The range of clinical care that has been put out to tender since the competition rules went live in 2013 now covers most of what the NHS provides to patients. The rules greatly widened the scope of NHS contracts being advertised. Despite this the NHS still provides most care to its patients, but in services like diagnostics, mental health and elective surgery the NHS is reliant on private provision.
Outsourcing of NHS services to firms and charities is not new as successive governments have shown a willingness to experiment with private sector involvement.
Who wins the contract race? Our research over several years shows that the private sector wins 65% of the value of all contracts advertised and 51% of the number of contracts put up for tender.
From 2018/19 discussions around a policy change led to a reduction in larger contracts being advertised, but in the previous year private firms won 13 out 20 of the most lucrative contracts. The new framework for the procurement of health services – the Provider Selection Regime (PSR) – launched in January 2024 should consign to history the large-scale competitive tendering regime. BUT lack of capacity in the NHS and the large-scale infiltration of the NHS by the private sector for over a decade means that private companies will still win contracts and carry out work.
NHS England plans to switch funding from hospitals into community based healthcare as part of its 10 year plan for the NHS published in 2019.
Outside of hospital, NHS organisations provide just over a half of community services, therefore to implement the new vision either there will be a greater use of non-NHS organisations or a big expansion of the NHS workforce working in the community.
In most areas private provision is increasing, but the NHS is still the main provider. However the private sector have moved into areas where they can generate a reliable return, such as:
- Elective surgery, such as hip operations where private firms now perform a third of these procedures in certain areas, and ophthalmology, in particular cataract operations where by April 2021 46% of operations were conducted in the private sector
- Inpatient mental health, where it supplies over 30% of child and adolescent care
- Community services, where the NHS is now heavily reliant on non-NHS providers to deliver services.
And this raises the question - where is the tipping point, when, like in dentistry or long term care, non-NHS organisations become dominant?
nationally 6% of NHS by the private sector, this includes a third of all hip operations
LONG TERM CARE
"the vast majority of both home care and residential care in England is now provided by private companies." Around 72% of the adult social care workforce are now employed by the private or voluntary sectors with only 14% still employed by local authorities.
A Health Foundation study found that NHS providers hold over half (53%) of the total annual value of contracts
awarded for community services. This gives the remainder of the contracts (47%) to non-NHS organisations including
private companies, general practices, local authorities, charities and not-for-profit companies. In their sample, private providers held 5% of the total
annual value, but 39% of the total number of contracts issued.
Nationally, just under three fifths (58%) of all respondents stated they had visited an NHS dentist in the last two years. Of the remaining, 10% didn’t try to see an NHS dentist because they stated they “didn’t need to go” or “don’t like going” and 8% didn’t try because they prefer private dentistry.