Introduction

This is the sixth 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. For the first time, we have included indicative numbers for activity delivered by independent sector insourcing providers, based on information supplied to us by IHPN members.

Overall activity

Data from the SUS returns show a continued steady increase in independent sector activity post the Covid-19 pandemic, albeit with a reasonable amount of month-to-month variation. Independent sector providers again delivered more than 500,000 NHS appointments in July, and have now surpassed the half-million mark in 9 of the past 12 months.

Overall, SUS data shows that the IS delivered more than 6.15 million total care episodes across the 12 months to July 2025, and is on track to deliver a record 6.2 million care episodes in 2025 – doubling the amount of pre-pandemic activity delivered by independent sector providers.

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 2025, the sector is delivering an average of more than 19,000 inpatient appointments and over 100,000 outpatient appointments every week.

Post-pandemic, the independent sector has significantly increased the amount of NHS activity it delivers. In March, the IS delivered more than 30% additional activity compared with the pre-pandemic baseline.

In terms of activity share, the independent sector is now consistently delivering between 9 and 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 the first seven months of 2025, activity by IS providers has already removed more than 970,000 people from NHS waiting lists.

In addition, IHPN’s analysis of member data has shown that more than 750,000 additional patient care episodes were delivered as insourced activity within NHS Trusts by independent sector providers in 2024/25 – and early data for 25/26 indicates a similar volume contributing to NHS activity levels this year.

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.

Waiting times

According to RTT data, there were 416,000 patients waiting for their NHS-funded treatment with an independent sector provider at the end of July 2025, compared with 6.99 million waiting with NHS providers. Among patients who completed their RTT pathway in March, patients seen in the IS had waited an average of 10 weeks – this is compared with an average of 16.9 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 76% 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. The number of very long waiters at independent sector providers continues to fall, with just 0.8% of these patients waiting more than one year, compared with 2.8% 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 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.