Executive summary

This is IHPN’s third report on UK independent healthcare quality. Following on from our previous reports, all information has been updated, and we investigate several new areas.

The report examines numerous aspects of how independent providers are delivering safe, high-quality services to patients. Key points include:

Regulation

• Over 5,600 independent healthcare organisations – a record number – are now registered by the CQC.
• On average, over 90% of overall ratings for independent healthcare organisations are good or outstanding.
• 94% of services run by IHPN members are rated good or outstanding.
• While independent sector services with CQC ratings generally perform well, we are increasingly concerned that the proportion of unrated independent sector locations has grown and that newly registered services typically have to wait several years to be assessed.

Working across Scotland and Wales

• IHPN members in Scotland and Wales:
  • Bring 7,700 employed and contracted staff
  • Carry out over 715,000 treatments and consultations per annum.
• Over 25% of all hip, knee, shoulder, elbow and ankle replacements in Scotland are carried out by independent providers.

Safety, openness and culture

Building a culture of greater transparency and openness – listening to patients and staff

• There are now over 600 Freedom to Speak Up Guardians in the sector – double the number that were in place in 2023 – and an increase has been seen in reported cases, demonstrating increased openness.
• There has been proactive adoption of Martha’s Rule, supporting patients and families to escalate concerns where necessary.
• A programme of support for sexual safety has been rolled out across the sector.
• New initiatives are in place working with Patient Safety Partners to co-design systems, ensuring their voices are integrated into the learning process.

Fostering a learning environment within and across organisations

• More providers are submitting information to Learning from Patient Safety Events (LFPSE).
• An active IHPN-led Share and Learn community of practice is supporting learning across organisations.
• We are supporting members to implement the Patient Safety Incident Response Framework (PSIRF) and share practice.
• A growing community of Patient Safety Specialists is responsible for bridging national policy with local frontline practice.
• Engagement with the CQC, NHS England and partners is supporting greater data alignment.

Robust governance and oversight

• Work is underway with the Health Services Safety Investigations Body to support the implementation of a safety science approach.
• Reporting of adverse event data for privately-funded activity has increased.

Addressing specific clinical priorities

• An extremely low number of never events occurred in 2025, but close scrutiny and learning take place whenever they do occur.
• 2025 saw a high rate of VTE assessments, with the sector exceeding the national standard.
• A systematic programme of activity across providers is in place to ensure continued safe care utilising established transfer arrangements in those rare cases where a patient’s health unexpectedly deteriorates.

Outcomes, audits and registries

• Considerable progress has been made in submitting data to the Outcome Registries Platform, and through it, the Medical Device Outcome Registry (MDOR), directly and via existing registries. Despite this progress and engagement, two key areas remain to be addressed adequately:
  • Outstanding gaps in NHS England’s information governance guidance
  • The flow of information back to providers to improve patient care.
• Further significant progress has been made in the availability of information about privately funded care, with PHIN achieving its ‘silver milestone’, and we are on track towards fulfilling its mandate from the Competition and Markets Authority during 2026.
• While significant progress has been made on PHIN’s mandate, we are disappointed to report that the Acute Data Alignment Project (ADAPt) appears to have made little, if any, progress during 2025.

Listening to patients

• Patient reported outcome data shows:
  • Data submission levels have increased.
  • Seven of the top 10 providers treating NHS patients for both hips and knees are independent providers.
  • Over 98% of privately funded hip replacement operations led to a patient reported health gain and 99% positive outcomes were recorded for cosmetic surgery such as augmentation mammoplasty.
• Over 98% of NHS inpatients treated by independent sector organisations would recommend their provider to their friends or family.
• Overall, 97% of privately funded patients rated their experience positively at independent providers.

Specialist areas

Ophthalmology

• The mean waiting time for admitted ophthalmology by independent providers is just 10 weeks, compared to over 19 weeks at NHS providers.
• There are high levels of transparency in data submitted by independent providers for audit.
• National Ophthalmic Database (NOD) data shows that all independent providers have complication rates that are well below expected limits.

Orthopaedics

• The volume of joint replacement data submitted to the National Joint Registry (NJR) has more than doubled from just under 74,000 records in 2015 to almost 149,000 in 2025.
• 54% of the National Joint Registry (NJR) gold award winners for data quality were independent providers.
• High patient consent rates enable datasets to be linked. Consent rates had been hovering around 90% since 2010 but reached almost 94% in 2025, the highest on record.

Endoscopy

• 98 independent sector providers are Joint Advisory Group (JAG) accredited (48% of relevant independent providers). By contrast, 32% of relevant NHS providers are JAG accredited.
• Independent providers make up half of all JAG accredited sites in the UK.

Breast and cosmetic implant surgery

• 73% of patients were treated in the independent sector.
• Over 70% of operations carried out by independent providers are augmentations (this accounts for 97% of all augmentations). 21% of the sector’s activity are replacements or exchanges of implants.

Cancer care

• 72 independent providers currently hold the Macmillan Quality Environment Mark (MQEM) award, which is independently awarded to cancer services.

Diagnostics

• 60% of the bodies accredited by the UK Accreditation Service for Diagnostic Imaging Services are independent organisations.

Neurodevelopmental

• We estimate that over 50% of all NHS ADHD assessments and more than 33% of all NHS autism assessments are delivered by independent sector providers.

Autism Accreditation Programme

• There has been considerable growth in the range of independent providers offering specialist services to patients with autism over recent years, with several using the Autism Accreditation Programme as a framework to drive improvements in care.