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Hidden figures: private care in the English NHS

Breaking Point, NHS info graphics
Do (ISPs) independent sector providers give good and good value care? NHS spending on (ISPs) independent sector providers keeps increasing.

The health service in England is facing the greatest financial challenge in its history, and yet the independent sector is increasingly involved with the provision of patient care within the NHS.

The English health service is heading towards a projected £30 billion funding gap in 2020/21; the government has committed £10 billion to help mitigate the situation, although the BMA has argued that in real terms, and factoring in the cuts to other services, the figure is closer to £4.5 billion. Within this climate, one of the few areas where funding is increasing is amongst ISPs (independent sector providers) of NHS care.

We want to find out what this means for the provision of patient care.


Key points

Building on our 2016 report on privatisation within the NHS in England we've looked into the data behind these headlines.

Our analysis uncovered the following key points:

  • NHS spending on non-NHS and independent sector provision grows each year (there was an increase of £2.6 and £2.1 billion respectively between 2013/14 and 2015/16);
  • The proportion of the total Department of Health budget spent on ISPs is also increasing (from 6.1% in 2013/14 to 7.6% in 2015/16);
  • There needs to be more transparency about the level of private provision of NHS services;
  • The principal area of spending on ISPs is in the community health sector;
  • The NHS relies very heavily on a small number of ISPs despite acknowledged risks from individual ISPs having an excessive market share;
  • CCGs spending a higher proportion of their budget on ISPs received worse ratings from NHS England than their counterparts.
Breaking Point, NHS info graphics
Do (ISPs) independent sector providers give good and good value care? NHS spending on (ISPs) independent sector providers keeps increasing.


Key data

The report contains in depth data analysis. Here are some of the key data tables.

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Department of health spend on non-NHS provision

All figures are 2015/16 prices 2013/14 2014/15 2015/16
Independent sector providers £6.6bn £8.1bn £8.7bn
Increase (13/14 - 15/16)     £2.1bn (33%)
Total non-NHS £9.6bn £10.4bn £12.2bn
Increase (13/14-15-16)     £2.6bn (27%)


DH spend on non-NHS provision as a proportion of their total budget

All figures are 2015/16 prices 2013/14 2014/15 2015/16
Proportion of RDEL spent on ISPs (%) 6.1 7.3 7.6
Proportion of RDEL spent on non-NHS providers (%) 8.9 9.4 10.7


Non-NHS spend by sector

Service sector Percentage
Community Health Services 44%
General and Acute 25%
Mental health and learning disability 11%
Other Contractual 8%
Social Care 8%
Primary Care 2%
A and E 1%
Maternity 0%


Contracts over £50,000 (from the 73 CCGs who responded to our FOI requests with this data)

Provider Contracts
  Largest Average size Number Total value
Arriva 3,603,182 1,270,135 9 11,431,216
BMI 8,796,508 1,478,861 52 76,900,797
BUPA 4,978,539 1,092,828 23 25,135,042
Cambian 3,102,397 585,465 24 14,051,148
Care UK 6,769,000 1,602,823 26 41,673,404
Circle 21,976,373 2,829,829 14 39,617,609
Cygnet Healthcare 1,491,000 328,440 13 4,269,721
Four Seasons 1,393,787 462,848 16 7,405,575
Nuffield Health 8,243,491 1,639,233 26 42,620,053
Ramsay 16,806,000 3,016,575 28 84,464,099
Spire 12,184,000 1,419,562 49 69,558,517
Virgin 18,534,115 5,711,336 7 39,979,351


ISPs spend vs CQC rating


ISP spend per registered patients

ISP spend as % of CCG allocation







Requires Improvement







Inadequate - Outstanding



Inadequate - Good





Download the full report