The chief executive of the Independent Healthcare Providers Network talks new opportunities for the independent sector and how he works with the NHS.
David Hare has been chief executive of the Independent Healthcare Providers Network (IHPN), the only membership network for independent healthcare providers, since 2014. In that time, he has consolidated industry representation and grown membership from just over 20 members to 100 today. He talks to Healthcare Today about how the independent sector plans to work with the NHS, why he expects to see opportunities in community and primary care services, and why a positive relationship with the Labour government will improve services for patients.
“The independent sector is essential to the NHS.”
Paying for treatment has become, as you say, the “new normal”. Is the independent sector now essential to the NHS?
The independent sector is essential to the NHS – and, I believe, to the health of the nation more broadly. What we are seeing now is a growing acceptance that NHS recovery and reform require capital, capacity and capability from the independent sector. For the first time in a long while, there is now cross-party consensus in England that this is necessary.
This shift was clearly signalled by the partnership agreement signed between the sector and the NHS in January, accompanied by a strong statement from the government that it intends to work with the independent sector to improve NHS services.
Alongside this political shift, there is also growing public acceptance of private healthcare – whether people are choosing to fund it themselves or through private medical insurance. One in seven people in the UK now have private medical insurance, a figure not seen since before the financial crash in 2008. Increasingly, private healthcare is becoming normalised – both as part of the NHS landscape and as a separate system – and the public appears broadly comfortable with that.
How would you respond to critics who claim that NHS use of the independent sector is a form of privatisation?
The debate around “privatisation” has, for far too long, held back meaningful healthcare reform in this country. The involvement of the independent sector in frontline service delivery does not mean that patients will have to pay for treatment, nor does it suggest anything is being taken away from the NHS.
Yet the term is often used in conjunction with phrases like “the Americanisation of healthcare” – and, in my view, that is irresponsible and misleading scaremongering. It plays on fears that the NHS, already under immense pressure, is somehow at risk of being lost. Fortunately, there is no longer a political champion for that frankly nonsensical argument.
The cross-party consensus now in place gives us a real opportunity to move beyond this kind of unhelpful narrative.
“The independent sector is already delivering record volumes of NHS care.”
To what extent can the independent sector help the NHS reduce waiting times, and what are the limits to its capacity?
In terms of pure capacity, the independent sector is already delivering record volumes of NHS care. Each year, around a million NHS patient referrals are withdrawn or blocked from the system and subsequently offered to private patients. That figure gives a sense of the untapped capacity that could be made available immediately if demand were better managed.
With the right market conditions, there is also scope for further investment in new services and facilities. In recent years, independent providers have built and operated community diagnostic centres, bringing much-needed additional capacity. The same approach could be applied to a new wave of diagnostic centres or dedicated surgical hubs.
Beyond capacity, the independent sector can make a vital contribution to improving productivity. That includes working in partnership with NHS trusts to raise efficiency in key areas such as diagnostics, where throughput remains a challenge.
There is significant potential here – but success depends on partnership. The private sector cannot achieve this alone. It needs the NHS itself to function more effectively.
How do you see the role of independent providers evolving within the NHS?
I think we’re already seeing signs of that evolution. There has been a wave of new market entrants moving into different parts of the healthcare system. Cataract treatment is a prime example. Ophthalmology is now the only major speciality where median waiting times are shorter than they were before the pandemic. That improvement is almost entirely due to new capital investment, expanded services and overall low waiting times.
We’re now seeing similar developments in other choice-based services, as well as in areas such as ADHD, where new private sector providers are moving into the mental health space.
What are the operational and financial challenges that independent healthcare providers are facing?
Like all healthcare providers, the independent sector in the UK is affected by the global shortage of healthcare professionals. The private sector is by no means immune. In our annual industry barometer, which we publish on our website, workforce issues consistently rank among the top concerns raised by our members – particularly around access to highly trained professionals.
That said, the private sector tends to perform well when it comes to staff retention. There’s significantly less churn, and the sector places a strong emphasis on empathy and supportive working environments. We’re also seeing more clinicians actively choosing to move from the NHS into the independent sector. Many are drawn by the calmer, more predictable working conditions and a greater ability to focus on patient care – what brought them into the profession in the first place.
On the financial side, while inflation has eased over the past year or so, the earlier energy price spikes and broader inflationary pressures created serious challenges – particularly in terms of construction costs and capital investment. These pressures have been especially acute for providers working closely with the NHS. Given the financial constraints within the NHS, price increases for contracts have not kept pace with inflation. As a result, providers have had to work harder and more efficiently just to maintain margins.
“Providers across the sector have made real efforts to improve standards.”
Do you think that regulatory frameworks like the Care Quality Commission adequately reflect the risks and structures of independent provision?
We work closely with the Care Quality Commission (CQC) to help ensure it understands the independent sector – particularly the differences between how we operate and how the NHS does. We have an excellent regulation team here that engages with the CQC every day to support that effort.
In many cases, the CQC’s understanding of the sector is quite strong. The sector’s performance record reflects that progress: 94% of Independent Healthcare Providers Network (IHPN) members are now rated as “Good” or “Outstanding”. That marks a significant improvement from where we were seven years ago and is the result of a great deal of work on both sides.
Providers across the sector have made real efforts to improve standards, while the CQC has also worked hard to better understand independent provision and to regulate it appropriately.
While challenges remain – and we acknowledge that the CQC itself is undergoing a period of rebuilding – we’re working closely with its new leadership team to ensure that the upcoming changes to the assessment framework are fit for purpose and fully reflect the needs of the independent sector.
How does IHPN work with NHS England, the Department of Health, and other stakeholders to shape healthcare policy without being seen as lobbying for profit over public interest?
We try to be transparent in our approach. When a trade association lobbies purely to generate more income for its members – particularly at the expense of service users or the organisations delivering care – that’s neither credible nor sustainable. In our experience, the Department of Health in England, and indeed governments in other parts of the UK, are quite attuned to that. They tend to engage with industry in a mature and thoughtful way.
There’s a good comparison to be made with how government engages with the pharmaceutical sector: it’s a sophisticated relationship that acknowledges commercial realities, but also recognises the shared goal of delivering better care.
Where industry engagement is narrowly focused on profit and earnings, government tends to take a step back. But where there is genuine alignment – on improving regulatory environments, securing the right policy and funding frameworks, and ultimately ensuring the best outcomes for patients – then meaningful conversations can and do take place.
What is your dream? How should governments engage with independent providers to design long-term NHS strategy?
I believe the government is taking a number of positive steps. We are now just six months into a new Labour administration, and given Labour’s recent history on NHS policy, the signing of a strong and constructive partnership agreement between the government and the independent sector is especially welcome. It commits both sides to a series of actions aimed at improving services for patients – and that, I think, is a very encouraging starting point.
The priority now is to ensure that those commitments are delivered and that real progress is made. Beyond that, we need wider recognition across the entire healthcare system that a diversity of provision is a strength.
These approaches should not be seen as substitutes for the NHS, but as complementary. They can help ensure more timely access to care while easing pressure on public services. Because at the end of the day, we are all NHS patients too.
