Adam Brenton, Director of Specialist Care Services at Compass Associates, explores what self-pay growth, the diagnostics shift and the expansion of digital health mean for hiring across private healthcare this quarter.
“Self-pay is still growing on the back of long NHS waiting lists, and providers I speak to expect that to continue for another 12 months. At the same time, digital health is broadening out well beyond the patient-facing apps we used to focus on, into diagnostics, medicines and the systems that run hospitals and community services.”
Across private healthcare in Q3 2026, self-pay demand continues to climb as NHS waiting lists remain stretched, surgical vacancies are ticking back up, and AI keeps working its way into diagnostics. Alongside that, we are seeing early but real momentum in digital health, as the market moves beyond the patient-facing apps that have traditionally defined the space and into the systems, data and infrastructure behind care delivery.
This builds on the themes we set out after Q2, when investment in diagnostics and oncology was accelerating and the candidate market was at its strongest point of the year. Three months on, growth in those areas is still there, but it is now sitting alongside a familiar cycle in surgical hospital recruitment teams, and a broader question about how far the UK is keeping pace with the rest of Europe on healthcare technology.
Self-pay keeps climbing as NHS waiting lists stay high
Surgical vacancies are increasing again this quarter, something we track every month. It may prove cyclical, and it is linked in part to funding, but the trend is clear in the data. The clearest driver behind it is self-pay. Long NHS waiting lists mean more patients are choosing to pay to be seen rather than wait, and that demand shows no sign of slowing.
The pattern is not even across providers. Groups with strong self-pay reputations, including HCA, Spire and Nuffield, are performing well as self-pay income grows. Ramsay Health Care, which is more NHS-led, has had a tougher year as NHS contract income comes under pressure. Private medical insurance, by contrast, is plateauing at a fairly steady rate.
When I attended the HealthInvestor Healthcare Summit 2026 in London last week, the CEOs of Nuffield and Bupa both said they expect self-pay to keep growing for at least another 12 months. Beyond that, the picture depends on the NHS. Its targets for reducing waiting lists over the next 12 months look realistic, but the ramp-up after that is expected to be much faster, and providers may see the benefit differently, through NHS-funded elective surgery rather than self-pay, if the NHS moves seriously to hit those timelines.
Diagnostics growth is moving from clinical delivery into sales and management
We have historically focused on the clinical side of diagnostics, radiographers, sonographers and similar roles, but the growth in this sector is increasingly in sales and management capacity, and we are shifting our own focus to follow it.
AI is a significant part of why diagnostics is growing. It allows images to be interpreted more quickly, and it helps prioritise workloads by clinical urgency, so a patient with a suspected cancer diagnosis can move to the top of a list rather than waiting in turn. That matters directly for the pressure on NHS waiting lists, and it is one of the clearest examples of AI changing how care is delivered rather than simply supporting it.
AI was a consistent theme at the Healthcare Summit more broadly, alongside a recurring sense that the UK is behind the rest of Europe, both on technology adoption and in some of the commercial decisions being made within the NHS. One question raised was why some hospitals are spending significant sums on regeneration or opening new units when that money could instead fund partnerships with private providers to reduce waiting lists, or be spent on more immediate needs such as maintaining core facilities in areas like A&E.
Surgical hospital groups are still caught in the same recruitment cycle
One pattern keeps repeating in the surgical hospital sector. When business is tighter or vacancies are low, groups cut central costs, often starting with internal recruitment and onboarding teams. When the market improves and vacancies rise again, they come under pressure from hospital directors and other stakeholders and start rebuilding those same teams from scratch.
One group has already restructured its internal recruitment and onboarding function once this year and may do so again. The honest advice we give to clients going through this is that it is often cheaper to hold on to the team through the trough than to lose it and pay the cost of re-recruiting, rehiring and retraining once the market turns again. By the time that cycle completes, providers may as well have kept the team they started with.
Cost pressure is building as the sector awaits the Autumn Budget
Alongside these growth trends, providers are also bracing for the next Autumn Budget, due on 28 October 2026. Employer National Insurance, the National Living Wage and general inflation have already pushed up staffing costs across healthcare and social care over the past 18 months, and any further changes to employment taxes or business rates in the Budget would add directly to that pressure, at a time when many providers are also trying to fund investment in diagnostics, digital health and new site openings.
For hiring, the practical effect is similar to what we are seeing elsewhere in the sector: providers are being more disciplined about headcount and central costs, while still needing to compete for the specialist and leadership talent that supports growth. Businesses that plan hiring and pay decisions around the Budget, rather than reacting once the detail lands, are likely to be better placed to keep search timelines on track.
Leadership change continues at the top of the market
Consolidation and leadership change at the top of the sector remain a live theme too. Spire Healthcare, one of the providers benefiting from strong self-pay growth, is being acquired by Toscafund Asset Management in a deal worth just over £1 billion, and Paolo Pieri, the former chief executive of Circle Health Group, is set to join as chair once the deal completes. Pieri built a strong reputation growing Circle into one of the UK’s largest private healthcare providers, and his move to Spire is a reminder that leadership appointments at group level continue to shape how the wider market, and the roles beneath them, take shape.
Moves like this tend to have a ripple effect on hiring further down a business, as new leadership reviews strategy, structure and sometimes senior teams. It reinforces the point running through this quarter more broadly: providers that can move quickly and confidently on leadership appointments, whether prompted by growth, cost pressure or a change of ownership, are the ones best placed to capitalise on where the market is heading.
Investment is concentrating in clinical specialisms and oncology
Our consumer care work is performing particularly well at the moment, though it is not yet clear whether that reflects a genuine shift in market demand or simply that we are getting more traction as a business in that space. What is clearer is the growth we are seeing in oncology, where we are supporting a provider that is actively looking to expand its offering.
At the Healthcare Summit, leaders were asked where they would direct £100 million of investment if it was available to grow their business. Every answer pointed to a specific clinical specialist area, oncology among them.
That fits a pattern we see with self-pay patients more broadly: when someone is paying for their own care, particularly for something as serious as a cancer diagnosis, they want a provider that specialises in exactly that problem rather than a generalist service.
Digital health is broadening well beyond patient-facing apps
The clearest area of new growth for us this quarter is digital health, and specifically how much wider the market has become. Historically, our focus has been on patient-facing digital health providers. We are now getting involved across a much broader set of verticals, working from a market estimated at $5.5 billion.
Using the LaingBuisson report as a starting point, we mapped out where investment in the market is moving: emerging technology and innovation, diagnostics, medicines, primary care, community and mental health, acute and enterprise systems, and patient engagement. In practice that spans everything from at-home monitoring, virtual wards and drone delivery of prescriptions, to telehealth and online consultation, social prescribing, and the administrative and clinical record systems that run hospitals, community and mental health services.
We have a longer-term plan to build out a dedicated hire in each of those verticals. Whatever the specific system or technology, these businesses still need clinical leadership at the top, directing the service, working alongside the technical teams that build and run it.
What advice am I giving to hiring managers within healthcare?
Hold on to recruitment capacity through the quiet periods
The cost of dismantling an internal recruitment or onboarding function during a slow period is rarely recovered by the savings it produces. Providers who keep a lean team in place through the trough are better positioned when vacancies rise again, and avoid the cost and delay of rebuilding from scratch.
Look for diagnostics candidates with sales and management experience, not only clinical backgrounds
As diagnostics growth shifts toward sales and management, providers that continue to search only within traditional clinical pools will find the market narrower than it needs to be. Broadening the brief to include strong commercial and operational candidates opens up a much wider pool.
Build genuine clinical specialism into any expansion plan
Self-pay patients are increasingly choosing specialists over generalists. Providers investing in growth, whether in oncology or elsewhere, should be building leadership and clinical teams around a clear area of specialism rather than a broad general offering.
Start building digital health capability now, not once the market matures
Digital health is widening quickly, and the strongest candidates in the newer verticals, such as at-home monitoring or clinical systems, are still relatively scarce. Providers that begin building relationships and search capability in these areas now will be better placed than those waiting for the market to mature further.
Looking for expert support with your recruitment needs?
Our healthcare team has a clear view of where the market is moving, which organisations are growing, and where the leadership gaps are emerging. Whether you are actively looking to hire or want to understand your options, we are happy to have a confidential conversation.