New figures published earlier this month show the extent to which some Integrated Care Boards (ICBs) have increased their use of the private sector since Labour took office last July, and the extent to which a minority of ICBs have become much more dependent on private providers than others.
Some readers will be shocked to find that the penetration of the private hospital sector – after so many years of privatisation – is not at all on the level implied by some exaggerated accounts. While some specialties have suffered greater erosion than others, the lion’s share of elective treatment as a whole (as well as all emergency care) is still entirely delivered by the NHS.
The most privatised of NHS elective services are ophthalmology and orthopaedics, but even here the NHS is still by far the largest provider: the July figures show the private sector delivered 22.1% of ophthalmic and 20.5% of orthopaedic procedures, leaving 77.9% and 79.5% of caseload respectively to the NHS.
Of course, the damage done is more wide-ranging than the bare numbers suggest. The drain of resources away from NHS providers, and the profit margins that keep the private sector seeking more NHS-funded work mean that every pound spent in the private sector delivers less value in the form of patient care than the same amount spent on in-house NHS services.
There is no denying Labour has had an impact: the latest figures show the numbers of NHS patients treated by ‘independent sector’ hospitals and clinics have increased by almost 10% in Labour’s first year (535,000 in the 12 months to July 2025), compared to the equivalent to July 2024. The biggest increase by far has been in South East London, up by a massive 71% from 161,000 in the 12 months to July 2024 to 275,000 to July 2025.
While Health Secretary Wes Streeting has championed the private sector as his main “reform” policy, the data shows considerable variation across the country.
Seven ICBs recorded dramatic increases over the 12 months to July 2025. Dorset led with a 52% jump, followed by Cambridgeshire & Peterborough and Suffolk & NE Essex (both up 41%), and four others with rises above 25%. Another nine increased their private referrals by more than 10%. The scale of these jumps raises questions about the impact on NHS finances, staffing and core services.
But five ICBs barely changed their approach at all, with Lancashire & South Cumbria, Hertfordshire & West Essex, and Coventry & Warwickshire recording no increase, and two others rising by just 1%.
More strikingly, seven ICBs actually cut their private referrals over the year. Frimley slashed its use by 26% (from 44,000 to 32,000 cases), while Cornwall reduced by 10%. Five others made smaller cuts of 2-6%.
The trend appears to be strengthening. Comparing just July 2025 with July 2024, even more ICBs – 17 in total – reduced their reliance on private providers, with Mid & South Essex cutting by 28%, Leicester & Leicestershire by 24%, and Staffordshire & Stoke on Trent by 19%.
Overall, private referrals increased by 9,825 cases (9%) in July year-on-year, driven largely by SE London (up 4,680) and three others with increases above 2,000.”
Several ICBs recorded dramatic increases in private provider use over the 12 months to July 2025. Dorset’s referrals jumped 52%, while Cambridgeshire & Peterborough and Suffolk & NE Essex both rose 41%. Four others increased by more than 25%, and another nine by over 10%.
Given Wes Streeting’s championing of private providers as his main “reform” policy, these rises are unsurprising – though their scale raises questions about the impact on NHS finances, staffing and core services.
Yet five ICBs barely changed their approach, recording either no increase or just 1%. And seven actually cut their private referrals over the year, with Frimley slashing its use by 26% (from 44,000 to 32,000 cases) and Cornwall reducing by 10%.
The trend towards cutting private use appears to be strengthening. In the single month comparison of July 2025 versus July 2024, even more ICBs – 17 in total – reduced their reliance on the private sector. The largest cutbacks were in Mid & South Essex (down 28%), Leicester & Leicestershire (24%) and Staffordshire & Stoke on Trent (19%).
In absolute numbers, Mid & South Essex cut 5,030 cases in July; Staffordshire & Stoke on Trent cut 3,125; and two others reduced by over 2,500. Meanwhile SE London increased by 4,680 cases, with three others adding over 2,000 each. Overall, private referrals rose by 9,825 cases (9%) for the month.
Dependence on private providers varies dramatically. Almost three-quarters of ICBs (30) used the private sector for less than 10% of their elective caseload in July, which averaged 8% nationally. Seven used it for under 5%, with SW London at just 0.9%.
At the other end, Lancashire & South Cumbria was most dependent at 18.2%, followed by Staffordshire & Stoke on Trent (16.5%) and Bedfordshire, Luton & Milton Keynes (10.2-15.2%).
In total, the NHS handled 6.6 million elective episodes in July, while private providers handled 539,000 – a 51% increase since July 2019, before the pandemic.
But context matters. The private sector filters out higher-risk patients with complex needs, who are all treated in the NHS. Not every elective episode involves a hospital admission, and the case mix handled by private providers is fundamentally different
Moreover more minor operations can more easily be done as day cases ensuring private hospitals have no ‘bed blocking’ problem. Statistics clearly show that only 2 percent (10,725) of the 539,000 private sector cases were inpatient admissions (averaging just 447 per working day in July across the private hospitals in England), while another 14% (74,000) were admitted as day cases: the remaining 84% were outpatients.
By only admitting the simplest of elective cases, the private sector also avoids any need to engage with the dysfunctional social care system that complicates and delays the discharge of thousands of patients from NHS hospitals.
The NHS also handles all of the emergencies and the overwhelming majority of medical cases (including the treatment of COVID, which continues, with latest figures showing 1,250 beds in England filled with Covid patients in August). This is why the NHS experiences problems in maintaining elective services at times of increased demand for emergency care.
Despite this apparent advantage for the private sector, and the fulsome backing they have enjoyed for many years from Tory and now Labour governments, they still remain very much junior bit-part players on the fringes of day to day NHS services.
The actual numbers of NHS patients sent to private sector providers have risen significantly in 12 months, but from a relatively small base – and the increased use of private beds and clinics has made no obvious difference to the 7.4 million on waiting lists, many of whom are waiting for services only the NHS can do. (See [link to separate story on waiting list situation])
So Mr Streeting has not even delivered more than a fraction of the one “reform” he seemed to have hatched up after Labour’s 14 years in opposition, and what he has done has, as many warned, done little to improve waiting lists or waiting times.
Moreover given the most recent trends, and the increased financial pressures on local NHS systems as Rachel Reeves pursues Tory-style austerity rather than tax the rich, it’s doubtful if the private sector can hope to pick up a much greater share of the NHS funding pot.
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