Insured healthcare activity reached a peak in Q4 2025 according to Healthcode’s latest analysis of invoice volumes. The UK’s official clearing organisation processed 3 million invoices for private healthcare providers in the final three months of the year, up 5% on Q3 and 5% compared with Q4 2024.
This took the annual invoice total for 2025 to 11.8 million, up by just under 4% compared with 2024 (11.4 million), generating £7.5billion revenue for the sector. The increase in Q4 was most marked in October which proved to be the busiest month of the year with 1,081,582 invoices. It was the fourth month to exceed the million milestone in 2025, compared with three in 2024 and none at all in 2023.
Healthcode’s invoice data is an important indicator of the healthcare market because private hospitals and more than 70% of practitioners, practices and clinics use its secure Clearing Service to charge for insured patients. As well as measuring healthcare activity, the data can also be analysed for insights about episode settings, specialties and regions.
Healthcode’s Managing Director, Peter Connor said: “2025 was the fifth successive year that private hospitals, clinics and healthcare professionals raised their level of activity. As more patients experience high quality diagnostic investigations and treatment for themselves, it’s not surprising that researchers are finding a positive view of the sector across a broad spectrum of the population, while providers have more opportunities to invest in their facilities, digital services and AI-powered healthcare. So, while there’s been a natural moderation in the rate of growth, we’re still confident that the sector is in great shape as we head into 2026.”
Here are the headlines from Healthcode’s analysis of PMI invoice activity in Q4 2025:
Treatment setting
Invoices submitted by hospitals were on a par with Q4 2024 while those from non-hospital sources increased by an average 8%.
Q4 saw the highest level of outpatient invoices (2.76 million) which was up 5.8% year-on-year while admitted volumes (279,751) fell by 2.9%. However, both were up on Q3 by 5% and 4% respectively.
The total annual invoice volume for outpatients was 10.7 million (up 4.2% year-on-year) while for admitted episodes it was 1.1 million (down 0.5%).
Hospital specialty
Orthopaedics was the busiest hospital specialty in Q4 with 198,000 invoices which was up on Q3 (189,000) by just under 5%. The annual total of 768,000 was up 7% from 2024 (718,000). Radiology was second with 127,000 which was up by just short of 9% on Q3 (117,000) but the annual total of 482,000 was down 5% on 2024. Hospital Physiotherapy invoice volumes of 80,000 in Q4 (79,000) were up fractionally on Q3 (79,000) while the annual total of 328,000 was on a par with 2024.
40,000 cardiology invoices were processed in Q4, up 5% on Q3 (38,000) while the annual total of 160,000 represented a significant 8% rise compared with 2024.
Countries and regions
Of the UK countries, hospitals in Wales had the best Q4, exceeding 2024 PMI volumes by 12% when averaged across the three months. Scotland was a close second (up 10%) and had a good 2025 overall with higher year-on-year volumes in ten out of twelve months. There was no significant change for hospitals in England in Q4 and average growth for 2025 was just under 2%.
Most English regions had a better Q4. The exceptions were London and the North West where year-on-year hospital volumes were down 6% and 3% respectively when averaged across the three months. The North West had the most challenging year overall: with insured invoice volumes lagging behind 2024 in seven months while London hospital volumes were lower in five months. Both posted anaemic growth across the year. By contrast, the South West performed strongly in Q4 (up 11% on average) and recorded invoice volumes above 2024 in nine out of 12 months (up just under 10% across the year).
