these centres played a role in reducing the price paid for ‘spot purchases’ with private providers. previously when the nhs had made use of the independent sector on an ad hoc basis, it often paid 40-100% more than the equivalent cost to the nhs. in the nhs improvement plan: putting people at the heart of public services, published in 2004, there was an expectation that the independent sector would supply up to 15% of nhs services by 2008, but this figure was not reached. rules to prohibit nhs consultants from charging "top-up fees" to nhs patients for extra services were clarified in 2008 to make it clearer that paying for chemotherapy treatment not available on the nhs would not prevent patients from subsequently accessing nhs treatments. when the coalition government introduced what became the health and social care act 2012 it appeared to pave the way for a bigger role for private companies, but the impact of austerity on nhs budgets meant that take up of private capacity was low. in september 2018 it was said that the private sector in england had the capacity for around 100,000 additional inpatient procedures in the last six months of 2018-19. although nhs waiting lists had risen significantly there did not appear to be any concrete plans to employ private providers to reduce it. since early 2017 private provision had been steadily about 6% of the total nhs caseload for elective surgery according to nhs gooroo. as of recent years, the private sector accounts for approximately 10% of elective care, with this split evenly between nhs funded and private funding of care costs. controversy the issue of privatisation of health services was an issue in the 2015 united kingdom general election. the government's position was that "use of the private sector in the nhs represents only 6% of the total nhs budget - an increase of just 1% since may 2010". it is unclear what this statement meant. some nhs services, such as dentistry, optical care and pharmacy, have always been provided by the private sector and, technically, most gp practices are private partnerships. all the drugs, supplies and equipment used by the nhs are privately provided. taken together this amounts to around 40% of the nhs budget. in addition some nhs organisations subcontract work to private providers. the nhs accounts for 2013/4 show that £10 billion of the total nhs budget of £113 billion was spent on care from non-nhs providers. the main growth in private provision has been in mental health and community health services. any qualified provider any qualified provider was a government policy intended to encourage all nhs, private, third sector or social enterprise health service providers to compete for contracts on an equal footing. scotland scottish health boards spent at least £130,866,841 on private providers from 2015 to 2018, about 0.5% of the budget compared to 7.3% in nhs england. mental health further information: mental health in the united kingdom private provision of psychiatric beds has been largely financed by the nhs, as few psychiatric patients have the means to finance their own treatment and health insurance does not often extend to mental health. 1,700 beds were closed by nhs mental health trusts from 2011 to 2013. as a result, large numbers of patients are admitted in crisis to private institutions, often in remote locations. the cost is around £500 per day. most residential care for children is privately provided. in 2019 laingbuisson predicted annual growth in the market, currently worth about £1.9 billion, of 5.2% for independent providers of nhs-commissioned mental health care between 2018 and 2023 because the nhs is focussing on community services, not institutional care. after series of scandals in services run by cygnet health care, nhs england set up an independent oversight board in october 2019 to scrutinise inpatient mental health, learning disabilities and autism services for children and young people and a taskforce to make a rapid set of improvements in care. the board will be chaired by the children’s commissioner for england, anne longfield. simon stevens said at the launch of the board that a “sometimes-inappropriate” level of private provision in mental health inpatient services should be squeezed “as nhs mental health services expand”. performance one of the criticisms of private care in the uk has been that private providers are not required to produce sufficient information about their services to permit comparison with nhs services. it is suggested that surgery in private hospitals may be dangerous because of inadequate equipment, lack of intensive care beds, unsafe staffing arrangements, and poor medical record-keeping. in 2018 it was reported that about 7,000 patients were transferred to the nhs each year from private facilities due to a lack of facilities to deal with problems in the private sector. staff who also work for the nhs may not be available for support when needed. most private hospitals do not have an intensive care unit, so if it is needed an ambulance must be called. a patient died from sepsis after bowel surgery to remove colon cancer at the independent berkshire hospital, run by ramsay health care uk, in 2017. failings in treatment led the coroner to call for a review of the way private hospitals monitor warning signs of serious problems with patients. nursing staff did not follow the national early warning score protocol. according to the independent expert the problem should have been suspected and detected five days before death and had it been, he would have survived. the care quality commission reported in april 2018 that 30% of the 206 independent acute hospitals required improvement, mostly because of a lack of formalised governance procedures. information about performance is collected by the private healthcare information network. they say that only 0.12% of admissions to private hospitals result in an emergency transfer to the nhs.