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From our regular and much-valued, non-Russian spy, France McKie, from Every Doctor, the campaign against NHS privatisation, yesterday:

I wouldn’t be surprised if you hadn’t heard of “NHS in-sourcing”, because the newspapers don’t talk about it very much. But it’s one of the most mind-boggling forms of NHS privatisation! Essentially, NHS Trusts are desperate to bring down their waiting lists, and many are now paying private companies to come in out-of-hours and use NHS resources to do NHS work…These private companies are using NHS facilities, NHS equipment and many also hire NHS staff to work out-of-hours, to do the work and enable the private companies to generate a profit! One wonders why the NHS trusts can’t just pay their own staff properly to do these extra shifts, instead of enabling private companies to make money like this…

Is there evidence for this claim from Every Doctor – NHS Trusts are desperate to bring down their waiting lists, and many are now paying private companies to come in out-of-hours and use NHS resources to do NHS work

This is a fully AI response, 41 sources checked, but you’ll remember, I hope, that as one (only so far) TuS follower said, I am ‘a fucking genius!’ So, AI can’t fool me. I’ve checked it thoroughly.

Yes, there is substantial evidence supporting the claim that NHS Trusts are actively seeking to reduce waiting lists by paying private companies to perform NHS work out-of-hours using NHS facilities and resources. This practice is commonly referred to as “insourcing” in the NHS context, where private providers deliver additional capacity within existing NHS infrastructure, often during evenings, weekends, or other underutilized periods, to address backlogs without transferring patients to external private hospitals. It’s distinct from traditional outsourcing and has grown significantly as a cost-effective strategy amid record waiting lists exceeding 7 million patients in recent years.What Insourcing InvolvesInsourcing typically entails NHS Trusts contracting private firms to supply specialist clinical teams (including doctors, nurses, and support staff) who operate in NHS hospitals or clinics. These teams use NHS equipment, operating theatres, and other resources during non-standard hours to maximize capacity. The NHS pays the private company for the services, often at rates 20-30% below the national tariff, making it cheaper than full outsourcing to private facilities. This approach helps Trusts meet targets like the 18-week referral-to-treatment standard and has been ramped up post-COVID to tackle elective care delays in areas such as surgery, diagnostics, endoscopy, and cardiology.

https://www.theguardian.com/society/2023/feb/12/nhs-consultants-run-private-firms-charging-to-cut-waiting-lists-at-their-own-hospitals

https://hospitaltimes.co.uk/long-waiting-treatments-nhs-insourcing-eliminate-private-self-pay

https://committees.parliament.uk/writtenevidence/140558/pdf

• The insourcing market has expanded rapidly, valued at £95 million in FY2021 and projected to reach £295 million by FY2024, reflecting Trusts’ desperation to clear backlogs. Analysts note it’s one of the fastest-growing segments in private healthcare, with Trusts awarding multimillion-pound contracts to firms for weekend and evening procedures.
• Specific examples include companies like 18 Week Support, which partners with over 50 NHS Trusts across the UK. https://www.nhsforsale.info/insourcing-how-private-companies-work-inside-nhs-hospitalsto deliver more than 100,000 procedures annually, focusing on out-of-hours slots to hit waiting list targets (e.g., reducing 65-week waits). hospitaltimes.co.uk Similarly, Frontline Insourcing provides flexible teams for evenings and weekends, leading to documented reductions like an 87% drop in a six-week endoscopy waiting list at one Trust over four months. https://www.frontlineinsourcing.co.uk/how-insourcing-reduce-patient-waiting-lists
• High-profile cases highlight the scale: In Bristol, Glanso UK (run by NHS consultants) earned £2.6 million in profits from insourcing contracts, using NHS facilities and staff for out-of-hours operations. Trusts defend this as cheaper than outsourcing, though unions raise concerns about staff burnout and conflicts of interest. bbc.com Nationwide, senior NHS clinicians have set up private firms to offer these services at their own hospitals, with deals worth millions. https://www.nhsforsale.info/private-firms-run-by-nhs-staff-charging-to-cut-waiting-lists-at-their-own-hospitals

Broader Context and Government Support

The UK government and NHS England have encouraged greater use of independent providers (including insourcing) as part of elective recovery plans, with independent sector activity removing over 1.5 million people from waiting lists in 2024 alone. Patients treated via these routes often wait just 11 weeks compared to the NHS average of 18 weeks. https://www.ihpn.org.uk/news/independent-providers-remove-1-5-million-people-from-nhs-waiting-list

However, critics like the Centre for Health and the Public Interest argue for bans on arrangements where NHS staff profit personally, citing transparency issues. https://www.theguardian.com/society/2023/feb/12/nhs-consultants-run-private-firms-charging-to-cut-waiting-lists-at-their-own-hospitals

NHS guidance emphasizes that insourcing should prioritize patient safety and avoid escalated pay rates. https://www.theguardian.com/society/2023/feb/12/nhs-consultants-run-private-firms-charging-to-cut-waiting-lists-at-their-own-hospitals

This evidence comes from reputable sources including government reports, NHS analyses, and investigative journalism, confirming the claim’s validity. While insourcing has proven effective in reducing waits, ongoing debates focus on its long-term sustainability amid staff shortages and potential privatization risks.

Is this true in NHS Scotland too?

No, the specific practice of NHS Trusts paying private companies to come in out-of-hours and use NHS resources (i.e., “insourcing”) to reduce waiting lists is not widespread or prominently evidenced in NHS Scotland in the same way it is in England.While NHS Scotland faces significant waiting list pressures (similar to the rest of the UK, with long waits for elective care in areas like orthopaedics, ophthalmology, and diagnostics), the approach to involving the private/independent sector differs notably from England’s model.

Key Differences in Scotland

• Primary reliance on outsourcing rather than insourcing: When NHS Scotland boards use private providers, it typically involves outsourcing patients to independent sector facilities (e.g., private hospitals like those run by Spire or others) for treatment, rather than bringing private teams into NHS hospitals to use NHS theatres, equipment, and infrastructure out-of-hours. Historical examples include the Scottish Government advising boards to block-book private hospital capacity during peaks (e.g., post-COVID recovery in 2020), and ongoing spending on private providers—such as reports of hundreds of millions pledged for private work to ease pressures. However, this is about transferring patients elsewhere, not utilizing spare NHS capacity internally via private firms.
• Limited evidence of insourcing adoption: Searches across government sites (gov.scot, nhs.scot), reports, and recent coverage show minimal mention of insourcing frameworks or contracts in Scotland. Terms like “insourcing” appear occasionally in planning documents (e.g., references to “maximise insourcing / outsourcing opportunities” in remobilisation or recovery plans), but these are broad and not tied to specific private company-led, out-of-hours use of NHS facilities. No major contracts, companies (like those active in England such as 18 Week Support or Frontline Insourcing), or dedicated frameworks equivalent to England’s NHS Shared Business Services insourcing agreement are highlighted for Scotland. Discussions of private involvement focus more on general independent sector support or national treatment centres (e.g., Golden Jubilee Hospital).
• Policy and structural context: NHS Scotland is devolved, and successive Scottish Governments (under the SNP) have emphasized public provision while using private capacity sparingly and often critically (e.g., opposition rhetoric highlights spending on private work as a last resort). Recent funding boosts (e.g., £135.5 million in 2025–26 for waiting times) target internal capacity expansion, cross-boundary working, extended hours, and efficiencies rather than private insourcing teams. There are no prominent scandals, profits reports, or union concerns about NHS consultants running insourcing firms in Scottish hospitals, unlike in England.

Broader Context

NHS Scotland does use independent providers to help with waiting lists—patients sometimes receive treatment in private settings paid for by the NHS, and some opt out for private care due to delays (e.g., thousands quitting NHS lists annually). But the “desperate” shift to private companies operating within NHS premises out-of-hours using NHS resources appears largely an England-specific phenomenon, driven by England’s elective recovery plans, financial incentives, and market frameworks that encourage insourcing as a cost-effective alternative to full outsourcing.If new evidence emerges (e.g., specific board-level pilots), this could change, but as of early 2026, the claim does not hold to the same extent in Scotland. The focus remains more on public system recovery, outsourcing where needed, and targeted funding rather than widespread insourcing.

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