My Medical Gateway Blog

The UK’s NHS faces an unprecedented elective care crisis, with waiting lists reaching 7.5 million patients in early 2025. To address this, the Labour government has expanded by 20% the role of private hospitals through a £2.5 billion annual funding increase, aiming to deliver one million additional appointments, scans, and operations yearly. But does the small UK private sector have the size, resources and capability to meaningfully reduce NHS waiting times for ordinary patients, and is it worth waiting in line at the NHS in the hope that you might be allocated treatment at a private hospital?

The 2025 so-called “Partnership Agreement” between NHS England and private healthcare providers decided that private hospitals would henceforth be a “permanent component” of England’s healthcare landscape. The agreement targets specialty-specific backlogs, particularly in gynaecology (260,000 women waiting >18 weeks) and orthopaedics (>40% waiting >18 weeks) and expanding choice in deprived areas where NHS provision is limited.

Despite its small size compared to European countries, in 2024 the UK’s private hospitals made a useful contribution to reducing waiting times, removing 1.5 million people from NHS waiting lists, delivering 460,000 monthly NHS episodes – over 50% higher than four years ago. While this is an excellent result, it is still only 10% of all NHS elective activity, is expensive and reduces the resources available to the NHS. Can the private sector ever make a significant dent in the structural challenges that are facing the NHS?

Capability and Resource Advantages

Private hospitals are more efficient than the NHS, which means that they are effective at reducing backlogs for treatment: they specialise in high-volume, low-complexity procedures that enables assembly-line efficiency. Also, the long-term contracts under the new agreement incentivise private capital expenditure, so providers like Spire Healthcare (£341m NHS revenue in 2023) and Circle Health Group (£1.1bn revenue) have grown slightly.

But the private sector’s small size and constraints make it doubtful that they can make a real, long-term difference to NHS waiting lists. Here are the reasons why:

1. The private sector shares the same clinician pool as the NHS. Private hospitals rely on NHS-trained surgeons (most work part-time in both sectors). Expanding private activity without expanding the overall workforce risks worsening NHS staffing shortages.
2. Outsourcing routine procedures to the private sector reduces surgical training opportunities in the NHS, thus reducing the pool of trainee surgeons. There have been more than 3 million lost surgical training opportunities since 2020. Surgical trainees at the NHS report inadequate theatre access (61%) and insufficient training time (52%). So the very act of farming out treatments to the private sector causes harm to the longterm prospects of the NHS.  
3. At £12.3–£12.4 billion annually pre-expansion, NHS spending on private providers was already a significant sum. The 20% expansion risks becoming too expensive.  Indeed, the government has already moved to cap the price that it is prepared to pay the private sector for routine elective surgeries, reducing their incentive to make an impact on the waiting list.

Only A Partial Solution

The UK private hospital sector has immediate, tactical ability to reduce specific waiting lists – particularly for routine orthopaedic, ophthalmic, and gynaecological procedures. Its streamlined operations and targeted investment can deliver short-term gains, as shown by the 1.5 million patients removed from waiting lists in 2024. 

However, its modest size (approximately 10% of elective activity), dependence on the NHS workforce, and selective case acceptance limit its ability to fundamentally resolve the backlog crisis. Mr. Tim Mitchell, President of the Royal College of Surgeons of England, has questioned the ability of the UK private medical sector to compensate for NHS shortfalls, stating: 

“The expansion of independent sector provision must not come at the cost of our future (NHS) workforce and patient care.”

Mitchell’s critique underscores that private sector involvement, while useful for short-term backlog reduction, cannot address systemic NHS weaknesses in training, infrastructure, or workforce sustainability. 

What does this mean for ordinary patients on the NHS waiting list? In short, if you are fortunate enough to be part of that 10% that may be able to access a private surgical treatment more quickly than those limited to treatment by the NHS, you are in luck. But the government’s latest initiative in partnership with the UK private sector is unlikely to make a significant difference to the structural challenges facing the NHS – which is the remaining 90% of the country. 

You should not, therefore, imagine that private treatment will come automatically or easily. In the meantime, the Government’s initiative is welcome in the short-term but likely to store up even bigger problems down the line that will only worsen the NHS healthcare crisis.