NHS trusts spent almost £1bn on private companies to help tackle waiting lists

NHS trusts have spent almost £1 billion over three years paying private companies to provide additional healthcare services, much of it aimed at helping hospitals tackle elective care backlogs.

Figures obtained through Freedom of Information requests show 72 NHS trusts spent a combined £993 million on “insourcing” between 2023/24 and 2025/26.

The findings were published by EveryDoctor, a grassroots advocacy organisation made up of UK doctors, after it contacted 81 NHS trusts asking for details of their use of private insourcing providers.

Unlike conventional outsourcing, where NHS patients may be sent elsewhere for treatment, insourcing generally involves a private company providing additional clinical services within an NHS hospital or facility.

It can allow hospitals to make greater use of their existing operating theatres, diagnostic facilities and other infrastructure during evenings and weekends, providing additional capacity when normal NHS services are not running.

The approach has become one of the ways trusts have attempted to tackle the substantial elective care backlog that followed the Covid-19 pandemic.

EveryDoctor requested information about the private companies used by trusts, the clinical specialties in which they provided services and the amount paid to each provider during the three financial years.

Responses were received from 72 of the 81 trusts approached, meaning the £993 million figure does not represent spending across the entire NHS.

The findings nevertheless demonstrate the significant sums now being spent by some trusts to purchase additional capacity from private healthcare companies.

Insourcing expanded as the NHS attempted to recover elective activity following the pandemic. NHS England established the Elective Recovery Fund in 2021, allowing trusts to access additional funding as they increased the amount of planned care being delivered.

For hospitals facing lengthy waiting lists, bringing additional teams into existing NHS facilities can provide a way of carrying out more procedures without constructing new facilities or permanently expanding the workforce.

It can also mean NHS buildings and equipment that might otherwise be less heavily used during evenings or weekends are available for additional clinics and procedures.

However, the scale of expenditure has prompted questions about whether continued reliance on private companies represents the best long-term use of NHS resources.

EveryDoctor argues that greater investment should instead be directed towards building permanent capacity within the publicly provided NHS.

The findings come amid a wider debate about the role of independent healthcare providers in reducing NHS waiting lists.

Private providers already carry out a proportion of NHS-funded treatment, and national policy has encouraged greater use of available independent-sector capacity where it can help patients receive treatment sooner.

Insourcing is different because the dividing line between public and private provision can be considerably less visible to patients.

A person can remain inside an NHS hospital and receive NHS-funded care while some of the additional service being delivered has been commissioned from a private provider.

The arrangements can involve NHS staff undertaking additional shifts through an insourcing company, alongside staff supplied directly by the provider.

For patients waiting for an operation, diagnostic procedure or outpatient appointment, the immediate benefit is straightforward if additional capacity means they can be seen sooner.

The more difficult question is whether repeatedly purchasing temporary additional capacity represents value for money when compared with increasing the NHS’s own staffing and ability to provide the same services.

That question becomes particularly important as hospitals face continuing pressure to improve productivity and reduce costs while simultaneously bringing down waiting lists.

The £993 million identified by EveryDoctor covers three years and 72 responding trusts rather than representing the total amount the NHS spends on private healthcare.

Independent providers are used much more widely across the health service, including for operations, diagnostics and other treatments delivered in their own facilities.

Insourcing represents a specific part of that relationship, with private companies effectively being brought into NHS facilities to increase the amount of care those facilities can deliver.

The figures therefore do not, by themselves, establish that the money has been wasted. Additional clinics and procedures can help patients who might otherwise remain on waiting lists for longer, while hospitals have had to find ways to increase activity following the disruption of the pandemic.

But almost £1 billion spent by 72 trusts over three years demonstrates how substantial the market for additional private capacity within NHS hospitals has become.

As the health service continues trying to reduce waiting lists, the longer-term question is whether insourcing remains a temporary tool for clearing exceptional backlogs or becomes an established part of how NHS care is delivered.

For patients, who owns the organisation providing an additional clinic may matter considerably less than whether they receive safe treatment without an excessive wait.

For the NHS, however, the question is bigger: whether paying private companies to provide extra capacity inside its hospitals is the most effective way to recover services, or whether that money could ultimately be used to build more capacity within the health service itself.

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