The NHS in England spent more than £1.4bn of public money on private mental health beds between 2019 and 2024.
The eye-watering figure was uncovered through Freedom of Information requests. EveryDoctor, a grassroots advocacy group made up of British doctors, says it exposes the de-facto privatisation at the heart of our mental health care system.
Between 1988 and 2019, the number of NHS mental health beds in England fell by nearly three quarters, from 67,100 to 18,400. Bed-strapped trusts and integrated care boards (ICBs) have been forced to turn to private providers to fill the gap.
“NHS staff have spoken up repeatedly about the lack of hospital beds and the false economy of outsourcing care to private companies, and have mostly been ignored,” said Julia Patterson, CEO of EveryDoctor. “Meanwhile, enormous sums of public money are being funnelled into private companies.
“Private companies have no place in the delivery of public healthcare, because profit creation is often not aligned with the interests of patients, or the staff who aim to provide excellent care within a sustainable service.”
Overall spending on independent sector beds increased by 68% during this half-decade. For some individual trusts, the figure was much higher.
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Surrey and Borders Partnership NHS Foundation Trust told EveryDoctor it was spending ten times as much on private mental health beds in 2024 as it had in 2019. Lancashire & South Cumbria NHS Foundation Trust’s spending jumped from £3.8m in 2019/20 to a staggering £40m in 2023/24. In Dorset, the mental health trust was spending just £800,000 on beds in 2019/20 but by 2023/24 this rose to £6.6m.
“There’s this kind of ridiculous idea that by cutting beds you’re somehow saving money,” said Ana, a psychiatrist has worked in the health service for three decades. She did not want her last name used.
“In actual fact the need is just the same, and you’re going to have to use out-of-area beds in the private sector, which is going to cost far, far more.”
The highest paid supplier was Cygnet Health Care, owned by US-based Universal Health Services. Cygnet received £382m in NHS England contracts between 2019 and 2024. Over the period between 2019 and 2022, the latest available accounts, the company reported profits of more than £84m, though it is unclear what proportion of this comes from providing mental health beds.
The “profit imperative” of outsourcing interferes with patient care, explains Benjamin Goodair, the Wellcome Trust doctoral scholar at the University of Oxford.
“The promise of outsourcing was that it would provide similar quality care in the private sector, but that it would be more efficient to do so,” he said. “What we’ve seen with the available research is that this hasn’t been the case.”
“It’s hard to incentivise private sector providers to deliver the same quality of care. Where possible, private sector providers are cutting costs to try and make larger profits. Quality suffers.”
Indeed, Cygnet has faced controversies over the care it provides to vulnerable patients. In 2019, staff at one private hospital run by the company were filmed taunting, intimidating and repeatedly restraining patients with learning disabilities or autism.
Earlier this year, Goodair and Oxford colleagues published a study linking privatisation to worse patient care. In 2022, they published research associating outsourcing with 557 ‘treatable’ deaths over five years.
Outsourcing also leads to more out-of-area mental health placements, Goodair said.
“When trusts can’t place mental health patients themselves, and they’re using the independent sector, patients are often placed quite a large distance away from home,” he explained. “This means that they’re away from their family and support network, and the care they’re going to receive afterwards is fragmented.”
Last year, NHS England recorded 280,000 patient days of ‘out of area’ mental health placements with independent providers.
“The deterioration of NHS mental health is brutal,” Goodair said. “This goes beyond a political thing, any ideology of like, ‘privatisation bad.’ Really terrible things are happening to people who need care.”
NHS England defended the use of capacity in the private sector, telling the Big Issue: “NHS staff are working incredibly hard to treat more people than ever before across mental health services with staff in contact with two million patients a month in both community and secondary mental health settings.”
“With many patients not always getting the timely care they need, it is right that all capacity available to the NHS is used – all services must provide safe, high-quality care and deliver on the commitments in their contracts, irrespective of whether they are NHS or independent sector led.”
The new Labour government has promised to inject resources and reform into mental health care, recruiting “8,500 specially trained mental health staff” and establishing “an open access early intervention hub in every community”.
They recently pledged to uplift junior doctor salaries by 22%, and to increase other NHS staff salaries by 5.5%. There are, however, funding challenges. The outgoing Conservative government left a £20bn hole in public finances, chancellor Rachel Reeves has claimed, compelling the new government to pause former prime minister Boris Johnson’s “unfunded” pledge to build 30 hospitals by 2030.
“The argument I’ll make unapologetically is that those people who say we shouldn’t use the private sector to cut waiting lists will have to be honest about the fact that they’re telling people who can’t afford to go private that their leftwing principles say they should be waiting longer,” he wrote for the Sun in April.
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