A significant proportion of routine NHS mental health care is
being outsourced to private companies, charities and other
independent providers, concludes a new study.
The analysis, conducted by health and care charity The King's
Fund, finds that more than 1 in 4 NHS mental health inpatient
beds is being outsourced.
Independent sector inpatient beds purchased by the NHS are still
free at the point of use for patients, and there is a long and
effective history of NHS services procuring independent sector
capacity during periods of high demand and for specialist mental
health care.
However, researchers at The King's Fund conclude that use of
independent sector beds has gone far beyond acting as valuable
surge capacity and instead has become a core part of mental
health provision in England.
The research is the first of its kind to show the scale and type
of NHS mental health care that the public are receiving from
non-NHS providers. The authors of the study examined data on the
number of inpatient beds available for NHS care from independent
sector providers of mental health care registered with the Care
Quality Commission.
The analysis shows that between January to March 2025, NHS trusts
reported almost 18,000 available mental health beds, 89.5% of
which were occupied. However, this new analysis finds that in
March 2025 there were an additional 7,195 beds available in the
independent sector for use by the NHS. This equates to
approximately 29% of NHS-funded mental health bed capacity in
England being provided by the independent
sector.
The increased use of independent sector beds comes with a
financial cost and could lead to longer lengths of stay for
patients. But the researchers say the NHS has little choice –
using the independent sector appears to be the only option when
demand outstrips NHS inpatient capacity.
The new research also looks at the types of mental health care
that the independent sector provides for NHS patients. It finds
that independent providers are providing an increasing proportion
of care for people with the most complex needs and who are the
most vulnerable, including those with a diagnosis of a
personality disorder, and people with learning disabilities and
autism.
Researchers at The King's Fund argue this raises concerns about
transparency, as the independent sector is not subject to the
same level of data collection as NHS providers. They warn it
could leave national and local leaders with less information
about patient experience and patient outcomes, including for some
people with the most complex needs.
There are several factors that may be driving the lack of NHS
mental health bed capacity. This includes many years of low
capital investment in mental health buildings and equipment, as
well as insufficient support in the community to keep people
well.
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.
‘However, our analysis reveals that there has been a significant
increase in the share of NHS mental health inpatient care being
outsourced to independent providers. Far beyond acting as
valuable surge capacity, the NHS has become reliant on the
independent sector for delivery of routine mental health care.
This exposes the health service to greater risk of higher costs,
could leave patients facing longer stays in hospital, and means
the public has less transparent data about the quality of
services.
‘For the NHS to be sustainable in the long term, there needs to
be far more focus on providing care in the community that keeps
people well. Traditionally, the mental health sector has made
great progress in delivering community-based care. However, some
patients with greater or more complex mental health needs may
need inpatient care, and the NHS must do all it can to treat
people in the appropriate setting for their health needs.'
