Introduction

This is the third 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, with a limited overview of diagnostic activity. This update does not yet include activity for community-based services. This is because activity data is not so easily accessible for these types of services.

Overall Activity

Data from the Weekly Activity Returns show a continued increase in independent sector activity since publication of this dataset began in July 2021, albeit with a reasonable amount of month-to-month variation. Independent sector providers are on average delivering more than 101,000 patient care episodes per week so far in 2024 (an increase of, on average, more than 30,000 patients per week since the dataset began publication in 2021).

Overall, WAR data shows that the IS delivered more than 5 million total care episodes in 2023, with data from the first five months of 2024 indicating that this record figure is likely to be surpassed again this year.

Of this activity, some two-thirds of all activity is outpatient activity – with the remainder evenly split between inpatient treatment and diagnostics. At the present time, only a very limited set of diagnostic providers submit data to WAR, and so the dataset represents only a small portion of total IS diagnostic activity. Among those providers that do submit data, diagnostic activity has almost doubled in 2024, compared with the start of data collection in 2021.

So far in 2024, the sector is delivering an average of more than 15,000 inpatient appointments and almost 72,000 outpatient appointments every week. Across the first eight months of 2024, the independent sector has already delivered more than 3.5 million appointments for NHS patients.

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 over the first half of 2024 – with RTT activity in August more than 32% above comparable activity in August 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 million patients from the waiting list so far in 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 more than 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 August 2024, trauma and orthopaedics activity was up 19.1% compared with August 2019, while ophthalmology, driven by a significant increase in capacity for delivering cataract replacement procedures, was up 168% from that baseline (37,478 RTT episodes in August 2024, compared with 14,008 in August 2019). For August 2024, the independent sector delivered 26.3% of all NHS trauma and orthopaedics elective activity and 24.4% of all NHS ophthalmology activity.

Waiting Times

According to RTT data, there were 380,808 patients waiting for their NHS-funded treatment with an independent sector provider at the end of August 2024, compared with 7.25 million waiting with NHS providers. Among patients who completed their RTT pathway in August, patients seen in the IS had waited an average of just over 11 weeks – the shortest average wait recorded since the pandemic. This is compared with an average of 18 weeks for those seen by NHS providers.

The newly-published 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 57% of NHS patients. Just 1.8% of independent sector patients have been waiting more than one year, compared with 4.2% of NHS-provider patient waiting lists.

Datasets

Currently, NHS England activity data relating to the 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 Independent Sector Weekly Activity Return (WAR) 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. While RTT data only covers elective activity commissioned by an ICB, WAR also covers diagnostic activity, and, importantly, activity directly commissioned (sub-contracted) by another provider – usually an NHS Trust. It does not capture insourced activity (activity delivered by staff from an external organisation using an NHS Trust’s own facilities), 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.