Specific FOI exemptions highlight ongoing transparency challenges in fully accounting for the public funds directed to private healthcare
Northern Ireland’s Health and Social Care Trusts are increasingly reliant on the private sector to deliver medical procedures, treatments, and diagnostic services for NHS patients, with spending soaring into the tens of millions of pounds each year. New figures obtained by Belfast Live reveal a dramatic increase in the amount of public money being channelled to private healthcare providers across the region since 2020.
In the five financial years between April 2020 and April 2025, the combined total spend on private healthcare appointments by the Health and Social Care Trusts in Northern Ireland totalled at least £302,203,303.
The unprecedented expenditure comes as Trusts grapple with persistent pressure on services and lengthy waiting lists. Earlier this year, the Health Minister announced a series of measures aimed at reducing health waiting lists, including partnership arrangements with independent sector providers to clear outpatient waits of four years plus in Ophthalmology, Orthopaedics, General Surgery, Gynaecology, ENT, and other specialities.
The Belfast Health and Social Care Trust, the largest in Northern Ireland, has seen its spending on private providers jump from £12,599,429 in 2020/21 to a peak of £25,438,526 in 2022/23. While figures for 2023/24 (£20,547,305) and 2024/25 (£16,488,781) show a recent decline, the overall trajectory since 2020 remains significantly higher.
The South Eastern Health and Social Care Trust also reported a consistent rise, from £10,079,801 in 2020/21 to £15,739,426 in 2024/25.
In the Southern Health and Social Care Trust, private spend more than tripled over five years, escalating from £4,607,000 in 2020/21 to £14,687,000 in 2024/25.
The Northern Health and Social Care Trust saw a massive increase, from £2,590,869 in 2020/21 to £12,729,082 in 2022/23, before showing a decrease in the most recent years.
While the Western Health and Social Care Trust could not provide overall annual financial totals due to system limitations, their detailed breakdown of expenditure by speciality as part of their Waiting List Initiative framework confirmed the ongoing use of private providers. This included spending of at least £694,458 in 2020/21, rising to £12,790,072 in 2022/23, and £8,947,033 in 2024/25 and may not represent their total overall spend on private healthcare.
The FOI responses reveal a broad spectrum of services being outsourced to private companies. These include diagnosic scans such as MRI, CT, Ultrasound, and X-rays are frequently provided and reported by private firms like Alliance Medical Radiology, Everlight Radiology, and 4ways.
It also included a wide range of surgeries and treatments across specialities such as Orthopaedics at Orthoderm and the Sports Surgery Clinic, Dermatology, including procedures at Belfast Skin Clinic and Cathedral Dermatology, Gynaecology, Gastroenterology (Endoscopy procedures), Urology, and Ophthalmology, such as cataracts, from providers including Spa Medica Limited.
The spending has also included mental health services, notably, Adult Autism Spectrum Disorder (ASD) assessments and the Western Trust confirmed that since September 2022, a number of Financial Capacity Assessments have been undertaken by private Consultant Psychiatrists.
Several private providers consistently appear across multiple Trusts, indicating their significant footprint in Northern Ireland’s healthcare landscape. These include 352 Medical Limited, Alliance (Medical/Clinical Services), and Orthoderm.
While the spending figures are substantial, obtaining precise patient and procedure numbers linked to this expenditure proved challenging across some Trusts.
The South Eastern Health and Social Care Trust provided patient numbers, showing a fluctuation from 30,083 patients in 2020/21 to 36,847 in 2024/25. The Northern Health and Social Care Trust reported covering between approximately 11,000 and 21,000 patients annually through private spend.
The Belfast Health and Social Care Trust provided detailed activity for new and review outpatients, inpatient, and daycase procedures, alongside imaging scans, noting some data gaps due to system limitations or cost exemptions
However, the Southern Health and Social Care Trust stated that recording patient numbers centrally for private spend was not feasible, and a manual trawl would exceed FOI cost limits of £450.
The Western Health and Social Care Trust also cited cost limits for not providing Gynaecology patient numbers and withheld the names of single private providers for commercial confidentiality reasons, arguing it could prejudice future tendering processes.
These exemptions highlight ongoing transparency challenges in fully accounting for the public funds directed to private healthcare, making it difficult to ascertain the exact volume of NHS patients being treated by the private sector or the specific commercial details of these contracts.
Responding to the figures, People Before Profit MLA Gerry Carroll said: “The Department’s eyewatering spend on private healthcare is completely unacceptable. The more money invested in the profit-making private sector, the less money there is to invest in building capacity within the public healthcare system.
“This stealth privatisation has disastrous impacts on the HSC workforce and patients alike. Outsourcing care to private companies will only widen health inequalities – a significant challenge that the Minister repeatedly claims he wants to tackle, but has failed to act on.
“Relying on private providers to tackle waiting lists and ease pressure on our health service is a dead end. While healthcare CEOs line their pockets, working class people are dying on waiting lists. The Health Minister must stop funnelling money into the private sector, and invest directly into our health and social care system and its workers.”
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