What health policy still doesn't understand about the independent sector

A patient and technician in a CT scanner. 6.15 million appointments, tests and operations were delivered by independent providers for NHS patients.

It was great to attend NHS ConfedExpo in Manchester last week. But something important was missing from the agenda.

The conference was full of positive conversations about innovation, partnership and the future of healthcare - and there was a clear sense of ambition to improve patient outcomes and tackle growing demand.

Of course, the NHS cannot meet that challenge alone, and it was encouraging to see so many examples of collaboration driving progress. We heard excellent presentations showcasing how new health technologies and partnerships between NHS organisations and pharmaceutical companies are delivering results.

Yet one important partner was largely absent from the conversation - the independent sector.

The NHS rightly highlights partnerships with tech and pharma, but we hear far less about the contribution independent providers make to patient care every day - even though this is explicitly recognised in both the 10 Year Health Plan and NHS Confed's own frameworks as essential to managing rising demand.

This feels like a significant missed opportunity. And the timing couldn't be more pointed.

It’s well document that the overall NHS waiting list stands at 7.11 million, with the NHS making recent progress to bring this down to the lowest in over three years. But what has been less well known is that there is a record 1.92 million patients in England currently waiting for diagnostic tests - including CT, MRI and ultrasound scans - with more than 400,000 waiting beyond the NHS's six-week maximum. This diagnostic waiting list has grown by 500,000 since 2022 and is now 83% higher than pre-pandemic levels. At the same time cancer waiting times are being missed against three key measures - faster diagnostic standard, 62-day RTT standard and 31-day to decision to treat.

Against that backdrop, the independent sector is already stepping up - in two distinct ways. The first is direct: independent providers working alongside the NHS to take on NHS-funded activity, easing the backlog whether that is diagnostic, elective or in the case of mental health acute care. This is the NHS partnership model the 10 Year Health Plan envisaged, and it is happening – quietly and at scale. In 2025, by October, a total of 6.15 million appointments, tests and operations were delivered by independent providers for NHS patients. 

The second is indirect, but no less important: independent providers absorbing self-pay and private medical insurance (PMI) funded demand that would otherwise add further pressure to an already strained system. And here, the Overton window has shifted decisively. Self-pay and PMI-funded care are no longer niche or uncomfortable choices. For a growing number of people, they are simply how healthcare works - a pragmatic response to waiting times and a genuine desire for choice and control.

Our recent work with Harley Street Health District on its first Impact Report - built on brand new analysis of PHIN data, the government-mandated body that independently certifies private healthcare information - reveals the scale of what the independent sector is quietly delivering through that second route.

In the last year alone, there were approximately 17,865 chemotherapy treatments in the District - a 25% increase year on year. Cancer treatment now accounts for 28% of all activity in the District, more than double the national private healthcare average of 12.3%. And strikingly, one in four private chemotherapy treatments in the entire UK is delivered in one square mile of central London. Nationally, 95% of private chemotherapy is funded through PMI - a reminder that this is not a story about wealthy self-payers. It is a story about a mixed economy of care that is already deeply embedded in how cancer treatment is delivered in this country.

You can read more in this article we placed in The Times(£) exploring the evolving role of Harley Street heath District.

Both models matter. Both deserve recognition. And both are largely invisible in the conversations that shape NHS policy and public discourse.

At ZPB, we believe the independent sector deserves a seat at the table - not as a political statement, but as a practical necessity. The demand is there. The public comfort is there. The policy framework is there.

It's time the conversation caught up.