Introduction

This is the fourth quarterly update on independent sector NHS elective activity. All the data is taken from datasets collected and published by NHS England. We have extracted the information that relates to independent sector providers including hospitals and clinics across England.

The data largely covers hospital activity, including both inpatient and outpatient care. This update does not currently include activity for community-based services. This is because activity data is not so easily accessible for these types of services.

Since the publication of our last quarterly data, the datasets published by NHS England covering independent sector activity have changed. The Weekly Activity Report (WAR) has been discontinued, and ‘live’ activity tracking is now based on Secondary Usage Statistics (SUS) data. While similar, SUS covers slightly less activity than WAR – notably only capturing limited sub-contracted activity. This means that, while broadly representative, the data below may not be directly comparable with previous editions of this update.

Overall Activity

Data from the SUS returns show a continued increase in independent sector activity post the Covid-19 pandemic, albeit with a reasonable amount of month-to-month variation. Independent sector providers delivered, on average, more than 460,000 care episodes a month in 2024 – an increase of more than 50% (160,000) as compared with 2021.

Overall, SUS data shows that the IS delivered more than 5.3 million total care episodes in the first 11 months of 2024.

Of this activity, some two-thirds of all activity captured by SUS is outpatient activity – with the remainder evenly split between inpatient treatment and diagnostics.

So far in 2024, the sector is delivering an average of more than 18,000 inpatient appointments and almost 105,000 outpatient appointments every week.

Independent sector activity has increased and so has the share of overall activity

Post-pandemic, the independent sector has significantly increased the amount of NHS activity it delivers. It surpassed its pre-pandemic total activity volume in 2022, and by the end of 2023 had increased NHS activity by more than 28% compared with a 2019 baseline. This trend has continued in 2024 – with RTT activity in November again more than 28% above comparable activity in November 2019.

In terms of activity share, the independent sector is now consistently delivering 10% of all NHS elective care – up from around 8% pre-pandemic. This proportion is higher still in the case of admitted elective activity, with the IS treating almost 1 in 5 admitted elective patients overall in the past 12 months.

In total, activity by IS providers has removed more than 1.5 million patients from the waiting list in the first 11 months of 2024.

Specialty specific data

Trauma and orthopaedic surgery and ophthalmology services to be the most significant specialty areas for the independent sector, between them accounting for about 50% of all independent sector activity.

Trauma and orthopaedics and ophthalmology also remain the biggest contributors to the overall increase in independent sector activity since 2019. For November 2024, trauma and orthopaedics activity was up 19.7% compared with November 2019, while ophthalmology, driven by a significant increase in capacity for delivering cataract replacement procedures, was up 143% from that baseline – though this represents a significant drop-off from a post-pandemic peak of 205% of pre-pandemic activity in January 2024 (though it should be noted that monthly actual volumes remain consistently between 36,000 and 40,000 episodes per month.

For November 2024, the independent sector delivered 22.1% of all NHS trauma and orthopaedics elective activity and 21.8% of all NHS ophthalmology activity.

Waiting Times

According to RTT data, there were 392272 patients waiting for their NHS-funded treatment with an independent sector provider at the end of November 2024, compared with 7.08 million waiting with NHS providers. Among patients who completed their RTT pathway in November, patients seen in the IS had waited an average of 11.5 weeks – this is compared with an average of 18 weeks for those seen by NHS providers.

The WLMDS dataset gives an indication of the distribution of waiting times among patients who are still waiting to be treated. Some 73% of patients waiting to be treated at an independent sector provider have been waiting for less than 18 weeks, compared to 56% of NHS patients. The number of very long waiters at independent sector providers continues to fall, with just 1.1% of these patients waiting more than one year, compared with 3% of NHS-provider patient waiting lists.

Datasets

Currently, NHS England activity data relating to the independent sector is published in three main reports.

The first, Consultant-led Referral to Treatment (RTT) waiting times data looks at patient pathways – the journey a patient takes from the point of referral to the point at which a treatment episode ‘stops the clock’ on their waiting time. There are four groups of patients covered by RTT data:

• Admitted patients – patients whose RTT pathway ends as the result of being admitted to a care setting for treatment during the period the dataset covers
• Non-Admitted patients – patients whose RTT pathways ends for reasons other than being admitted to a care setting for treatment
• Incomplete pathways – patients still waiting to start treatment at the end of the period the dataset covers
• New admissions – patients who have been newly referred and started an RTT pathway during the period the dataset covers.

The second is the monthly summary from the Secondary Usage Statistics (SUS) dataset. This data covers a broader range of activity than RTT data, and is published closer to the end of the reporting period – but has less opportunity for providers to update their reporting for greater accuracy.  SUS does not capture insourced activity (activity delivered by staff from an external organisation using an NHS Trust’s own facilities) or diagnostic activity, and only partially captures sub-contracted activity, but is currently the most complete measure for ‘total’ independent sector activity.

In April 2024, NHS England also began publication of RTT data from its Waiting List Minimum Data Set (WLMDS) data collection. This replicates some of the information gathered through the RTT dataset, but has a shorter lag time. The long term intention is to replace the RTT data publication with WLMDS.

Finally, NHS England also publishes a monthly diagnostic dataset, covering waiting times and activity and a community services waiting times dataset. These include some data for independent providers, but are not yet a comprehensive data source for IS activity.