Listening to patients – outcomes and experience

Patient reported outcome measures (PROMs)

Patient reported outcomes are a key measure of whether patients’ health has improved following specific interventions.

Privately-funded cohorts tend to present earlier than NHS-funded cohorts, so they have greater scope for potential health gain. In addition, different metrics are available for NHS-funded and privately-funded activity. Nevertheless, we can see useful information from the range of metrics available.

NHS England publishes PROMs data for patients undergoing orthopaedic procedures. Results are generally published annually. The last refresh of orthopaedic PROMs data was published by NHS England in early 2025. Looking at this information for primary hip and knee replacements for NHS patients, we see:

• 129 independent hospitals reported PROMs data, of which 60 reported sufficient information to calculate adjusted health gain information. 
• Despite making up under 40% of the hospitals with available adjusted health gain information, independent providers are disproportionately represented among those hospitals where patients report the largest health gain. The EQ-5D Index shows that six of the top 10 for hip replacements and half of the top 10 for knee replacements are independent providers. 
• 90% of NHS patients undergoing a primary hip replacement and 80% of patients with a primary knee replacement at an independent provider report a health gain as measured by EQ-5D. The proportion showing a health gain when measured by the Oxford scores are even higher. These figures are similar to those reported at NHS organisations. 

The chart below shows the average adjusted health gain for the top 20 providers for primary hip and knee replacements for NHS patients:

We also have an insight into the reported outcomes of privately-funded patients through information published by PHIN, which covers a wider range of procedures than is available for NHS patients, including:

• Primary hip replacements
• Primary knee replacements
• Cataracts
• Cosmetic surgery.

In the latest data, only three NHS private patient units had submitted sufficient information to calculate improvement rates, so clearly comparisons between sectors are inappropriate. Also, as previously noted, privately-funded and NHS-funded cohorts typically differ so it is not possible to compare the two.

Despite these caveats, we see that the percentages of patients reporting their conditions improved after private surgery were:

• 98% for hip replacements
• 95% for knee replacements
• 76% for cataract surgery.

Cosmetic Surgery

PHIN also reports data relating to three cosmetic surgery procedures. Data completion rates are steadily improving but are considerably lower than for the joint replacements and cataracts, which in part is because these are newer collections. The percentages of patients reporting improvement after their procedures are:

• 98% for augmentation mammoplasty
• 87% for liposuction
• 96% for rhinoplasty.

Friends and Family Test

Independent providers consistently ask patients if they would recommend their healthcare provider to friends or family members – the question known as ‘the friends and family test’ (FFT).

Although this question is asked of both NHS patients (data published by NHS England) and privately-funded patients (data published by PHIN), because one cohort is free at the point of care and the other is funded either by self-pay, employer or insurance, it is inappropriate to compare results between each group.

Looking at NHS inpatient care, we see that over the past 12 months, over 98% of NHS inpatients treated by independent sector organisations would recommend their provider to their friends or family. By contrast, the figure for those treated by NHS trusts is around 94%.

When viewed by site, we see a distribution as below:

PHIN publishes patient satisfaction information relating to privately-funded acute inpatient care. As discussed above, privately-funded and NHS patients are not comparable and PHIN follows a different methodology designed to capture the views of private patients.

The latest tranche of patient satisfaction data for privately-funded patients covers the period from 1 July 2022 to 30 June 2025. 287 independent sites submitted data relating to 555,565 procedures over that period. Considerably fewer NHS private patient units (PPUs) submitted sufficient data to publish over that period – just 51 hospitals covering 12,903 procedures – though it is encouraging that this is roughly double the rate of a year ago.

The proportion of patients who rated their experience as ‘very good’ was 87% at independent providers, compared to 84% at NHS PPUs. Overall, 97% rated their experience positively at independent providers, as did 96% at NHS PPUs.

Elective cancellations

One issue that has a significant impact on patients is when operations are cancelled at the last minute for non-clinical reasons. This hardly ever happens for NHS patients treated at independent providers.

During 2025, 82,790 elective operations for NHS patients in England were cancelled at the last minute for non-clinical reasons (0.9% of all NHS operations). Of these, just 57 were at independent sector organisations – that’s around one in 155,500 of all operations or 0.069% of all cancellations.