The NHS has become reliant on the independent sector for inpatient mental health care in England, raising concerns about data quality and financial costs, says a report from The King’s Fund.
Nearly 29% of NHS-funded mental health bed capacity in England was being provided by the independent sector, according to the study, which examined the scale and type of NHS mental health care received by the public from non-NHS providers.
Researchers analysed data on inpatient beds available for NHS-funded care from independent providers registered with the Care Quality Commission (CQC).
Between January and March 2025, NHS trusts reported 17,999 available mental health beds, 89.5% of which were occupied. Alongside this, 7,195 beds were available in the independent sector for NHS use – 28.6% of NHS-funded mental health bed capacity.
The King’s Fund noted that while there is a history of NHS buying services from independent providers, this level of use suggested it had become ‘a core part of mental health provision in England’.
Siva Anandaciva, director of policy at The King’s Fund, said: ‘Independent sector health care capacity acts as an important release valve for many NHS services when they face periods of high demand. It would make no sense to leave private beds empty when the NHS could purchase spare capacity and patients still receive care, free at the point of use.’
But he said the ‘significant increase’ in outsourcing went beyond that.
‘Far beyond acting as valuable surge capacity, the NHS has become reliant on the independent sector for delivery of routine mental health care,’ said Mr Anandaciva.
The King’s Fund argues that this could leave healthcare leaders with less information about patient experiences and outcomes, including for some of the most vulnerable people receiving care, as the independent sector is not subject to the same level of data collection as NHS providers.
The report said there were ‘particular areas of care that the independent sector specialises in’, including inpatient treatment for people with neurological conditions and acquired brain injury, eating disorders, and people with learning disabilities and autism.
This shift, the researchers said, could increase costs for the NHS and result in longer hospital stays.
However, the analysis acknowledged that the NHS has little choice but to use the independent sector when demand outstrips NHS inpatient capacity.
Years of low capital investment in mental health facilities and limited community support to help people stay well were cited as factors behind the shortage.
The report said that concerns about the issue were not new.
In 2016, a national commission said that the inadequate access to inpatient beds was symptomatic of broader challenges across the sector. And, more recently, consultancy LaingBuisson said that the value of the independent sector mental health hospitals market had reached a record £2.36 billion. It estimated that 92% of the market value was accounted for by public-funded care and driven by high NHS occupancy levels.
In March this year, CQC highlighted concerns about people being discharged too early without sufficient support and out-of-area placements.
This article was edited to reflect that the independent sector typically specialises in care for certain patients, including those with learning disabilities. It had previously suggested the proportion of care for those patients was increasing in the independent sector, however this is not known from the analysis.
