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Sources · Private providers in public healthcare

This house believes private providers should play a bigger role in public healthcare.

Fact bank v1 · 12 cards

  1. PHC-01False

    “The NHS has already been privatised: most of its money now goes to private companies.”

    False. In 2024-25, NHS England spent £14.1 billion on private (independent sector) providers. That was 7% of the health department's day-to-day budget of £198.2 billion. Most NHS care is still bought from NHS hospitals and trusts.

    The private share has been 6% or 7% every year since 2019-20. If you also count councils, charities and other groups outside the NHS, the NHS bought £20.4 billion of care from outside, about 10% of the budget. Some people use a wider measure that also counts GPs, dentists, pharmacists and opticians, which are mostly private businesses. On that measure, around 22% of health spending in England went to groups that are not NHS trusts or other public bodies (Nuffield Trust, 2019). The private share grew a lot before 2019: Full Fact found it was 2.8% in 2006/07 and about 7.6% in 2015/16.

    “Most healthcare services are purchased from NHS providers (NHS trusts and foundation trusts)”
    Department of Health and Social Care·Department of Health and Social Care annual report and accounts 2024 to 2025 (Annex: purchase of healthcare from non-NHS providers, Table 65)Government / parliament · 16 Dec 2025 ↗

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  2. PHC-02True

    “The NHS has always used private businesses: GP surgeries are privately run.”

    Confirmed: almost all the GPs, dentists, pharmacists and opticians who treat NHS patients are private businesses, and have been since the NHS began in 1948.

    GPs are largely independent contractors. That means they run their own practices and hold contracts to treat NHS patients. Most people still see them as part of the NHS. Private hospitals treating NHS patients is newer. It grew after reforms in the 2000s let patients choose a private hospital, which then sends the bill to the NHS.

    “almost all the GPs, dentists, pharmacists and opticians who treat NHS patients are private businesses”
    Nuffield Trust·Privatisation in the English NHS: fact or fiction?Independent research institute · 15 Nov 2019 ↗

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  3. PHC-03True

    “Private hospitals already do around a third of NHS hip and knee replacements.”

    Confirmed: in England in 2021/22, private providers carried out 36% of NHS-funded hip and knee replacements and 41% of NHS-funded cataract operations.

    Across all planned hospital stays, the share is much smaller. NHS patients in private hospitals made up 6.2% of planned admissions in 2021/22 and 7.5% in 2022/23. Private hospitals mostly do routine, planned operations like these. Urgent care is almost all done by the NHS. The share has grown: private providers did very few NHS hip and knee replacements in 2003/04, but almost 19% by 2011/12. The government says they now do more than 100,000 NHS appointments and operations every week.

    “the proportion of NHS-funded procedures delivered by private providers was highest for hip and knee replacements (36%) and cataracts (41%)”
    Nuffield Trust·How much planned care in England is delivered and funded privately?Independent research institute · 23 Jun 2023 ↗

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  4. PHC-04Mostly true

    “Letting private hospitals treat NHS patients means more patients get treated, not just the same patients moved out of NHS hospitals.”

    Mostly true for planned operations. A study of hip replacements in England found that when private hospitals opened to NHS patients, the number of NHS-funded hip replacements rose by 12%, and NHS hospitals did not do fewer.

    The extra patients tended to be milder cases who got treated sooner. The study found no sign that the competition made NHS hospitals better. It looked only at hip replacements after reforms in the 2000s, so other treatments may differ. Across England, NHS-funded hip and knee replacements rose by half from 2003/04 to 2011/12, but the total barely changed, as fewer people paid for their own. The government says private providers took over 1.6 million cases ('patient pathways') off the NHS waiting list in 2024-25.

    “We find private hospital entry increased the number of publicly funded hip replacements by 12% but did not reduce volumes at incumbent public hospitals”
    Journal of Health Economics (abstract via PubMed, US National Library of Medicine)·The impacts of private hospital entry on the public market for elective care in England (Kelly and Stoye, Journal of Health Economics, 2020)Government / parliament · 9 Jul 2020 ↗

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  5. PHC-05Mixed

    “NHS patients get better results when they are operated on in private hospitals.”

    Mixed. A study of 18 common operations in England found NHS patients treated in private hospitals went home sooner and less often had to come back into hospital as an emergency. Death rates were no different. But the authors say they cannot rule out that private hospitals simply got patients who were easier to treat.

    The study covered NHS-funded operations from 2006 to 2019. An earlier study of hip, knee, hernia and varicose vein operations found patients at private treatment centres were slightly healthier, had milder symptoms before surgery and were better off. Some of their results were better, but the differences were small. Private hospitals mostly do routine, planned operations, which makes fair comparisons hard.

    “Elective surgery in an ISHP is associated with shorter lengths of stay and lower readmission rates than treatment in NHS hospitals across 18 operation types.”
    BMJ Quality & Safety (abstract via PubMed, US National Library of Medicine)·Outcomes for surgical procedures funded by the English health service but carried out in public versus independent hospitals: a database study (BMJ Quality & Safety, 2021)Government / parliament · 7 Sept 2021 ↗

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  6. PHC-06Mostly true

    “Private providers cherry-pick the easiest patients and leave the complicated ones to the NHS.”

    Mostly true. Studies in England found NHS hospitals treat patients with more health problems, who need more procedures and more often come from poorer areas, than private treatment centres do. In some studies the differences were small.

    One study looked at the 30 kinds of planned treatment that made up most of the private centres' work in 2007-08. NHS patients had more other illnesses, had more procedures, and were more likely to live in poorer areas. Both kinds of hospital were paid a fixed price for each treatment. The authors said that if sicker patients cost more to treat, a fair system would pay NHS hospitals more. A 2011 study found similar but small differences. These studies show who ends up where. They do not prove that firms pick easy patients on purpose.

    “In general, the NHS is treating more complex patients than private providers.”
    Journal of the Royal Society of Medicine (abstract via PubMed, US National Library of Medicine)·Private sector treatment centres are treating less complex patients than the NHS (Journal of the Royal Society of Medicine, 2010)Government / parliament · 7 Jul 2010 ↗

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  7. PHC-07Mixed

    “Outsourcing NHS services to private companies has caused hundreds of extra deaths.”

    Mixed. A 2022 Oxford study linked more NHS spending on for-profit firms to more deaths from treatable causes a year later: about 557 extra deaths from 2014 to 2019. But the authors say this does not prove that outsourcing caused the deaths.

    'Treatable' deaths are deaths from causes that medical care should be able to treat. The study tracked spending in 173 local NHS areas in England from 2013 to 2020. When an area's share of spending on for-profit firms went up by 1 point (say from 5% to 6%), treatable deaths there rose by 0.38% the next year. The 557 figure is uncertain: the likely range was 153 to 961. Areas that outsourced more may have differed in ways the study could not measure. A separate study of NHS-funded operations found no difference in death rates between private and NHS hospitals.

    “our findings should not be interpreted as necessarily showing a causal relationship between outsourcing and mortality rates”
    The Lancet Public Health (full text via PubMed Central, US National Library of Medicine)·Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013-20: an observational study of NHS privatisation (The Lancet Public Health, 2022)Government / parliament · 1 Jul 2022 ↗

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  8. PHC-08Mixed

    “Research shows for-profit hospitals have higher death rates.”

    Mixed. Studies from the US found for-profit hospitals had slightly higher death rates than non-profit hospitals. But a review of reviews found no clear difference between for-profit and public (government-run) hospitals.

    Non-profit hospitals are private but do not pay profits to owners. A 2002 review of 15 US studies, covering more than 26,000 hospitals and 38 million patients from 1982 to 1995, found patients at for-profit hospitals had about a 2% higher risk of death than at non-profit ones. Very few studies compare for-profit and public hospitals directly.

    “When comparing PNFP and public providers, as well as for PFP and public providers, no clear differences were found.”
    PLOS ONE·Does ownership matter? An overview of systematic reviews of the performance of private for-profit, private not-for-profit and public healthcare providers (Herrera et al., PLOS ONE, 2014)Peer-reviewed research · 1 Dec 2014 ↗

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  9. PHC-09Mostly false

    “Private hospitals are more efficient than public hospitals.”

    Mostly false. A review of research from eight EU countries, including the UK, found that most evidence suggests public hospitals are at least as efficient as private ones, and sometimes more.

    'Efficient' means getting more care out of the same money and staff. A few studies, from Austria, Germany and Portugal, did find private hospitals more efficient. In Germany, hospitals that switched to for-profit owners also became more efficient. A wider review of reviews found no clear answer on efficiency either way. In England, private hospitals do send NHS patients home sooner, but they also tend to treat simpler cases.

    “Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals.”
    International Journal of Health Planning and Management (abstract via PubMed, US National Library of Medicine)·Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review (Kruse et al., 2018)Government / parliament · 2 Mar 2018 ↗

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  10. PHC-10Mostly true

    “Bringing private providers into the NHS helps richer patients more than poorer ones.”

    Mostly true. A study of England's reforms in the 2000s found that new for-profit surgical centres improved access to care twice as much for the richest patients as for the poorest, and six times as much for white patients as for ethnic minority patients.

    The study used a computer model to estimate how much each group gained, mainly from shorter waits. About half of the gaps came from where people live and how healthy they are. A different study found the extra NHS hip operations that came with private hospitals did not differ between richer and poorer areas. Even so, NHS-funded private care is less common in the least wealthy parts of England.

    “entry of for-profit providers benefitted the richest patients twice as much as the poorest, and white patients six times as much as ethnic minority patients”
    Health Economics (abstract via PubMed, US National Library of Medicine)·Divided by choice? For-profit providers, patient choice and mechanisms of patient sorting in the English National Health Service (Health Economics, 2021)Government / parliament · 5 Feb 2021 ↗

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  11. PHC-11Mostly true

    “When something goes wrong, private hospitals have to send patients to NHS hospitals because they lack intensive care.”

    Mostly true, but it is rare. Many private hospitals lack intensive care. In a study of NHS-funded operations, 0.09% of operations in private hospitals were followed by an emergency transfer to another hospital, against 0.07% in NHS hospitals.

    That is fewer than 1 in 1,000 operations in either kind of hospital. Emergency transfers were more common after private operations for 7 of the 18 types studied, and never less common. The authors say this does not by itself mean private care is less safe. A patient who has an emergency in an NHS hospital is usually already in a place that can treat them.

    “Many ISHPs lack the full range of services, including intensive care, required for management of an emergency case.”
    BMJ Quality & Safety (full text via PubMed Central, US National Library of Medicine)·Outcomes for surgical procedures funded by the English health service but carried out in public versus independent hospitals: a database study (BMJ Quality & Safety, 2021)Government / parliament · 7 Sept 2021 ↗

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  12. PHC-12Mostly false

    “Patients have a better experience in private hospitals than in NHS hospitals.”

    Mostly false. A study of NHS-funded patients in England found that, for the average patient, whether the hospital was private or public made no difference to their overall experience.

    Each kind of hospital did better in some types of care or for some groups of patients. Gaps in average scores came from the kinds of patients each hospital treated and from differences between individual hospitals, not from who owned them. This is one study from 2013. It used patient surveys and did not measure medical results.

    “hospital ownership in and of itself does not affect the level of quality of the average patient's reported experience”
    Journal of Health Economics (abstract via PubMed, US National Library of Medicine)·Does hospital ownership affect patient experience? An investigation into public-private sector differences in England (Journal of Health Economics, 2013)Government / parliament · 16 Mar 2013 ↗

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