The company 18 Week Support specialising in insourcing in the NHS. Under contract with a hospital trust, 18 Week Support carries out elective surgery within NHS premises and using NHS infrastructure during what is normally theatre downtime, such as weekends and bank holidays. The company employs NHS staff working on their days off. The company reports that it has relationships with over 80 NHS hospital trusts.
Last updated: June 2026
Strategy
18 Week Support is one of the UK's leading provider of managed insourcing clinical services. It was founded in 2014 by Alexander Chilvers, but he resigned in September 2022, and Dr Conal Perrett. The company now has four officers, 3 directors, including Dr Conal Perrett, and company secretary. 18 Week Support conducts elective surgery for the NHS within NHS premises during times when theatres are not being used by the NHS, such as at weekends.
For details of how insourcing works see Insourcing – how private companies work inside NHS hospitals
One of the company's core services is endoscopy, but it is also involved in general surgery, ophthalmology and gynaecology procedures.
In 2025, 18 Week Support, backed by its private equity owners Summit Partners, acquired dermatology specialist Medical Clinics to diversify away from core clinical insourcing services.
In the company's annual accounts to March 2024, it highlights the growing NHS waiting list, which means demand for its services will continue to grow.
Financials
The company's most recent accounts for the year to end March 2025 show revenue of £45 million, down from £64.15 million in the year to March 2024, leading to a post-tax profit of £4.6 million, down from £8.53 million in the previous financial year.
All the company's turnover is generated from the NHS.
18 Week Support Ltd and Medical Clinics Ltd (acquired in February 2025) are owned by Tower 18 Topco Ltd (company no: 13904422). Tower 18 Topco Ltd reported revenue of £48.9 million for the year to March 2025. Loss for the financial year was £19.7 million, up from £15.2 million in the previous year.
Contracts
18 Week Support is on a number of framework contracts. Companies listed on these have already gone through a competitive tendering procedure and can be used by trusts without additional contract tendering. Contracts awarded from this framework are called call-off contracts.
18 Week Support is on the national framework agreement in place, Insourcing of Clinical Services, with NHS Shared Business Services listing 40 companies. The framework began back in 2018 and runs until July 2027.
In December 2025, 18 Week Support was listed on the framework contract Clinical Diagnosis and Treatment set up by the East of England NHS collaborative Procurement Hub. The three year framework worth a total of £18 million covers nine specialities: Dermatology; Oral and Maxillofacial surgery; Audiology; Ophthalmology; ENT (Ear, Nose & Throat); Gastroenterology; Urology; Endoscopy; and Managed Services.
In June 2025, 18 Week Support was one of many companies listed on the framework Total Workforce Solutions III: Clinical Insourcing Solutions set up by HealthTrust Europe LLP (HTE) acting on behalf of Mid and South Essex NHS Foundation Trust (MSE). The framework covers the insourcing of the full range of elective surgical and medical specialties.
18 Week Support reports that it works with over 90 NHS organisations, with its customer base expanding continually. In an article in HSJ in September 2025, the company reported it treated 339,957 patients in 2024/25.
Recent contract awards include:
In June 2026, a call-off from a framework agreement for an insourcing contract with University Hospital Southampton NHS FT for an initial contract period of 12 weeks with a value of £237,072 beginning May 2026 with one or more optional extensions to May 2028. The lifetime value of the contract is £2,054,624.
Over 2025,18 Week Support was awarded contracts (many which were call-off contracts) for a variety of specialities, including gastroenterology at Blackpool Teaching Hospitals, gynaecology at Liverpool Women's NHS Foundation Trust and the Royal Wolverhampton NHS trust, ENT at Somerset NHS FT, orthopaedic services at Somerset NHS FT, insourcing services at University Hospitals of Leicester NHS Trust, and dermatology at Sheffield Teaching Hospitals NHS Foundation Trust.
In November 2025, 18 Week Support was awarded a 12 month contract for insourced ENT services at Musgrove Hospital, Taunton, worth £500,000 and in September 2025 the company was awarded a contract for Insourced Services Managed Services Solution on behalf of University Hospitals Leicester, worth £16 million.
In November 2024, 18 Week Support was awarded a 12 month contract for the Supply of Echocardiography Insourcing service at Scarborough Hospital to reduce the current Patient back-log. This is a call-off contract from a Framework contract and worth £100,000 to £195,000.
In October 2024, 18 Week Support was awarded a place on the framework "National Flexible Framework for the provision of On-Site Surgical and Medical Capacity Solutions", along with Health Now Ltd and National Clinical Insourcing Ltd.
In May 2024, a call-off contract was awarded to 18 Week Support for "Insourced Bowel Screening Capacity" work at Leeds Teaching Hospitals NHS Trust. This was a 12 month contract worth £150,000.
In January 2024, Salisbury NHS Foundation Trust awarded a call-off contract to 18 Week Support for "Dermatology Insourcing" worth £375,000 over 12 months.
Concerns
There are concerns over the process of insourcing, rather than individual companies.
Workforce availability affected
There are already signs that private companies are trying to fudge the system leading to issues with workforce availability. In January 2022, NHS England and NHS Improvement had to send out guidance after it became aware that several staffing agencies were approaching NHS trusts offering insourcing solutions that were just providing staff at an escalated rate of pay.
These insourcing solutions have included “the provision of individuals or teams of clinical and medical staff who are paid at an escalated rate above the NHS England and NHS Improvement price caps” and who are engaged through a staffing agency not on the insourcing framework.
The use of escalated pay rates attracts workers from elsewhere in the NHS, which in turn reduces the supply of agency workers available to fill shifts in the trust and wider health system. It also has “a ripple effect on general agency rates, as it raises the pay expectations of agency workers, and forces other departments and trusts to increase their rates to attract their workers back.”
Conflict of interest issues
The Centre for Health and the Public Interest (CHPI), an independent thinktank, has called for a ban on such arrangements between insourcing companies led by consultants and the trust they are employed by. The General Medical Council said current conflict of interest policies did not always deliver “the transparency and assurance that patients rightly expect”.
The trusts say all rules were followed and interests were publicly disclosed and managed appropriately.
Alan Clamp, chief executive of the Professional Standards Authority, which oversees regulation of health professionals in the UK, called for a cross-sector review of managing conflicts in healthcare and urged regulators and employers to “tackle business practices” that “risk undermining public confidence”.
David Rowland, director of the CHPI, said the current rules were “woefully weak” and called for a ban on arrangements of the sort identified by the Observer.
