivery. The UK National Health System is widely regarded as one of the most successful healthcare systems globally. It is also a huge source of pride and social cohesion for citizens. But an article in the Observer recently revealed the NHS trusts tell patients they can go private and jump hospital queues. Observer investigations found a ‘two-tier’ health system emerging in England, with rapid access available to those able to pay. According to the article in The Guardian observed that hospitals are offering hip replacements from £10,000, cataract surgery for £2,200 and hernia repairs for £2,500. MRI scans are offered for between £300 and £400.

This comes as figures show a record 7.21 million people are waiting for NHS treatment in England, with routine breaches of the maximum waiting time of 18 weeks for non-urgent referrals.

What are the key points here?

1. The English health system is buckling under ever-lengthening waiting lists for critical surgical and other procedures;
2. Increasingly, patients are channeled to the “private sector” to skip the long waiting lists; and
3. The “private sector” services referred to above are offered by the same NHS facilities and clinicians, leading to ethical and financial controversies.

Many won’t know that this exact problem is not unknown in South Africa, with some public hospital wards being reserved for “private patients”.

Some of the expected advantages included the following:

1. Increased revenues for public hospitals;
2. Keeping senior clinicians on public hospital premises, and
3. Improving retention of highly sought-after skills in public service.

Well, unintended consequences got in the way… What is the risk of a “two-tier” service? Those who can’t pay will have to wait much, much longer …

Read the full article here:


Thanks to our valued partners and to all the Fellows who continue to contribute in many ways.

  • Aspen Global Leadership Network
  • Yellowwoods
  • Barloworld
  • Tshikululu