Introduction

This is the first 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. We intend to expand the range of data presented in future updates.

Overall Activity

Data from the Weekly Activity Returns show a steady increase in independent sector activity since publication of this dataset began in July 2021. Independent sector providers are on average delivering more than 102,000 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 January and February 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, not all diagnostic providers submit data to WAR, and so the dataset only partially captures IS diagnostic activity. Among those providers that do submit data, diagnostic activity has almost doubled in the first two months of 2024 compared with the start of data collection in 2021.

So far in 2024, the sector is delivering an average of almost 17,000 inpatient appointments and more than 71,000 outpatient appointments every week.

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

As a whole, the independent sector has continued to increase 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. Early data for 2024 shows that this upwards trend is likely to continue – with RTT activity this February some 38% above comparable activity in February 2019.

In terms of activity share, the independent sector delivered 9.63% of all NHS-funded elective care in 2023 – up from 7.81% in 2019. That share has now been over 10% for five of the past six months, with 10.6% of all NHS elective care delivered by independent sector providers in February 2024. 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 removed more than 1.67 million people from the NHS waiting list in 2023.

Specialty specific data

Trauma and orthopaedic surgery and ophthalmology services to be the most significant specialty areas for the independent sector. For the week ending 3^rd March 2024, trauma and orthopaedics made up 29.5% of all IS activity as recorded by WAR, with ophthalmology contributing another 23.8%.

Trauma and orthopaedics and ophthalmology are also the biggest contributors to the overall increase in independent sector activity since 2019. For February 2024, trauma and orthopaedics activity was up 19.9% compared with February 2019, while ophthalmology, driven by a significant increase in capacity for delivering cataract replacement procedures, was up 190% from that baseline (36,946 RTT episodes in February 2024, compared with 12,111 in February 2019). For February 2024, the independent sector delivered 25.7% of all NHS trauma and orthopaedics elective activity and 22.6% of all NHS ophthalmology activity.

Waiting Times

According to RTT data, there were 381,294 patients waiting for their NHS-funded treatment with an independent sector provider at the end of February 2024, compared with 7.16 million waiting with NHS providers. Among patients who completed their RTT pathway in February, patients seen in the IS had waited an average of 12 weeks – compared with an average of 19 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 72% of patients waiting to be treated at an independent sector provider have been waiting for less than 18 weeks, compared to 55% of NHS patients. Just 1.5% of independent sector patients have been waiting more than one year, compared with 4% 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.