Introduction
The NHS procurement landscape is undergoing significant changes, particularly in Non-Emergency Patient Transport Services (NEPTS). This blog follows on from our previous discussion, “The pitfalls of monopoly in NEPTS,” and takes a deeper dive into how NHS Integrated Care Boards (ICBs) like https://www.surreyheartlands.org are shaping the sector, often at the expense of supplier diversity and long-term service resilience.
While outsourcing patient transport services to private providers was initially aimed at improving efficiency and reducing NHS resource constraints, recent procurement trends have raised serious concerns about monopolisation and its unintended consequences. With a single private provider (SPP) now dominating NEPTS contracts in certain regions, this has created a highly concentrated market, raising significant risks to service continuity, patient care, and financial sustainability for smaller private providers.
How ICBs created a monopoly in NEPTS
ICBs are responsible for ensuring cost-effective procurement while maintaining patient care standards. However, their recent procurement decisions have resulted in multiple NHS regions awarding all NEPTS contracts to a single provider, effectively eliminating competition.
While centralised procurement may seem like an efficient approach, history has shown that reliance on a single provider leads to inefficiencies, reduced resilience, and increased patient transport delays (NHS Support Federation, 2025) https://nhscampaign.org/ . Without alternative suppliers, the NHS is left vulnerable to disruptions, service failures, and lack of contingency planning.
The impact of monopolisation on service quality
- Increased patient wait times: With one provider handling all contracts, delays become inevitable, affecting timely patient transport.
- Lack of contingency planning: The NHS has limited backup options in case the single provider underperforms or fails to meet demand.
- Reduced service resilience: Smaller providers, who previously provided essential capacity, are now excluded, limiting flexibility.
- Strain on emergency services: Delays in non-emergency transport put additional pressure on ambulance services, diverting critical emergency response resources.
The role of Bounded Rationality in ICB procurement failures
According to Bounded Rationality Theory (Simon, 1979) https://plato.stanford.edu/entries/bounded-rationality/ , decision-makers operate within cognitive and informational constraints, leading to suboptimal procurement choices. In the case of NEPTS procurement:
- ICBs prioritised short-term cost savings over long-term sustainability.
- Decision-makers overlooked supplier diversity risks, leading to monopolisation.
- The NHS failed to consider the impact on smaller private ambulance providers, weakening overall service resilience.
These constraints resulted in procurement strategies that were shaped more by immediate financial concerns than by comprehensive, rational evaluations of supplier diversity and long-term sustainability.
Organisational Culture Theory further explains how NHS procurement culture has reinforced these poor decision-making patterns. Institutional norms focused on cost-cutting over risk management have created systemic inefficiencies, making procurement teams resistant to supplier diversity initiatives.
The devastating impact on smaller providers
Workforce sustainability challenges
- Job insecurity has risen among medical transport staff, affecting morale and retention.
- Limited HR resources have made it difficult for small providers to compete with larger firms.
- Lack of structured HR protections has made the sector more vulnerable to workforce instability.
According to Strategic Human Resource Management (SHRM) principles, workforce stability is essential for sustaining service quality. However, without NHS contracts, small providers struggle to retain talent, leading to service gaps in patient transport.
How this affects patients and NHS service delivery
- Longer wait times for non-emergency patient transport.
- Increased pressure on NHS ambulance services, as more patients rely on emergency transport.
- Higher risk of service failure, as contingency options are reduced.
- Reduced patient choice, eliminating competition and lowering service quality standards.
The way forward: ensuring a sustainable NEPTS model
Strengthen NHS procurement regulations
- Mandate supplier diversity to prevent monopolisation.
- Ensure transparent and competitive bidding.
- Implement structured decision-making frameworks to counteract cognitive biases.
Improve NHS leadership in procurement
- Train leaders in risk management strategies.
- Enhance transparency in contract awarding.
- Shift focus from short-term savings to long-term resilience.
Support SMEs and alternative providers
- Reinstate competitive contract allocations.
- Develop partnership opportunities for smaller providers.
- Encourage collaboration to foster a sustainable transport network.
Conclusion
The consolidation of NEPTS contracts under a single private provider threatens the future of supplier diversity and patient care. Without intervention, the NHS risks creating an unstable, uncompetitive transport market, with fewer providers and higher service risks.
We remain committed to advocating for supplier diversity, improved NHS procurement policies, and long-term service resilience. By implementing structured procurement reforms and embracing competition, the NHS can create a more sustainable, patient-first transport system that benefits all stakeholders.
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