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Privatisation and independent sector provision of NHS healthcare

Get more on the report

See the impact in numbers

Read our recommendations


Overview of the report

The NHS is facing unprecedented financial pressures. Every area where spending is increasing needs to be rigorously evaluated.

Independent sector providers should be held to the same standards as NHS providers, including transparent reporting of patient safety incidents and performance

Every year for the past five years, the amount of money spent by the NHS England on healthcare that is provided by the independent sector has increased, with the current yearly total at nearly £7bn, totalling 6.3% of the total NHS budget.

In response to this, we have released a report examining the increasing extent of privatisation within the NHS, including:

  • examining the amount of NHS England budget that is spent on independent providers
  • looking at case studies of where independent providers have taken over NHS services and the effect it has had on healthcare provision
  • undertaking a survey of doctors asking for their opinions of independent sector provision of NHS healthcare
  • using the survey results, as well as data from a number of privatisation indicators, to make eight recommendations for independent sector provision of NHS healthcare

Read our full report and recommendations

See our BMA member survey and the results

Get more detail on the level of privatisation across the NHS


NHS privatisation; the impact in numbers infographicThe impact in numbers

Our survey of BMA members found that more than two-thirds of doctors are fairly or very uncomfortable with independent sector provision of NHS services, with the most common concern being that it destabilises NHS services.

Click our graphic and see the impact in numbers


Our recommendations from the report

Our report shows that there are still a number of unknowns with regard to independent sector provision of NHS healthcare.

These eight recommendations are a starting point for understanding the effect that using independent sector providers of NHS care has on the NHS as a whole.

They also outline exactly how important it is that independent sector providers are held to the same standards as NHS providers when providing NHS care.

The BMA supports a publicly funded and publicly provided NHS but we believe that these recommendations will help to ensure that, where independent sector providers are already delivering NHS care, the priority remains for them to support the NHS to deliver high quality services.


Our eight recommendations

  1. NHS England should collect data on levels of independent sector provision of NHS services by sector, for example for community services, acute services, mental health services, learning and disability services etc.

  2. Before any independent sector provider is chosen as a preferred bidder, there should be a thorough impact analysis taken to ensure that the decision will not destabilise existing NHS services or cause disruptions to the patient pathway

  3. During any procurement process that involves an independent sector bidder, CCGs should carry out a full risk assessment for what might happen if NHS staff do not wish to TUPE (transfer of undertakings under present employment) to an independent sector provider and how this might impact on the continuity of service provision

  4. Independent sector providers of NHS services should be subject to the same requirements as NHS providers in relation to transparent reporting of both patient safety incidents and performance

  5. The CQC should develop a more standardised approach to regulating independent sector providers in line with NHS providers

  6. Safeguards should be introduced to protect NHS patients and services if contracts are terminated early by independent sector providers

  7. The Department of Health should carry out a regular review of admissions from independent sector providers to the NHS to determine the nature and cost of these incidents

  8. The NHS Standard Contract should be amended to include a clause requiring independent sector providers to contribute towards the education and training of the NHS workforce - either financially or by virtue of making available suitable opportunities. This would be in addition to the existing requirement to support the work of HEE (Health Education England) and LETBs (local education and training boards)


Private care report

In 2017 we published a new report Hidden Figures: Private care in the English NHS, which looks at the data behind the headlines of privatisation.

Find out more


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