A study of NHS-funded hip and knee replacement operations has found fewer surgical admissions within NHS hospitals and rising waiting times even as NHS contracts with private providers have expanded.

Researchers at Newcastle University found that on average, patients funded by the NHS and treated by private providers waited half as long as those treated in NHS hospitals.

The study, published in the International Journal of Social Determinants of Health and Health Services, covers the years 1997 to 2019 and highlights a widening inequality. It shows the poorest 20% of patients were significantly less likely to be treated in the private sector and were facing longer waiting times than the richest 20%.

Between 2003 and 2008—when the proportion of NHS patients treated in the private sector was negligible—NHS surgical admissions rose and waiting times more than halved. But after 2008, as private provision expanded, NHS capacity fell sharply and waiting times increased across the board.

Professor Allyson Pollock, Clinical Professor of Public Health at Newcastle University, said, “Our findings show that the private sector is now substituting for, not adding to, NHS capacity. This is leading to reduced in-house provision, longer waits for all, and a system skewed in favor of those able to access private facilities with NHS funding.”

Newcastle University’s Graham Kirkwood, co-author of the study, added, “The period of the 22 years that we studied marked the development of a two-tier system within the NHS—where patients receiving NHS-funded treatment in private hospitals enjoy faster access than those remaining within the NHS system.”

Consequences of outsourcing

The findings raise urgent concerns about the growing reliance on private companies for NHS services, undermining the founding principle of equitable access based on need, not wealth.

In the paper, the researchers call for a moratorium on NHS contracts with the private sector for elective surgery and an end to the private provision of clinical services in the NHS including:

• Urgent rebuilding of in-house NHS capacity to tackle waiting lists and restore equitable care
• A full investigation by Parliament and the National Audit Office into the true cost of outsourcing, the profits of private companies, and the additional income earned by NHS consultants and staff linked to this trend

Professor Pollock adds, “Our research makes it clear—outsourcing is worsening outcomes, fueling inequality, and hollowing out the NHS from within. This work demonstrates the damaging impact of private sector involvement in the NHS and confirms the creation of a two-tier system that benefits the wealthy while leaving poorer patients behind. It’s time to take action to reverse course.”