As the need for innovation intensifies across most sectors, Josh Langley, Co-Founder of LCI discusses how NHS Trusts and Boards can best approach Insourcing. He also explores why the NHS’s best chance at balancing patient need, workforce wellbeing, and financial sustainability is through a carefully constructed and bespoke Insourcing model. If the NHS are to eliminate waiting breaches by March 2026, this may be the most significant solution to maximise resources in a safe and cost-effective way.
Is Insourcing the Answer to NHS Waiting Lists?
‘Ministers are facing calls to tackle the NHS’s chronic lack of staff as figures reveal that the bill for hiring temporary frontline workers has soared to more than £10bn a year.’ (Guardian, 2025). As the NHS continues to weather some of the most intense pressures in its 76-year history, the need for exceptional third party support heightens. Faced with mounting waiting lists, workforce shortages, alongside funding gaps, many NHS Trusts and Boards are looking to Insourcing to solve a large proportion of their issues, specifically in relation to backlogs and bottlenecks.
With a target set by the government to eliminate 52-week waiting breaches by March 2026, NHS leaders are forced to think differently. Insourcing is emerging as a powerful and impactful alternative. It offers the potential to improve service delivery, reduce costs, and reassert control over standards of care. But can it deliver on this promise in the face of deepening financial and political uncertainty?
Let’s explore the case for Insourcing, and what needs to happen for it to become a long-term solution for the NHS.
The Waiting List Crisis
NHS England reported that over 7.5 million people are currently waiting for elective treatment. Of those, more than 300,000 patients have been waiting for over a year. Behind every number is a person living with pain, uncertainty, and/or deteriorating health. There is also a workforce that is stretched to what is often described as breaking point.
Though Trusts and Boards have been working tirelessly to tackle this backlog, capacity limitations, lack of staff, and rigid funding streams have made it incredibly difficult to make a significant dent in the numbers. The consequences are more than just clinical: long waiting times undermine public trust in the NHS and increase pressure on primary and emergency services.
What Is Insourcing?
Insourcing vastly differs from Recruitment. In an NHS context, it involves bringing clinical services and personnel into NHS facilities to deliver care, typically during evenings or weekends, using the Trust’s existing infrastructure. Rather than sending patients to private providers, or relying on costly agency or locum staff, Insourcing allows Trusts and Boards to retain control over quality, standards, and delivery.
It’s an increasingly common model for Endoscopy, Radiology, Elective Surgery, Dermatology, ENT and Ophthalmology and outpatient appointments. Though it is not merely plugging gaps. Insourcing represents a philosophical shift; a move towards sustainable and flexible capacity-building within the public health system.
Insourcing vs Outsourcing: Control and Continuity
Outsourcing has played an important role in expanding access to care. But it has come at a cost, financially and operationally.
In outsourced models, patients are sent to external providers, often in private hospitals or mobile units. While this approach can deliver rapid results, it typically removes the NHS Trust from direct oversight of the patient journey, increasing risks related to continuity of care, record-keeping, and even patient safety.
By contrast, Insourcing enables the Trust to maintain direct governance over the clinical setting, systems, and personnel. This means better integration with the Trust’s pathways, closer alignment with NHS values, and, crucially, greater consistency for patients.
Additionally, Insourcing reduces reliance on premium-spend locum and agency staffing, which has ballooned in recent years. According to NHS data, agency staffing cost the NHS over £3.4 billion in 2022/23, a figure that is widely viewed as unsustainable.
Political and Financial Uncertainty
While Insourcing presents operational benefits, it cannot be viewed in isolation from the wider political and financial environment.
The disbanding of NHS England (NHSE) and the absorption of its functions into the Department of Health and Social Care (DHSC) marks a dramatic alteration in how health policy is managed in the UK. This structural change brings with it risks of increased politicisation, as long-term health planning becomes tied to short-term political cycles.
With each new government potentially bringing its own policy priorities, Trusts and Boards may find themselves constantly having to pivot, making it difficult to commit to long-term Insourcing strategies. As Trusts and Boards are increasingly accountable to central government targets, rather than an independent health authority, the pressure to deliver results quickly, often without additional funding, will grow.
The Case for Insourcing: Value, Control, and Sustainability
The appeal of Insourcing lies not only in cost control, but also in the opportunity to build something more enduring.
Here are the primary benefits:
1. Improved Workforce Planning
Insourcing allows Trusts and Boards to plan staffing more effectively, reducing last-minute gaps and promoting greater continuity for staff and patients alike. Over time, this helps build more robust, reliable services.
2. Cost Efficiency
While initial investment may be needed to set up insourced models, the long-term savings, especially compared to agency or locum staffing, can be significant. Some Trusts and Boards have reported savings of up to 25-40% compared to outsourcing equivalents.
3. Better Use of NHS Facilities
Evenings and weekends often see under-utilised theatre space or clinics. Insourcing allows Trusts and Boards to make full use of their existing assets, without the logistical and transport challenges of outsourcing.
4. Improved Patient Experience
With care delivered on-site and integrated into existing systems, patients are less likely to experience fragmented or duplicated services. Communication between departments improves, and outcomes are easier to track.
5. Alignment with NHS Values
Unlike outsourcing, which may carry the reputational risks of working with profit-driven private providers, Insourcing reinforces NHS values: care based on need, continuity, and quality.
So Why Isn’t Everyone Doing It?
Despite its clear benefits, Insourcing is still under-utilised across the NHS. Why?
In part, it’s because of a lack of centralised strategy or support. Trusts and Boards often pursue Insourcing in isolation, meaning best practices are not always shared, and systems can be slow to develop. There’s also a misconception that Insourcing is merely a stopgap measure, rather than a viable long-term operational strategy.
Additionally, legal and procurement hurdles can delay implementation. Trusts and Boards need clear frameworks and trusted partners to deliver insourced services without unnecessary complexity.
Finally, there is a cultural barrier: the NHS has long been built around siloed services and funding streams. Insourcing demands cross-departmental coordination, data-sharing, and long-term planning, all of which require investment in leadership, digital infrastructure, and clinical governance.
What Needs to Change
If Insourcing is to become a central part of NHS recovery, five key things need to happen:
- Clear National Policy GuidanceThe DHSC and NHS England must provide Trusts and Boards with a clear, supportive framework for insourcing, including best practice models and funding guidance.
- Investment in Infrastructure To support increased use of NHS facilities out-of-hours, Trusts and Boards need resources to upgrade digital systems, workforce planning tools, and clinical environments.
- Workforce Engagement Insourcing cannot be a top-down directive. Trusts and Boards must engage clinicians and other healthcare staff in the planning and implementation of insourced services to ensure buy-in and sustainability.
- Data and Outcomes Tracking There must be rigorous data collection on insourcing outcomes, patient safety, waiting times, cost-effectiveness, so that successful models can be scaled and adapted.
- Long-Term Funding ModelsTrusts and Boards need more than one-off funding pots. Sustainable insourcing requires multi-year investment plans that factor in pay, training, and capacity-building.
A Future-Focused NHS
The truth is this there is no silver bullet for the NHS’s current challenges. However, Insourcing may be one of the most pragmatic, values-aligned tools available.
Used wisely, it allows Trusts and Boards to do more with what they have, to expand care without sacrificing quality, to future-proof without over-reliance on costly, short-term fixes. It’s not just about trimming agency bills; it’s about designing a healthcare system that values its workforce and puts patients at the centre.
But this won’t happen by accident. It will take leadership, collaboration, and vision. The NHS deserves more than temporary fixes. It deserves strategies that deliver now, and simultaneously prepare for the future.
What Are Your Thoughts?
Is insourcing the NHS’s best shot at balancing patient need, workforce wellbeing, and financial sustainability?
We’d love to hear from clinicians, managers, and patients on how we make insourcing work. For everyone.
