The number of people in England paying for private medical treatment has risen sharply, with nearly one in seven now opting to bypass the National Health Service for non-urgent care, new analysis reveals.
Data indicates 16% of people reported using private services for treatment or diagnostic tests in the past year, a significant jump from just 9% in 2023. The trend is being driven overwhelmingly by long NHS waiting lists, which have become the primary reason for going private. In 2025, 39% of those who paid cited excessive NHS waits as their main motivation, overtaking perceived better quality of care, which was the leading factor two years prior.
A System Divided by Means, Not Need
This accelerating shift is fuelling grave warnings from patient advocates about the emergence of a permanent “two-tier” system, where access to timely healthcare is dictated by personal wealth rather than clinical need. The patient watchdog Healthwatch England has been vocal on the issue.
Chris McCann, the organisation’s acting chief executive, commented that while the NHS 10-Year Plan aims to tackle long waits for elective care, “this work needs to move faster if we want to boost patient confidence, stop the move towards two-tier healthcare, and restore the NHS as a truly universal service for all.”
The financial barrier is stark. Research shows individuals earning over £80,000 are far more likely to have paid for private treatment. This growing divide is reflected in the market’s value, which reached a record £12.4 billion last year.
The Scale of the Waiting List Crisis
The pressure forcing people to make this choice is immense. As of January this year, an estimated 6.13 million people were waiting for planned NHS care in England, with 2.7 million having waited longer than the 18-week target. The total number of open care pathways across all providers has ballooned from 4.4 million in March 2020 to 7.5 million by March 2024.
The human cost is severe. In 2023, 43% of elective patients reported their health deteriorated while waiting for hospital admission. Long waits can devastate physical health, mental wellbeing, and financial stability.
Public confidence has been deeply eroded. Recent surveys show only 32% of people are confident in getting timely NHS hospital outpatient treatment, with even lower figures for non-urgent operations (22%) and scans (28%).
NHS Efforts and Persistent Gaps
In response, NHS England points to significant efforts to tackle the backlog, including delivering record numbers of appointments, tests, and scans in 2025. A spokesperson highlighted the expansion of community diagnostic centres, surgical hubs, and extended hours clinics, noting the waiting list had been reduced to its lowest level in three years.
The government has pledged to ensure most patients are seen within 18 weeks, with an interim target of 65% by the end of March 2026. However, performance has lagged, with only 59% treated within that timeframe in March 2025.
The NHS itself is also a major commissioner of private care to manage its lists, paying nearly £3.5 billion to independent providers last year. These providers delivered over 6 million appointments for NHS patients in the 2024/25 financial year.
Inequality, Communication, and Digital Divides
Beyond sheer numbers, patient groups warn that systemic failures are exacerbating inequalities. Healthwatch England states that patients from more deprived areas and ethnic minority backgrounds tend to wait longer, and has called for waiting list data to be published broken down by demographics to address this.
Communication failures are also undermining the experience for those on lists. Patients report receiving little information beyond occasional texts checking if they still need care, with scant guidance on managing their condition while they wait.
Furthermore, while digital innovations offer convenience for some, digital exclusion and poorly integrated systems risk creating another layer of unequal access within an already strained service.
The Department of Health and Social Care, acknowledging the problem, stated: “We will end the unacceptable, two-tier, healthcare system we inherited that leaves patients feeling they have no choice but to go private.” Healthwatch and others argue that restoring a truly universal service will require not just reducing lists, but implementing promised minimum patient experience standards and tackling deep-rooted inequities in who bears the longest waits.
