The chief executive officer of Welbeck Health Partners talks about the boom in the private healthcare market since Covid and private medical insurance.
After many years at international management consulting firm Oliver Wyman, leading its international healthcare team, Andrew Chadwick-Jones is now chief executive officer of Welbeck Health Partners. Here, he talks to Healthcare Today about how the UK’s private healthcare market has grown, how he avoids medical risk, and why the British healthcare system is struggling with budgetary inertia.
The government’s plans to work with the private sector earlier this year was a distinct statement of intent. Where do you see the opportunities for the private and public sectors to work more closely together?
It’s a positive development for the private sector overall. In areas such as imaging and a range of straightforward procedures, the private sector performs very well, so having a strong role for it in a mixed healthcare economy makes sense. A balance between government-provided and privately-provided services brings investment and benefits the system as a whole.
For us, though, NHS work has never been a major focus. We’ve always kept things relatively simple by concentrating on the private market – serving mainly insured patients and those who self-pay. That has been a deliberate business choice over the years, allowing us to stay focused on a single customer segment.
That said, we recognise our place in the wider health economy. On the occasions when we’re asked to support the NHS – for example, if a local MRI or CT scanner goes down – we are always willing to step in and help. We’re not dogmatic about it. While our core business is private healthcare, we also acknowledge the importance of collaboration when it’s needed.
The UK private healthcare market has grown significantly in recent years. Where is the demand for the private sector coming from? Is it via self-funded patients, or is there an uptake in private medical insurance (PMI)?
Initially, there was a big surge in self-funded procedures just after Covid. People had accumulated ailments during lockdown, NHS waiting lists were very long, and many decided to pay privately to catch up on treatment. But that was largely a one-off phenomenon, and we’ve seen that market die down since.
In reality, there are two quite distinct self-pay markets. One is made up of people without private insurance who are worried about NHS waiting times – that tends to be more outside London. The other, in London, has always been a high-net-worth market. For them, healthcare is often part of their lifestyle – for example, doing annual check-ups while they’re in London for the summer.
Where we’re now seeing the real growth is in the insurance-based market. It has been expanding at 5-10% a year, and one year after Covid it grew by as much as 30%.
A lot of that is employer-driven, but there’s also a growing consumer element: small business owners or individuals who decide to buy cover for themselves because they’re worried about NHS access.
“Private health insurance today is far more democratised.”
To what extent is PMI being driven by employees rather than the companies themselves?
It’s a bit of both. We did some research in Cambridge and found that almost every major employer there offers private health insurance. Clearly, they’re competing for talent in a competitive market. But it’s not just about recruitment – employers also want staff to use it. If someone has a hip problem and ends up on an NHS waiting list for 12 months, the employer is left managing long absences, which carries a real cost.
Private health insurance has changed a lot over the past two or three decades. It used to be a much smaller product, often reserved for company directors or senior managers. Today it’s far more democratised. In London, for example, providers now see staff across all levels of an organisation – from bankers to janitorial staff – because many companies now offer cover universally. That old perception, that private healthcare is only for the top of a business, really doesn’t hold anymore. And for private providers, that’s significant: it means the patient base is becoming more representative of the wider UK population.
Clinical negligence is on my mind because of the NHS Resolution figures that came up recently. How are you geared up to deal with clinical risk and clinical negligence liabilities?
It’s really a mix. In the private sector, indemnity typically works on two levels: individual doctors carry their own cover, and the facility itself has its indemnity. Those operate in parallel, since patients might pursue claims in either direction. For us, though, the cornerstone is always clinical quality. We push responsibility and empowerment for safety as far to the front line as possible, because staff closest to patients need to have the knowledge and freedom to act. Creating a culture where people feel able to speak up is critical. That’s why we have a full-time Freedom to Speak Up Guardian, and I actively encourage people to use that route.
Governance has to be layered. At the front line, we invest heavily in training and clear policies. At an organisational level, we run dashboards across all clinics, compare performance between sites, and carry out regular audits and inspections. On top of that, we pay close attention to the scope of practice: doctors in the private sector should, as far as possible, mirror their NHS practice. Where there are exceptions, they need clear oversight.
Because of this structured approach, our indemnity rates are surprisingly good. Each of our clinics is organised as a doctor group, which creates collective responsibility. In some cases, these groups even arrange group indemnity with providers, who value the governance that comes with it.
Finally, our risk profile is helped by the fact that we’re a day-case facility. We don’t take overnight patients, and we don’t do paediatrics – the kinds of work that generally carry higher indemnity risk.
How do you evaluate where to open new centres? You have Oxford and Cambridge opening next year. What does the pipeline look like?
Our aim is to build a network of around ten sites across the UK, typically in major centres with strong academic or clinical communities. We’re already focusing on places like Oxford and Cambridge, which are both high-growth regions with world-class doctor groups and limited existing hospital provision. We’re also looking at Hampshire and other major hubs, with a view to opening one or two sites a year.
“We are deeply committed to empowering frontline staff.”
You recently signed a recruitment process outsourcing agreement with healthcare recruitment agency Compass Associates. Is that a reflection of challenges in recruiting and retaining healthcare professionals?
Generally speaking, recruitment hasn’t been a major challenge for us, even though we’re opening two centres next summer, side by side, and probably a third one in London. Of course, it means interviewing a number of people to find those who are aligned with our ethos, but beyond that, we don’t find it especially difficult. I think there are a few reasons for this.
First, the work–life balance we can offer in a day-case setting is a big draw. Everything closes at the end of the day, so staff can work patterns that suit their lives. It’s very different from hospitals with night shifts, and it works well for people at every stage of life, particularly those with children.
Second, we are deeply committed to empowering frontline staff. Decision-making is quick, and if there are issues with patients or ways of improving the service, those things are addressed rapidly. That responsiveness translates into very high levels of staff satisfaction.
There is also a very strong bond between doctors and staff. Because the doctors are part-owners of the clinics, they value the contribution of their teams and recognise that it’s the staff who make things excellent. That relationship is something employees really appreciate. When we first opened in London, many people told us we’d never find staff, but in practice, it has never been an issue.
You have wide experience in the state sector and in policy. Do you have concerns about upcoming policy changes around private medical insurance, data sharing, or regulation of private providers? How will they affect you?
We feel pretty good about where things are. When you look at the state system, there’s always talk about budgets, but the real strength lies in primary care at scale, especially when it’s preventative. That’s what helps manage patients with multiple conditions locally. Policy recognises that, but you can never really have enough of it.
Generally speaking, around 5% of patients consume 50–70% of the healthcare budget. That group is mainly frail elderly people, those on a cancer journey, and a smaller group of children with very high needs. Take the elderly cohort: many of us have seen relatives go into hospital with several conditions, with poor communication between teams. Families keep calling ambulances, patients bounce back to A&E – it becomes a cycle. The UK actually has good primary care, so the opportunity is to scale it up into teams that manage and improve the lives of these patients.
The challenge here is budgetary inertia. Hospitals don’t like money being reallocated away from them, even though their focus should really be on complex surgery and intensive care. To make primary care teams like this work, they need some control over local budgets – to hire health coaches, for example, and save on avoidable admissions.
Data can help too. In the US, groups like Iora use predictive analytics: mobility data, pharmacy records, prescription refills. They can spot when something is going wrong and call patients directly. That kind of proactive, population-level management is where UK policy needs to head. The GPs here have the skills and the entrepreneurial mindset to do it. The question is why it hasn’t happened at scale yet.
