Introduction

This is the fifth 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.

May’s NHS data publication also allows us to review activity for the full accounting year 2024/25. Activity in the independent sector for the full year was up by more than 885,000 appointments compared with 2023/24 – and by almost two million appointments compared with 2022/23. For the first time ever, independent sector providers delivered more than 6 million appointments for NHS patients last year.

Further, average waiting times for NHS patients seen in the independent sector have fallen by almost 2 weeks since this time last year – with the average wait for a first appointment now 10.6 weeks, compared with 12.4 weeks in March 2024.

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 delivered more than 500,000 NHS appointments in March, the fourth time in the past six months they have exceeded the half million mark.

Overall, SUS data shows that the IS delivered more than 5.3 million total care episodes in 2024, and is already on course to exceed this total in 2025.

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 almost 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 20% additional activity compared with the pre-pandemic baseline.

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 the first three months of 2025, activity by IS providers has already removed more than 400,000 people from NHS waiting lists.

Specialty 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 381,000 patients waiting for their NHS-funded treatment with an independent sector provider at the end of March 2025, compared with 7.04 million waiting with NHS providers. Among patients who completed their RTT pathway in March, patients seen in the IS had waited an average of 10.6 weeks – this is compared with an average of 17.6 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.