Public payment and private provision: the changing landscape of health care in the 2000s

This report examines the changing relationship between the public and private sector in the provision of NHS funded care in the past decade.


Published: 22/05/2013

ISBN: 978-1-905030-66-8

Download the report [PDF 378.3KB]

Listen to an audio slideshow with co-authors Sandeepa Arora, Nuffield Trust, and George Stoye, Institute for Fiscal Studies, who outline the key findings from the research.

The report, authored by Sandeepa Arora and Anita Charlesworth of the Nuffield Trust, and Elaine Kelly and George Stoye from the Institute for Fiscal Studies (IFS), examines trends in the public and private sector, in both the financing and delivery of health care.

These trends are particularly important in light of the changes legislated in the Health and Social Care Act 2012, which altered the way NHS health care is commissioned in England.

To explore these issues in more detail, the report examines the changes in the roles of the NHS and the private sector in the funding and provision of two elective in-patient procedures: hip and knee replacements.

The changing pattern of the provision and financing of hip and knee replacements provides a clear example of how the relationship between the NHS and private sector health care providers has altered over the past decade
Elaine Kelly, Research Economist, Institute for Fiscal Studies and report co-author

The main findings of the report are:

  • the economic crisis has had an impact on both public and private spending but thus far the impact has been greater on private spending;
  • the role of non-NHS providers in delivering NHS-funded care in England increased markedly from 2006 onwards, reflecting Government policy decisions;
  • the single largest share of secondary care spending on non-NHS providers went to independent sector providers (ISTCs and other private sector providers) and this has grown more quickly over the last five years than spending on services provided by the voluntary sector and local authorities;
  • primary care trust (PCT) spending on what are defined in the accounts as independent sector providers varies across the country, but it increased in all regions between 2006/07 and 2011/12.

This report forms part of our joint research programme with the Institute for Fiscal Studies: Understanding competition and choice in the NHS.



Suggested citation

Arora S, Charlesworth A, Kelly E and Stoye G (2013) Public payment and private provision: the changing landscape of health care in the 2000s. Research report. Nuffield Trust and Institute for Fiscal Studies.