The analysis, conducted by health and care charity The King's Fund, finds that more than one in four NHS mental health inpatient beds is being outsourced.

Researchers at The King's Fund conclude that use of independent sector beds has gone ‘far beyond acting as valuable surge capacity' and instead has become a core part of mental health provision in England.

The analysis shows that between January to March 2025, NHS trusts reported almost 18,000 available mental health beds, 89.5% of which were occupied. However, this new analysis finds that in March 2025 there were an additional 7,195 beds available in the independent sector for use by the NHS. This equates to approximately 29% of NHS-funded mental health bed capacity in England being provided by the independent sector.  

The researchers say the NHS has little choice – using the independent sector appears to be the only option when demand outstrips NHS inpatient capacity. 

In addition, the research finds that independent providers are providing an increasing proportion of care for people with the most complex needs and who are the most vulnerable, including those with a diagnosis of a personality disorder, and people with learning disabilities and autism.

Researchers at The King's Fund argue this raises concerns about transparency, as the independent sector is not subject to the same level of data collection as NHS providers. They warn it could leave national and local leaders with less information about patient experience and patient outcomes, including for some people with the most complex needs.

There are several factors that may be driving the lack of NHS mental health bed capacity, according to the researchers. This includes many years of low capital investment in mental health buildings and equipment, as well as insufficient support in the community to keep people well. 

Siva Anandaciva, director of policy at The King's Fund, said: ‘Our analysis reveals that there has been a significant increase in the share of NHS mental health inpatient care being outsourced to independent providers. Far beyond acting as valuable surge capacity, the NHS has become reliant on the independent sector for delivery of routine mental health care. This exposes the health service to greater risk of higher costs, could leave patients facing longer stays in hospital, and means the public has less transparent data about the quality of services. 

‘For the NHS to be sustainable in the long term, there needs to be far more focus on providing care in the community that keeps people well. Traditionally, the mental health sector has made great progress in delivering community-based care. However, some patients with greater or more complex mental health needs may need inpatient care, and the NHS must do all it can to treat people in the appropriate setting for their health needs.'

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Rebecca Gray, NHS Confederation mental health director, said: ‘With bed occupancy rates in NHS mental health trusts consistently over the safe limits recommended by the Royal College of Psychiatrists, independent sector provision can provide much-needed capacity in some areas.

‘While our ambition should be to reduce the need to admit patients in the first place by continuing to improve community mental health services and prevent crisis and admission, some patients will still need inpatient care when they are very unwell. As such, all hospital provision – whether in the NHS or independent sector – must meet the highest possible standards of care and safety.

‘With limited capital available, it is important that we continue to see active engagement between the NHS and independent providers in strategic discussions about appropriate and cost-effective use of high-quality independent sector capacity.'

Unison general secretary Christina McAnea said: ‘Leaving the NHS with an increased reliance on private firms for these services is a false economy. It costs everyone more, delivers less and reduces accountability for patients. There's also a risk government ambitions to shift care out of hospitals will be in tatters.

‘The damage done to adult social services by years of underfunding and privatisation is plain to see. History cannot be allowed to repeat itself with mental health. It's high time ministers made good on their insourcing promises. Properly funded, publicly delivered mental health services will benefit patients, staff and taxpayers.'