When working for a health charity recently, we were made aware of a new type of company offering private ‘triage’ services to the NHS. These companies are intermediary providers offering services such as blood tests and health assessments. However, if a patient needs hospital care, then they generally join the NHS queue, where the same tests are often repeated. What we were told by a few concerned doctors approaching the organisation was that some of these companies end up offering little additional value when it comes to actually treating patients – potentially diverting staff and money away from the NHS for little tangible return.
Another instance of private providers soaking up scarce NHS funding, includes the private companies offering cataract surgery. Recent reports in the media reveal that these companies are making a very handsome profit – at the same time as hollowing out in-house NHS ophthalmology services. Recent research by the Centre for Health and the Public Interest (CHPI) think tank, for example, found that the five key companies providing cataract removals and other eye treatments to the NHS in England made around £170m in profit in 2023-24 alone. There can also be conflicts of interest: there are over 100 NHS ophthalmic consultants who own shares or equipment in the private clinics which provide NHS-funded cataract care.
We see the same scenario in the acute mental health sector where private companies providing services to the NHS have become central to service provision. In 2023, the NHS spent more than £2bn on the treatment of patients in private psychiatric units (compared to £3.5bn spent on in-house NHS beds). This follows years of cuts to NHS bed numbers and represents over a 10% increase in private acute mental healthcare spending in one year alone. The two biggest private providers, Priory Group and Cygnet Health Care, made £509m and £560m revenue in that year (if not profit).
In October 2024, the LowDown NHS reported on how private equity in the UK is heavily involved with the care home sector, education and children’s social care, making huge profits – sometimes at the expense of care standards. It concluded, “According to a March 2022 report by the Competition and Markets Authority (CMA), the UK has “sleepwalked” into a dysfunctional market for children’s social care with local authorities forced to pay excessive fees for privately run services that often fail to meet the needs of vulnerable children.” The Labour Government said in October 2024 that they were committed to tackling excessive profiteering by private companies in the youth social care sector, so that is very welcome, but their feet need to held to the fire on this.
In August this year the Health Service Journal reported that two private providers offering ADHD and autism assessments to the NHS, had seen a huge increase in their income, while at the macro level, in a letter to the Guardian on 30 September, Margaret Greenwood, former Labour MP for Wirral West, warned that the reforms envisaged in Labour’s new 10 Year Health Plan for England (2025) “could lead to the NHS going the way of social care, where the state is longer able, or willing, to deliver”. If this turns out to be the case, the private health care sector will already be rubbing their hands in glee!
Whilst the de facto privatisation of some health services started under the Conservatives, it doesn’t appear that the Labour Party is planning to reverse this trend any time soon – if anything they appear to be embracing this approach. Is the increase in funding for the NHS announced under Labour actually being frittered away on more privately provided care? If so, what is the Lib Dems’ response going to be?
* Judy Abel is a Lib Dem member who has worked in health policy for several major health charities. (She is still working)
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15 Comments
I share these concerns. There is also a patient safety issue.
A member of my extended family was recently approached on the street by someone offering free eye tests. She took the test, and was told she needed a cataract operation, performed free in a private clinic “under the NHS umbrella.” It was botched, and had to be sorted out by an NHS hospital.
It is quite possible that her cataract was not bad enough to need an operation, and I have doubts about the competence of the person who carried it out.
When money is the main motive in medical treatment, one should worry.
@Mohammed – goodness that is shocking. Yes when money is the main motive in providing healthcare we always need to be vigilant.
The Conservstives have only one interest and they served that by keeping Council tax and income tax low forcing the closure of locally run services and the explosion in private care. They benefitted from the illusion of paying less whilst the services available crumpled.
Thank you for an important article.
Might the attached article be of interest/relevance?
https://www.taxresearch.org.uk/Blog/2025/10/02/economic-questions-the-j-k-galbraith-question/
@David – Agreed and what is often lost in all this is the overriding aspiration and priority to deliver the highest quality, humane, care for vulnerable people.
@Steve – thank you for sharing that article. Will read today over a coffee!
This is an interesting question, to which the answer is ‘maybe’. There is a need for a private sector, because there are people in the country whose entitlement to the NHS is limited and there are employers who need to limit of sickness absence of key employees. And it’s clearly sensible when the NHS lacks resources, especially temporarily, to employ the private sector to fill these gaps. This came to a head in Covid, when NHS investigations and treatment were carried at lots of small private facilities most of which I’d never heard of. This because traditional NHS treatment involves having, say, 20 people in a waiting area, which became taboo. The country has a complex clinical, personnel and financial relationship between public and private healthcare. Inside the NHS, GPs and patients put effort into choosing which NHS facility is best suited for particular patients and their ailments.
A few weeks ago, my local health centre invited me to an annual asthma review. This one, it was explained, would be provided to them, free of charge, by a representative of Astra Zenica. I went along with all my current medication and personal information as is usual for these annual events, none of which was even mentioned by the AZ rep, let alone examined. In a brief chat, admittedly asking some of the expected questions, she quickly moved on to AZ’s latest wonder inhaler that combines preventer with reliever drugs, and is much smaller. I felt pressured to agree to give it a trial, upon which she promptly changed my prescription, and removed from my regular list all the current items I had been using.
I got this the next day, and found it much more awkward to use. After two weeks, my average peak flow had dropped by 10%, along with my confidence, and I asked the health centre to reverse the change … with which, I’m grateful to say, they immediately complied, and I’m slowly getting back to my previous condition.
Efficiency or not?!
@ Steve,
You seem to be fond of linking to articles by Richard Murphy. Some of what the says is OK but much of it is not. He’s very much of a maverick even by the standards of most modern economists. Nearly everyone else can find someone who they basically agree with.
Not our friend Richard though. He’s claimed at various times to be in the MMT camp. At other times it’s the RMMT camp: this being Richard Murphy Monetary Theory IMO! He’s the only one in it!
His ideas about government debt are an odd hybrid of the mainstream and MMT. Both groups would say, for different reasons, that he doesn’t have it right.
@Ian I think the difference now is that, while there have always been those who opted for private health insurance and care, the provision of NHS care by the private sector appears to be becoming more mainstream; the NHS is likely to become yet more reliant on the private sector as time goes by, especially given the Government’s quest to bring down waiting lists. As we have seen with the water companies, however, controlling the way private companies behave isn’t always that easy and the lines of accountability are less clear. Also, as I discuss in the article, private companies seem to be making significant profits out of delivering their services, which presumably the NHS can ill afford.
@Brian – goodness me that is an outright example of private pharma getting involved in NHS prescribing. You did well to extricate yourself from that situation! Glad to hear things are returning to normal now.
@Judy Abel I agree. As someone who has seen a lot of health professionals in the last few years, on my own and with my wife, I think the system is very complex and hard to understand. I am receptive to the idea that some providers, but not all, are taking advantage of it. But there is the feeling that nobody understands it enough and this may be to the detriment of some patients.
@Ian I think this topic certainly warrants further evaluation and investigation – I have only just scratched the surface! But it’s important as we see the NHS evolving further under Labour.
It would be so impactful if you would list all the companies performing NHS medical services. People should know who are profiting from NHS spending.
It’ll never end! What on earth is britain coming to! Something really needs to be done to get things back to NORMAL. What’s needed is for someone to take RESPONSIBILITY. Not big pharma throwing AI at the NHS doing a privatisation via the back door. Where is the COMMUNITY?