Private Hospitals Are Helping the NHS Cut Wait Times — With Trade Offs

Outsourcing patients to private hospitals is helping England’s overstretched National Health Service ensure most people get treated more than a month faster than they otherwise would, according to a Bloomberg News data analysis. It’s reducing the overall backlog too.

But it’s also fueling a two-track system, where patients with more easily treatable conditions can be seen relatively quickly at private facilities, while others wait for care at NHS hospitals. Opponents say a growing reliance on independent hospitals is undermining the publicly funded health service in fundamental ways.

For more than 75 years, the NHS has provided Britons with health care that is free at the point of use. But years of underfunding, staff shortages and a growing, aging population have left the service struggling to cope, while Covid-19 and the economic impact of Brexit have only intensified the crunch.

On Tuesday, the NHS announced that its chief executive officer, Amanda Pritchard, would step down just weeks after facing political criticism over the service’s productivity. As of December, more than 7.4 million cases were still on waiting lists.

In January, the UK government announced a new deal between the NHS and independent providers to tackle the backlog and bring the standard waiting time down to 18 weeks for 92% of patients. Private hospitals with spare capacity will provide as many as a million extra appointments a year for NHS patients in treatment areas such as orthopedics and gynecology. The NHS and the independent sector will work together to encourage long-term contractual relationships, cementing the role of private hospitals in the health service.

While successive UK governments have used the private sector to bolster publicly funded care in various ways for decades, the agreement is the first sign that the ruling Labour party — which founded the NHS in 1948 — sees the relationship as a permanent one.

The partnership arrangement is “the first of its kind in 25 years,” Health Secretary Wes Streeting said at the time. “This new agreement will see more NHS patients able to choose to be treated in a private hospital where there is capacity, paid for by the state.”

Nearly one in five NHS cases admitted to hospital in England last year received their care from a private provider — a proportion that has more than doubled over the past 13 years.

That translates to a record 659,000 inpatient treatments in private hospitals in 2024 paid for by the NHS — up nearly 50% from the pre-pandemic peak. Meanwhile, NHS hospitals handled about 9% fewer inpatient admissions than a decade ago.

The NHS sees nearly four times as many outpatient treatments as there are hospital admissions. While the NHS outsources a much smaller share of outpatient cases, its independent-sector partners still handled more than 1 million of them in 2024 — more than twice as many as 10 years ago.

The new deal is likely to increase NHS reliance on private providers even further.

Historically, the independent sector has played a supplementary role in the NHS, according to Siva Anandaciva, director of policy at the King’s Fund, a health care-focused think tank. “It feels increasingly like that dynamic is changing,” he said, with the relationship “moving from help to reliance.”

Patients don’t necessarily care who provides their treatment. Only 17% of Britons actively oppose using private companies to provide NHS services, while about 46% are supportive, according to polling by Ipsos. And the prospect of quicker service that comes with shorter waiting lists is always going to be popular.

Historically, waiting times were only about a week shorter for NHS patients diverted to private healthcare providers. But since the pandemic, a larger gap has emerged. In late 2024, only 58% of NHS cases in the queue for a public-sector provider had been waiting 18 weeks or fewer since referral, compared with more than 75% of those waiting for a private provider — which still falls short of the NHS’s target.

“It would be a dereliction of duty not to use every available resource to get patients the care they need,” a spokesperson for the Department of Health and Social Care said. “The independent sector will play a vital role in busting the backlog.”

Ian Campbell, 59, who had a knee replacement last year, would “rather the NHS was set up” to swiftly carry out operations within its own facilities. But when he found himself in severe pain and struggling to walk, the median NHS wait time for orthopedic and trauma-related operations in England, including knee replacements, had been stuck at about four months since 2022. There are nearly 100,000 cases with wait times of more than nine months.

The NHS paid for Campbell, a retired finance sector worker who lives in Leeds, to attend a private hospital run by Spire Healthcare Group Plc. He was offered an appointment after about two months.

“The convenience of it, the speed of service and the quality of the service, it was really, really worthwhile,” he said in a telephone interview.

However, outsourcing treatment to the private sector can have negative knock-on effects, campaigners and health care researchers warn. These include underinvestment in services for more serious or complex health problems, fewer training opportunities for NHS staff and unequal access to treatment across different parts of the country.

In addition, many UK medical staff divide their time between public- and private-sector work, sparking concerns that employees are increasingly spending time in independent hospitals. In January, Labour MP Stella Creasy raised the risk that the government “could end up paying the same NHS doctors more to do operations in the private sector.”

Some researchers are studying whether increased outsourcing leads to higher mortality rates, as sending profitable patients to the private sector while keeping complex cases within the NHS could increase pressure on the health service.

“We absolutely will continue needing to use the private sector, particularly if we’re going to make this progress in the waiting list,” said Mark Dayan, head of public affairs at the Nuffield Trust, a London-based think tank. However, there is a real risk that this “will distort the kinds of care that we commission,” he said, since private providers are better set up to treat certain conditions.

The NHS spent £12.4 billion ($15.7 billion) on independent providers in 2023-24, the last financial year for which there are records — 35% more than in 2018-19.

That’s been a windfall for some providers. At Spire Healthcare, which is listed on the London Stock Exchange, revenue from the NHS rose by more than 15% in 2023, reaching £341 million. Analysts expect further growth in 2024. One of the country’s largest private hospital providers, Circle Health Group, had revenues of more than £1.1 billion in 2023. Income from NHS patients rose around 5% compared with the previous year.

While the number of NHS treatments being carried out in the private sector is increasing, admissions to NHS hospitals have remained flat compared to pre-pandemic levels, Bloomberg’s data analysis shows. That’s despite a 25% increase in staff in the six years to October 2024. Investment in land, buildings and IT has also grown substantially.

“Coming out of the pandemic, the NHS had experienced a significant shock to productivity and it has found it hard and slow going to recover,” said Anita Charlesworth, senior economic adviser at the Health Foundation.

Reducing waiting lists is not the service’s only goal, she added — for instance, handling winter surges in emergency admissions and managing patients who can’t leave the hospital until home care support is in place, can affect average waiting times.

“If you’re thinking about this in comparison to business, the NHS is a multi-product firm and it's a really complex supply chain,” she said. “If one bit in the chain hits problems, the knock-on impact through our system is profound.”

The private sector process is more streamlined, Charlesworth said, in part because private hospitals tend to take fewer patients with complex comorbidities.

Private hospitals mostly offer a limited range of relatively straightforward procedures for NHS patients. More than one in four inpatient operations in orthopedics and trauma are now carried out by the private sector, which has been steadily ticking up from about 14% in late 2011. In some months in 2024, nearly half of NHS ophthalmology operations were outsourced, up from less than 10% as recently as late 2017.

Simon Platt, a 59-year-old chartered engineer who is now semi-retired, had cataract surgery last year in Preston at SpaMedica, the largest provider of the treatment to the NHS. He compared the service to “an assembly line,” adding: “It’s very efficient. I was really impressed.” Using the private sector for routine surgeries is what the NHS “should be doing,” he said.

“Because of the specialized nature of cataract surgery, they're doing essentially the same thing to thousands of people.”

But critics say independent providers are cherry-picking easier surgeries, leaving more complex and costly operations to the NHS. In addition, private hospitals generally don’t offer emergency care, meaning patients with more advanced conditions will usually be treated at NHS facilities.

“There is a risk that you end up underinvesting in the services for the most unwell patients, the patients with the most complex health problems,” said Nuffield Trust’s Dayan.

Independent sector providers play an important role in supporting the NHS to bring down waiting lists, said an NHS spokesperson in a statement. The service is working with the independent sector to review criteria that might exclude patients from being treated in private facilities.

Outsourcing routine procedures reduces training opportunities, according to John Puntis, a retired pediatrician and co-chair of the campaign group Keep Our NHS Public. Cataract surgeries are the “bread-and-butter training operation for training NHS ophthalmologists,” he said.

The overall pot of funding for ophthalmology services is also limited. “If you are doing more cataract surgery, which is what has happened, then you actually have less money for everything else,” he said. That includes “things like glaucoma, retinopathy of prematurity, macular degeneration — actually problems which will make you go blind unless you are treated promptly.”

The overall proportion of the NHS eye care budget spent on more serious diseases declined from 73% to 64% over the past five years and waiting times at NHS hospitals for some of the most serious conditions increased, according to research by the London School of Economics.

Even for routine operations, access to the shorter waiting lists that private hospitals can bring isn’t equal around the country.

In most parts of England, the share of hospital procedures carried out by the private sector rose in tandem with waiting lists before the pandemic. After Covid hit and the backlog of patients rocketed, the West Midlands, North West and North East came to rely far more on the independent sector. In London, the share of hospital procedures carried out by the private sector was relatively flat, while it rose more slowly in the South East.

A contributing factor may be that London and the South East have more private patients accessing private care through workplace insurance or out of their own pocket.

Private providers say they have a positive role to play within the NHS. “We obviously just don’t accept that there is anything that is threatening to the overall NHS model in using the independent sector,” said David Furness, director of policy and delivery at the Independent Healthcare Providers Network, an industry body.

“The thing that is threatening to the NHS is people not being able to get the care they need,” he added. “We’re playing a role to try and help people access that care when they need it.”

Tens of thousands of appointment slots offered by private providers to the NHS go unused each month, the IHPN estimates. Many patients don’t know that when their doctor refers them for specialist treatment they can choose to be seen in a private hospital.

An additional 10,000 monthly appointment slots over the last five years could have decreased the overall waiting list by nearly 10%.

If private hospitals do free up an extra 1 million appointments in the coming year, that would almost fully offset the net growth in the waiting list going back to April 2022.

While the government increases use of the private sector, the NHS itself has been slowly selling off its own buildings and land. Over the past few years, roughly 220 hectares belonging to the NHS have been identified as surplus, equivalent to more than 300 soccer pitches. At least 80 plots have been sold for £73.2 million to generate cash for improving existing NHS facilities or building new ones. But campaigners fear that the NHS is only trying to plug financial deficits rather than finding funds to re-invest.

Away from the heated debates, experts like Anandaciva say that the government needs to make strategic decisions about the private sector’s role in British health care, rather than just relying on it as a stopgap solution to the waiting list crisis.

“If you don’t have that strategy, it can feel very ad hoc and unmanaged,” he said. “And that’s the opposite of what you want.”