NHS England is planning a major expansion of private sector involvement in diagnostic services to tackle lengthy test and scan backlogs. This move, however, is anticipated to face “resistance” both within the health service and externally, according to a senior NHS figure. The proposal comes as the NHS struggles with persistent waiting lists, staffing shortages, and pressure to meet key performance targets.bThe plan, discussed by senior NHS leaders, proposes a significantly broader remit for private clinics in delivering scans, imaging, and other diagnostic tests, services traditionally provided primarily by NHS hospitals and community diagnostic centres. While exact procurement targets are unconfirmed, sources indicate the scale of private sector usage will be substantially higher than current levels.
Currently, private providers are a significant contributor, carrying out over 6 million NHS tests, scans, and outpatient appointments over the past year, representing about 10% of all elective activity.
Rationale: Addressing Crisis-Level Demand
The expansion is driven by the fact that diagnostic services, including MRI, CT scans, ultrasounds, and blood tests, have been under severe strain for years. Demand has outpaced capacity, and workforce shortages have affected all service areas. Despite prior capacity increases, national diagnostic targets are stalling, and backlogs persist
NHS leaders argue that utilising independent providers is a pragmatic step to accelerate waiting time reductions and ease the burden on core NHS infrastructure. The Independent Healthcare Providers Network suggests that integrating patient choice into independent sector-run NHS community diagnostic hubs could save significant capital expenditure while rapidly expanding capacity.
Internal and External Resistance
Despite the clear need, a senior NHS England source has cautioned that the proposed expansion will not be universally accepted. Staff and professional bodies are concerned that this represents a diversion of resources away from long-term investment in NHS capability and a dangerous over-reliance on external providers, especially amid acute workforce shortages.
A key concern is the cultural resistance to outsourcing core functions. Many clinicians fear that a wider private sector presence could worsen recruitment and retention problems by luring staff away from the NHS with better pay. Outsourcing has been linked to a shift of finite workforce resources out of NHS control, a dynamic already observed in areas like ophthalmology.
Sustainability and Financial Concerns
Professional groups like the Royal College of Radiologists stress that while private sector capacity offers short-term relief, it is not a sustainable substitute for investing in the NHS's core diagnostic workforce and infrastructure. They point to soaring costs for outsourced reporting (teleradiology), driven by clinical radiologist shortages, which have failed to solve the underlying capacity deficit.
Critics also warn that relying too heavily on private diagnostics could be a false economy. The risk is that the NHS will continually divert funds to pay external providers instead of investing in building up its own long-term capability through hiring, training, and technology upgrades.
The Pragmatic Defence
Defenders of the plan prioritise the immediate need to reduce waiting lists for patients, where early diagnosis is crucial for better outcomes. They cite the success of community diagnostic centres (CDCs), many of which use independent sector capacity as proof that blended delivery models can work effectively.
Health Secretary Wes Streeting has defended using spare private capacity as a pragmatic step to alleviate pressure, arguing against letting "ideological purity" obstruct patient care. Proponents also suggest this approach could lead to hundreds of millions of pounds in capital spending savings for the public purse by reducing the need for new NHS infrastructure.
The move fuels a broader political debate, with campaigners and some opposition figures labelling the trend a stealth privatisation that risks fragmenting care and eroding the NHS's ability to deliver comprehensive in-house services. Public opinion remains mixed: while some patients welcome the benefit of faster access to tests and scans, others are cautious about increasing dependence on for-profit providers within a universal public health system.
Implementation and Success Metrics
As NHS England progresses, key focus areas will be the design of the new procurement framework, which include covering contractual terms, quality, data sharing, and value-for-money. The vital challenge is ensuring that private involvement complements rather than undermines the NHS's own capacity, especially concerning training and workforce pipelines.
A hybrid model is seen by some trust leaders as a realistic compromise: using private providers to address current pressures while the NHS simultaneously commits to growing its own diagnostic workforce and infrastructure. The ultimate measure of success for patients will be the speed and equity with which they can access essential diagnostic tests across all regions and populations.
