How to build a long-term and mutually beneficial relationship with the NHS

First published on Healthcare Markets.

A ‘new agreement’ between the NHS and private sector will be welcomed by independent healthcare providers, but turning a short-term window of opportunity into a long-term partnership requires skill and expertise. Carly Caton, Partner at UK and Ireland law firm Browne Jacobson, explains how providers can develop a lasting partnership with the NHS that in turn drives financial, health and innovation benefits for all. 

In calling for closer collaboration between public and private healthcare, the Prime Minister is aiming to shift perceptions regarding the role of the private sector in the NHS.

While such moves inevitably attract an ideological backlash from sections of the public of “NHS privatisation”, despite private sector involvement having been the case for years, the government recognises the importance of narrowing the gap given the scale of financial and resource pressures facing state healthcare provision.

The immediate objective of making facilities and resources in the private sector available to the NHS is obvious – clearing the 7.5 million-strong NHS waiting list for planned treatment – but the inference here is this will be a short-term exercise to address emergency provision.

Therefore, the challenge handed down to independent providers is how they can turn this  window of opportunity and favourable wind to work with the world’s largest state health service into a long-term partnership.

This is not a new objective for the independent sector, but achieving longevity between the NHS and private sector depends on the ability to understand how the NHS operates and partners with others, its entry points, and where commercial operators can fit into a complex jigsaw in order to drive long-lasting benefits such as revenue stream growth, innovation and, ultimately, better patient outcomes.

Here are some of the ways in which the private sector can work with the NHS to do this.

Private patient units

Increasing private patient activity within the umbrella of NHS hospitals by working in partnership with a trust’s private patient unit (PPU) is one route to developing further collaboration between the public and private sectors.

Most trusts already run PPUs – separate rooms or wards within NHS hospitals, or sometimes a dedicated facility, for private patients – but the majority are relatively small, meaning they provide untapped economic potential.

Given that PPUs are ideally placed to serve high acuity or high complexity treatment, their potential is particularly large outside London, where lower private patient demand strengthens the argument to share services.

World-class examples of PPUs run “in-house” can be found at Royal Marsden and Moorfields Eye Hospital, funding pioneering research and treatments in cancer and eye care.

However, many smaller PPUs can’t expand alone. Julian Hartley, former CEO of NHS Providers, cited Harborne Hospital in Birmingham as a “successful example of NHS and private sector collaboration” in this space. HCA Healthcare UK and University Hospitals Birmingham NHS opened the 50-bed, multi-speciality private hospital in January 2024.

Partnership structures for PPUs can extend from commercial agreements to developing some form of physical expansion to estates. These options are being looked at by NHS organisations up and down the country.

Developing commercial activity through partnerships

NHS trusts are increasingly branching out beyond their state healthcare duties to establish joint ventures with private partners, as well as corporate or contractual partnering arrangements, with profits being circulated back into the trust.

With corporate ventures, trusts may retain control over the organisation or may be the minority stakeholder (there will be balance sheet treatment and other considerations to take into account). Partnership opportunities are available to the private sector in supporting NHS entrepreneurialism in this way.

Joint ventures are typically used to develop or expand clinical and non-clinical services, technologies or facilities that can generate income in any number of areas.

The Christie NHS Foundation Trust has a successful joint venture private care arm with HCA, the Christie Private Care LLP, which operates as a specialist cancer treatment centre on The Christie Campus. It has pioneered technology such as robotic surgery and cytoreductive surgery.

Provider collaboration for long-term joint working

Independent providers can sometimes get involved with provider collaborative models. Examples include the South West Provider Collaborative (SWPC), a partnership of five NHS organisations, one community interest company and two independent providers.

It commissions a wide range of specialised mental health, learning disability and autism services at scale to a population of five million people across six integrated care systems, with a focus on ensuring people receive high-quality care as close to home as possible. As the lead provider, Devon Partnership NHS Trust holds the NHS England contract.

The SWPC has collectively agreed a shared set of strategic aims that enable all provider partners to unite around a common vision for improving patient services across the South West, providing mutual benefits for all stakeholders and the taxpayer.

Exporting expertise

In an international context, trusts boast a huge amount of expertise that other countries would love to tap into in order to drive the same standards of quality and safety in their hospitals.

Therefore, opportunities are increasingly available for trusts to export their insights and services by providing consultancy, management services and training to healthcare providers abroad.

Often, trusts will join a consortium alongside other public and independent healthcare providers, universities and private sector suppliers, such as building contractors and digital services companies to respond to opportunities.

The UK International Healthcare Management Association (UKIHMA) is a good place to begin as it comprises members from across the public, private and third sector, which work together to provide expert, integrated healthcare services to international clients.

Maximising assets

The private sector can play a central role in supporting NHS trusts to maximise key assets that may have been underutilised until now.

Businesses could help trusts to generate revenue by renting out estates and facilities to develop commercial real estate projects, or offer parking and retail services.

The government is also reviewing the New Hospital Programme to put it on a more “realistic, deliverable and affordable footing”. Like other parts of public infrastructure that require renewal, it feels likely the limited reach of the public purse will continue to require private sector investment in new infrastructure projects.

Businesses can bring best practice on initiatives such as diversity, equity and inclusion deployed within their own organisation as part of a deeper partnership approach that supports NHS recruitment and retention efforts.

Supporting innovation

The new government’s long-term vision to move from a curative to preventative healthcare system will rely upon innovation and effective adoption of emerging technologies.

Biosciences, pharmaceutical and digital companies, along with universities, should identify opportunities to collaborate with trusts on research and development programmes that will explore the use of digital health initiatives to increase efficiencies and improve patient outcomes.

A partnership approach will be important more broadly to help develop new services, technologies and facilities that will have both cost-saving and commercial benefits.

Strolll, which uses augmented reality technology as neuro-rehabilitation and physical therapy for patients with neurological conditions like Parkinson’s disease, partnered with Leeds Teaching Hospitals NHS Trust for proof-of-concept and feasibility studies in its early phase. It has since raised millions in equity funding and grants, won a series of NHS contracts and registered with the FDA to open sales to the US market.

Investing time in nurturing relationships from the ground up is important when working with the NHS. A good starting point is to register with the NHS Innovation Service and connect with your local Health Innovation Network.