A worrying number of expatriates have no life or income protection insurance in place, according to William Russell.

A customer survey carried out by the provider shows that 61% of expat clients say they have no life or income protection in place. A further 6% said they were unsure whether they did or not, while the remaining 33% had at least one of the products in place.

Conversely, 70% of life and income protection clients said they had health insurance, while a further 7% were unsure.

William Russell said that while the results may be unsurprising when viewed alongside domestic figures, they do demonstrate a real need for expats to be adequately advised and informed about the risks of being uninsured against death or sickness absence.

James Cooper, sales director at William Russell, added: “Although we are pleased to see that a high number of expatriates are making provision against the risk of needing expensive medical treatment whilst they’re abroad, it is worrying to see how many expatriates are not making financial provision in the event of their untimely death, or an illness or accident that would prevent them from working.”

Earlier this year, Health Insurance examined the challenges facing intermediaries in selling protection to expats. Barriers to sales cited by those in the industry include a lack of providers in the international protection market, high premiums and EU legislation making provision complicated.

The report on private sector employer and employee engagement with workplace savings and benefits shows that the most common benefit offered by firms is an annual bonus at 35% of companies.

Employee benefits

Meanwhile, 33% offer a pension scheme, 24% offer life insurance or a death in service benefit, 23% offer health insurance and 22% non-financial benefits.

While 36% of employees value an annual bonus, only 16% value a pension scheme, 14% value life insurance, 15% value health insurance and 14% non-financial benefits.

Employees’ priorities also vary significantly according to age, with 21% of 35 to 44 year olds valuing a pension scheme as a workplace benefit, compared to just 7% of 22 to 24 year olds. The report said this age group is more likely to be focused on lifestyle benefits such as gym membership and a subsidised canteen, with 21% of 22 to 24 year olds valuing such perks compared to 13% of 35 to 44 year olds.

The report said that while there is a discrepancy between what an employee is offered and what they value, employers do appear to be embracing a broader range of benefit options.

The survey also shows that 78% of companies offer their employees some benefits beyond their basic salary, while 39% are looking for ways to motivate staff without ‘unduly increasing remuneration’.

In addition, the report examines how prepared employers are for the government’s automatic pension enrolment initiative due to come into force later this year.

It shows that 70% of firms are aware of the new legislation and 43% have actively started planning for its introduction.

But the report said: “However, when employers’ understanding and intended actions are more closely examined, the picture is less clear and perhaps suggests that many have not thought through the long-term requirements beyond their initial staging dates.”

While 23% of companies said they feel fully prepared and understand what measures they will put in place, 11% of those who have heard of the legislation have no plans at all, and 27% say that they have not started discussing the legislative implications for their business.

Furthermore, although the majority of employers are aware of the legislation, 68% of private sector employees have little or no knowledge of the subject.

The report said: “This illustrates a critical challenge that will need to be overcome if automatic enrolment is to gain traction in the workplace. Even those employees who said they had some knowledge on the subject, when questioned further actually had little depth of understanding as to what it might mean for them personally.”

The insurer’s survey of 1,000 employees in October found that around a third (30%) thought they would survive for less than a month while less than one in ten (9%) said they would remain solvent for a year or more.

Although these figures suggest that workers will be receptive to the marketing of income protection (IP), the survey also found that 80% of respondents thought it was unlikely that they would have to deal with long-term sickness. This finding follows a recent consumer survey conducted by the Association of British Insurers (ABI) which found that 82% of people had never been absent from work for more than three months as a result of sickness or injury. In this survey, 89% of respondents said they would pay less than £5 a week for IP, 29% said they would not be prepared to pay anything at all.

However, disability insurer Unum reports that 11% of people have taken more than six months off work through illness or injury and Aviva believes that many people overestimate the level of support they would receive from the State if they were unable to work through ill-health. Less than two in ten (19%) of its respondents knew how much statutory sick pay they would be entitled to while a quarter (26%) think they would receive more than the actual amount available.

Asked about how they would cope without a salary, respondents said they would eat cheaper food and cut down on family holidays. Asked about the return to work following a period of illness, they said that the provision of proper support would allay fears about the risk of relapse or being unable to cope.

Aviva also surveyed 500 employers and found that 25% agreed that the rehabilitation process is “vital” in tackling long-term absence. However, only one in ten said that they would consider how they could adapt the responsibilities of the worker to aid their return to work.

Last year, Unum teamed up with think-tank Demos to investigate the case for the Government to incentivise employees and employers to invest in income protection. Demos estimated that the Government could save £2.24bn a year by reforming statutory sick pay and giving incentives to those who opt to take out protection.

Like Unum, Aviva is currently promoting IP through a television advertising campaign.

The Clinic currently provides a range of services, including orthopaedic and spine surgery, physiotherapy and a sports injuries clinic.

The agreement proposes that Nuffield Health’s Manor Hospital, also based in Headington, a mile from the Clinic, will take over the patient lists, following the transfer of all staff.

The Manor Hospital provides a much wider range of services than the Clinic, including cardiology and oncology. It has six major theatres, an intensive care unit and MRI and CT scanning on site.

A spokesman for BMI Healthcare said that the decision to transfer the clinic was not influenced by a lack of demand in the area.

“As a specialist orthopaedic unit, The Oxford Clinic has and will continue to provide extensive patient care to the people of Oxford,” he said. “There is a continuing demand for high quality, private healthcare provision within Oxford.”

Duncan Whitwell, consultant orthopaedic surgeon, said: “We believe that this relocation will be a fantastic opportunity to facilitate growth and to further develop the excellent clinical services carried out at The Oxford Clinic.”

Contracts were signed yesterday evening between Hinchingbrooke Health Care NHS Trust and Circle, which will take over the management of the hospital from 1 February 2012.. The clinical and non-clinical services will continue to be provided by the Trust but will be managed by Circle, via a franchise agreement.

Circle was chosen as the preferred bidder to run the Trust in November 2010 following a 13 month procurement process. Another hospital group, Ramsay Health Care UK submitted a bid outside of the guidelines so was not invited to tender. Today’s announcement follows a 12 month period of scrutiny by the Department of Health.

Dr Stephen Dunn, director of policy and strategy at NHS Midlands and East which has managed the project to find a franchise partner, said the signing of the deal was a “momentous day”.

“Without this partnership, the future for Hinchingbrooke could have been uncertain,” he said. “Now, we have a solution which aims to repay the hospital’s taxpayer debt of almost £40m, as well as giving it the best chance of a sustainable future. Patients will continue to receive high quality NHS services from NHS staff in the NHS hospital they know. This is not privatisation. Staff and assets will remain in the NHS.”

Although both Circle and the NHS have emphasised that staff and assets will remain within the NHS, and that patients will continue to receive NHS services, concerns about privatisation have already been voiced. Although Circle describes itself as a “social enterprise” in the John Lewis mould (it is 49.9% employee-owned) it is partly owned by venture capitalists and recently listed on the stock exchange.

UNISON, the UK’s largest union, has warned that the deal “could lead to a second Southern Cross crisis”, referring to the collapse of care home operator Southern Cross.

Christina McAnea, UNISON’s head of health, said: “We know that the Government is intent on privatising our NHS – that is the clear outcome of the Health and Social Care Bill. Privatisation, which brings in the profit motive, will damage our NHS.”

The union has expressed “huge concerns” that jobs will be cut as part of the drive to return the hospital to financial stability.

“The hospital could have been kept running for the benefit of patients, rather than profiteers,” said McAnea. “This must not become a precedent for the NHS, or millions more staff and patients will be put at risk.”

The NHS body overseeing the deal has said that the franchisee “may well identify scope for improving efficiency and performance”, but cited the transfer of more services into the community or an extension of hours, rather than job losses.

Circle has been keen to emphasise the efforts at staff engagement undertaken in recent months. It already owns private hospitals in Bath and Nottingham, surgery units in Stratford upon Avon and Windsor and is building a private hospital in Reading due to open in late 2012. However, it does not yet have experience of running the full range of services available at Hinchingbrooke such as accident and emergency and maternity services.

Figures released today by the protection provider and general insurer show that new annual premiums rose to £23.4m, up from £13.2m in Q3 2010.

The provider, which was launched in 2008, now has a 7.8% share of the IFA market, compared to 5.1% in the same period a year ago. It has over 175,000 customers.

It halved its pre-tax loss to £1.6m compared to the same period last year. In 2010, the provider was hit with a one-off impairment charge of £5.6m relating to the loss of Click, the protection distribution firm, which has gone into liquidation.

The number of cancer cases is projected to climb from around 298,000 in 2007 to around 432,000 by 2030 and the charity warns that, without planning this could “threaten to overwhelm NHS resources”.

The main reason for the rise in cancer cases is that people are getting older. More than three out of five cancers are diagnosed in people aged 65 and over.

Prostate cancer is set to see one of the biggest rises in incidence, with cases set to increase from around 36,000 in 2007 to over 61,000, mainly due to the ageing and growing population. One of the challenges of the disease is making decisions about whether or not to treat early signs of the disease. Health Insurance recently reviewed the latest treatment available in the private sector.

Although cancer cases are set to rise, cancer rates, adjusting for the growing and ageing population, remain broadly stable over the 23-year period at around 400 per 100,000 men per year and 350 per 100,000 women per year.

However, some individual cancers will see an increase in rates including oral, liver, malignant melanoma and kidney cancers, especially among men.

The rate of malignant melanoma – the most dangerous form of skin cancer – has the biggest projected increase, rising by 52% for both men and women.

The study also predicted that the rate of breast cancer will decline by 7% with most of the decline in the age group 55-64  due to a significant reduction in the use of hormone replacement therapy (HRT) in recent years.

Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “We’ve witnessed huge improvements in recent decades, with cancer survival doubling over the last 40 years. Cancer Research UK has been at the heart of the progress through investment in research into more effective radiotherapy, many new drugs and improved surgery.”

Harpal Kumar, Cancer Research UK’s chief executive, said: “The NHS faces a perfect storm over the next 20 years. At a time when the finances of the health service are being squeezed, it is absolutely crucial that health commissioners plan now for a massive increase in demand for cancer services, to ensure we provide high quality care to all.”

Advisers have told Health Insurance that more could be done to help people fund private healthcare into their 60s, when they are more likely to need hospital care.

“We need constant innovation to invigorate the market,” said Debbie Kleiner-Gaines, managing director of Best Health UK. “We need to create reasons for people to talk to advisers and stimulate the medically insured to be inquisitive.”

Nick Jones, brand and marketing manager at Exeter Family Friendly, agreed.

“We need to put in place more flexible solutions that work with and complement the NHS, but also do so affordably,” he said. “Improving medical treatment and developments in expensive drugs has put pressure on PMI premiums. We need to find solutions to this by helping break cover down, so older customer can select what’s important to them; but not at the expense of clarity.”

NHS concerns

A “large proportion” of Kleiner Gaines’ clients are over the age of 60 and she suggested that they were motivated to take out PMI due to concerns about the level of care they might receive in the NHS.

“This is mainly due to the fact that they have had enough life experience to know of friends that have had terrible treatment and waited for treatment,” she said.

Damning reports exposing poor standards of elderly care in the NHS have hit the headlines in recent months. An investigation by the Care Quality Commission uncovered a culture that “allowed unacceptable care to become the norm, where it should have been an exception”.

Brian Walters of Cheltenham-based intermediary Regency Health, reports that half of his clients are aged over 60 and often cite concerns about hospital-acquired infections (HAIs) and the possibility of shared wards in the NHS.

“We have seen a recent trend for older people entering or returning to the PMI market citing concerns about the NHS, but these concerns tend to be expressed in vague terms,” he said.

Although rates of HAIs have fallen to a record low, the elderly are more at risk. Most cases of MRSA and C.difficile are reported in patients aged over 75. The NHS has also made progress on eliminating mixed-sex accommodation, although patients may still stay on mixed-wards.

Policy design

While various tools can be used to reduce the cost of PMI, advisers warn that not all are appropriate for older age groups. Walters believes that premiums contingent on high no-claims discounts are “particularly unsuitable” for older clients because “they are more likely to claim in successive years and are more susceptible to getting ‘locked in’ to a single insurer”.

Following the publication of our story yesterday, intermediaries revealed it was the first they had heard of the change.

Intermediaries at Lorica Employee Benefits, Gallagher Employee Benefits and ADVO Group reported that nobody in their firm had received news of the launch.

“Those of us building flex benefit platforms, those of us who are well into the renewal process and those of us who just want to advise our clients professionally find it wonderful that we find out from Health Insurance magazine – and thanks to the magazine,” said Karen Gamble of Gallagher Employee Benefits. “This may be a good thing but there are so many questions on the details.”

Other intermediaries said that they had been informed of the change by Bupa.

While brokers have raised concerns about the communication of the news, others questioned the wisdom of the change itself.

Magnus Kauders, commercial director at Blossoms Healthcare, a private GP and occupational health provider, was highly critical.

“Bupa are effectively asking GPs to step away from their responsibility to their patients, by making an insurer the arbiter of a patient’s care”, he said. “It’s a move which is universally offensive to clinicians, as it suggests they may not making the best decisions about the care of their own patients.”

Bupa has argued that most referrals are made without using any data on quality or value of specialist, a view shared by the Office of Fair Trading.

Kauders continued: “Placing any restrictions on access to care completely undermines one of the core reasons private medical insurance (PMI) is purchased in the first place, which is probably why this step is being pushed onto corporate clients and not individual policy holders.

“How are the purchasers of Bupa’s corporate PMI, mostly HR or benefits specialists, going to feel when their MD turns up at their desk saying that they can’t see the consultant recommended by their GP?  We’d imagine the HR specialist will be on the phone to their intermediary pretty quickly.”

While acknowledging that Bupa has access to clinical and claims information, Kauders suggested that, in the member’s eyes, “there’ll always be the perception that decisions are being made around fees, rather than quality”.

“It’s worth considering that most doctors are highly unlikely to provide an open referral without discussing it fully with their patient first, including the risks, particularly in complex therapeutic areas,” he added. “It’s also adding in lots of complexity for patients, which will probably just create lots of additional calls to HR teams, intermediaries and Bupa, discussing why one route is being suggested instead of another.

“Just about the only positive outcome we can see from the move is that it opens up the debate about quality of care, which most clinicians would embrace.”

The Commons Public Accounts Committee’s report on the NHS’s use of high cost equipment (MRI and CT scanners and radiotherapy machines) is highly critical, highlighting the service’s failure to use its scale to secure deals with manufacturers, resulting in wasted resources and variable standards of services for patients across the country. Half of all machines studied in the report need to be replaced over the next three years, at a cost of around £460m.

Committee chair Margaret Hodge MP said MPs were “shocked by the unacceptable response times for certain conditions”. Data suggests that an estimated 13% of cancer patients are not getting access to radiotherapy when it could prolong their lives.

“A modern NHS should not allow 50% of people who have a stroke to wait more than 24 hours for a scan,” she said. “There are unacceptable variations between trusts in the number of scans per machine, from 7,800 to almost 22,000 a year; opening hours and waiting times.”

The committee has concluded that devolving purchasing to individual hospital trusts “is not conducive to delivering value for money” and recommends that they work together to make bulk orders. It has also called for data be collected and published to enable trusts to compare costs and usage of machinery with one another.

The report raises questions about the wisdom of further devolving management of the NHS via the creation of hundreds of GP-led consortia and whether it will result in the NHS losing the advantages of scale. The possibility of fragmentation in the NHS is one of the chief criticisms of those who oppose the Government’s reforms.