Trends in the Private Sector

Trends in the Private Sector

Money from us (from our taxes) is passed to the government, which is passed down to the NHS to fund it. But how does the NHS department should get which money? And which departments should exist and get funded by the NHS at all?  How are private companies involved if the NHS is a public organisation?  The system set up to decide how the NHS’ money is spent is complicated, and it’s easiest if you just watch this video to understand:

[Here is a picture-of-the-nhs-structure if you can’t be arsed to watch it. The main thing to note is in the centre of the picture that the purple CCGs are choosing which green providers to buy services from. Some of the green providers are privately run services. The bits round the sides are mainly things to help CCGs decide or regulate the services.]

Ok so that was six minutes of your life you’re never going to get back, and what does the NHS still have to do with the private sector?

In a nutshell, an element of competition between healthcare providers was first  introduced to the NHS in the 1980s. Since then the Health & Social Care Act (2012) has created Clinical Commissioning Groups (CCGs) who choose and buy services from the competitive marketplace: made up of hospitals, community health, MH, voluntary & private providers.

In this way OTs may be providing services to NHS patients, but employed by private companies.

So the majority NHS funding now determined by clinical teams (CCGs) rather than government…will this mean a better awareness of OT’s value and commissioning of our services, or not?

The NHS Five Year Forward View describes how to implement how the HSC Act (2012). Two key aspects it aims to achieve are:

  • Prevention of disease (public health etc)
  • Greater integration of services, between
    • GP + Hospitals
    • Health + Social care
    • Mental + Physical care

Some examples below of how private OTs may be more in demand, due to the current trend in the NHS for choosing services from a ‘competitive marketplace’….

Demand for private practice in… Because… Examples of the work OTs carry out…
Residential care Increase in private and voluntary residential care for elderly & disabled people, due to increasing elderly popn ★Staff training in dementia care


★Moving+handling technique

Specialist / Adapted housing Housing associations providing more specialist housing, due to need to comply with legislation eg Housing Grants, Construction and Regeneration Act (1996) ie DFGs ★Design of new homes

★Advice on adapting existing housing

★Advising private individuals/relatives how to adapt homes to meet the age/disability related needs

Children Schools or parents need report from specialised OT to allocate

Special Educational Needs (SEN)

status to a child, and support their health/education care plans. Due to increased awareness of needs & obligation to comply with legislation

★Assessing and creating SEN reports

★Independent therapy for children eg SI or dyspraxia

★Advise teachers on SEN curriculums- obliged provide the support described in Early Years Foundation Stage framework (2014)

Demand for private practice in… Because… Examples of the work OTs carry out…
Personal injury litigation / Case management Solicitors and insurance companies need evidence of the necessary £ compensation after personal injury claims.

People with serious injuries allocated an OT to manage their care after serious brain/spinal injuries.

★Creating assessment reports to demonstrate £ needs for people disabled after accidental injury

★Organising & managing the  ongoing care package for someone injured- liaising between solicitors, health providers & client

Vocational services Companies want training and advice to keep their employees healthy, reduce sickness absence.

Government wants more people who are long-term unemployed to return to work.

★Training workshops to manage workplace stress

★Vocational rehab for people out of work long-term due to illness/injury eg Jobcentre

Social Enterprises CCGs now buying services from range of providers incl voluntary/not for profit. Social enterprises are privately run but give profits back to community rather than shareholders.

Helps individuals at local level- targets particular local community needs

★Social enterprises could employ OTs to provide therapy on sessional basis or as full-time employee

★Gardening projects, Care Farms, Cafes= OTs providing input in wide range of non-traditional settings

★Eg Anglican Community Enterprise

Some benefits of working privately as an OT are  the autonomy, more competitive pay, the opportunity for emerging roles, and the fact it can expose more people to Occupational Therapy who may not think it exists outside of hospital!

Some challenges that could occur as a result of using the private sector:

★ Competition “is in the best interests of everyone in England – an assumption that underpins the Health and Social Care Act”  but no evidence exists supporting that the NHS is more efficient with added ‘competition’ from outsourcing care (Bryan Fisher, Guardian article 2015)

★ Lack of quality control- cost-cutting means fewer jobs/higher staff:patient ratio

★ Lack of accountability- private OTs aren’t regularly audited by CQC, they only need to abide by HCPC regulations

★ Potential lack of access- if no profit and practices close, patients will have nowhere to go

★ Many private insurance companies refuse to pay for “experimental” treatments, stifling creativity and only allowing interventions that have existing research evidence to be provided

★ As solo practitioner in community, can be difficult to manage extra admin/ isolation to find time to include evidence-based practice (Barrett & Paterson 2009). Also there aren’t benefits such as sick pay, pension, holiday pay built into the role

★ Need for independent OTs to manage their own CPD and supervision if no employment infrastructure for this  (Courtney 2005, Otsar & Kifshitz 2012)   [linked to possible lack of quality control above]

★ Other countries with private healthcare systems have issues like group-work not being popular due to  difficulty billing individual clients – will this become a challenge for UK OTs too? (Moyer et al 2012)



COT Specialist Section Independent Practice

Barrett D and Paterson M (2009) Private practice insights. Evidence based practice in private practice occupational therapy: perceptions, barriers and solutions. Occupational Therapy Now 11(3):8–10.

Bristow A, Rugg S, Drew J (2008) The occupational therapists in independent practice national telephone enquiry line: who uses it, why and how? British Journal of Occupational Therapy, 71(6), 234-240.

Courtney M (2005) The meaning of professional excellence for private practitioners in occupational therapy. Australian OT Journal 52(3), 211-217.

Early Years Foundation Stage framework (2014) London: The Stationery Office

Fisher B, (2015) Why patients are campaigning against NHS outsourcing, Healthcare Professionals Network. The Guardian. Available at: [Accessed February 13, 2017].

Health & Social Care Act (2012) London: The Stationery Office

Home adaptations for disabled people (2013) London:Homes Adaptations Consortium

Otsar NK, Kifshitz N (2012) Professional development among self-employed occupational therapists. Israel Journal of Occupational Therapy, 21(2), E50-1 1p.

Moyer EA, O’Brien JC and Solomon JW (2013) “Occupational and Group Analysis: Adults” In O’Brien JC and Solomon JW (2013) Occupational analysis and group process. St. Louis, Mo: Elsevier/Mosby. (107-116)