Enhancing opportunities for inward investment in clinical service provision

Attracting inward investment into clinical service provision represents a significant opportunity for the NHS to expand capacity, improve service delivery, and address systemic challenges.

Successfully leveraging this investment requires a strategic approach to overcome barriers such as public scepticism, workforce shortages, and fragmented infrastructure. By fostering transparent partnerships, aligning investments with national health priorities, and implementing innovative models, the NHS can create a collaborative environment that supports sustainable growth while maintaining its core mission of equitable healthcare delivery.

Recommendation 5: A structured framework for international investment

Establish a structured framework for international investment to ensure private sector investment delivers tangible public benefits. 

Rationale: The absence of a well-defined approach to ensure that private investment supports public benefit has undermined trust and fuelled hesitation in utilising international investment to drive NHS growth. The lack of a clear proposition that defines specific service needs aligned with national health objectives has created significant barriers to attracting international investors, limiting the NHS’ ability to address critical service gaps.

The NHS 10 Year Plan and the 10 Year Infrastructure Strategy have explicitly encouraged the continued use of private sector capacity to support NHS service delivery in areas of high need and underperformance. These national strategies emphasise the importance of attracting international investment in key areas such as medical research, digital health, and innovation-led care models, presenting a timely opportunity to establish a structured framework to channel investment in ways that strengthen NHS delivery while safeguarding public benefit.

Overseas investment in the NHS presents a complex challenge of balancing opportunities for growth with public concerns about profiteering and private sector involvement in public healthcare. Public sensitivity around the idea of private or foreign entities profiting from the NHS has led to cautious government attitudes, influencing how such investments are structured and communicated. While the government explores private sector involvement to alleviate pressures like waiting lists, ensuring fairness and transparency is paramount. Initiatives such as the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG), which channels profits from medicine sales back into the NHS, provide a model for structuring agreements that balance profitability with public benefit.

Transparency and clear safeguards in investment agreements are essential to build trust and prevent negative perceptions. Lessons from past experiences in the social care sector, such as privately operated children’s homes and aged care facilities, highlight the risks of inadequate oversight and the potential for profits to be diverted offshore.

Investment frameworks should prioritise job creation, patient outcomes, healthcare innovation, and maintaining the NHS’ global leadership status while safeguarding public interests. Strategic communication is critical to ensuring that investment is framed as a means to enhance NHS capacity and quality, rather than as a step toward privatisation, thereby addressing public concerns and securing buy-in for essential funding.

Public-Private Utilisation (PPU) models and risk-sharing agreements provide an effective way to attract private investment while aligning with NHS priorities. These frameworks must balance investor objectives with public needs, maintaining transparency and accountability. Contracts must be clear and straightforward, offering flexibility while protecting the public interest. Where appropriate, clauses requiring a portion of international investors’ profits to be reinvested into the NHS should be included, safeguarding sustainability and delivering tangible benefits for patients and the healthcare system.

International models, such as the ‘certificate of need’ approach, demonstrate how structured frameworks can address specific service gaps—such as in cancer care—by inviting private investment to develop targeted solutions. However, barriers like unclear infrastructure programmes and challenges in integrating external investment into NHS operations have limited success. Defining service needs more clearly and aligning them with national health objectives is crucial to overcoming these issues and maintaining public trust.

By introducing PPU and Public-Private Partnership (PPP) models that balance immediate system pressures with long-term goals, the NHS can improve operational efficiency, leverage private sector expertise, and foster strategic partnerships. These measures will ensure private sector involvement enhances healthcare delivery, fosters innovation, and supports the NHS’ sustainability and capacity to meet future healthcare needs.

These contracts must be straightforward, transparent, and aligned with NHS priorities, ensuring investor goals are balanced with public needs and compliance with law and regulation including consideration to subsidy control. Where appropriate, contracts could include clauses requiring a portion of international investors’ profits to be reinvested into the NHS, safeguarding sustainability and delivering clear benefits for patients and the healthcare system.

Recommendation 6: A comprehensive healthcare workforce strategy

Develop a comprehensive healthcare workforce strategy that simplifies qualification recognition, ensures high professional standards, and supports cultural integration for international practitioners. 

Rationale: The lack of effective integration strategies for foreign-trained healthcare practitioners hinders their contribution to addressing workforce shortages and meeting the NHS’ operational and strategic needs.

The integration of foreign-trained healthcare practitioners represents a vital component of inward investment. The UK’s withdrawal from the Mutual Recognition of Professional Qualifications (MRPQ) with the EU has complicated recruitment, requiring unilateral recognition frameworks that ensure high standards while streamlining the process for international practitioners. Foreign-trained doctors already represent a significant proportion of the NHS workforce, with one quarter of NHS Staff being foreign nationals in February 2024.3

To maximise this form of investment, a healthcare workforce strategy should address the following considerations:

• Migration challenges and qualification recognition: Streamlining the recognition of foreign qualifications across borders, while maintaining professional standards, is essential to reducing recruitment barriers and ensuring a steady flow of skilled practitioners into the NHS and the development of a sustainable global clinical workforce more broadly.
• Cultural integration: Successfully integrating international practitioners into the NHS requires addressing cultural fit and providing mentorship, tailored training, and adaptation programmes to enhance collaboration and contributions to patient care.
• Governance barriers: Restrictive immigration policies, including Brexit-related changes and limitations on the Health and Social Care visa, exacerbate workforce shortages and hinder access to international healthcare professionals. Advocating for a more flexible and long term immigration framework is essential to expanding the workforce and supporting the adoption of new technologies and innovations within the NHS and across the global health sector.

Foreign-trained healthcare professionals play a critical role not only in addressing workforce shortages but also in contributing to the NHS’ broader operational and strategic goals. By viewing these practitioners as a form of inward investment, integrating ‘people as investment’ into workforce strategies, the NHS can enhance its capacity and tackle systemic gaps in service delivery.

Recognising their potential requires targeted efforts to provide international clinical training programmes, streamline qualification recognition, improve cultural integration, and ensure these professionals are fully supported to thrive within the UK healthcare system and beyond.

Additionally, the NHS must address key operational inefficiencies and align policy frameworks to unlock sustainable funding opportunities. While insourcing may help meet immediate needs, such as Referral to Treatment (RTT) criteria and urgent patient care, it often comes at a higher financial cost.

A balanced approach that leverages economies of scale and strategically incorporates external expertise can alleviate these pressures. However, long-term success will depend on policies that strengthen support for NHS workers and reduce dependency on costly outsourcing models.

Integrating ‘people as investment’ into workforce strategies should be a core focus of NHS reforms. Recognising foreign-trained healthcare professionals as an essential component of inward investment through streamlined qualification processes and improved support systems will not only address workforce shortages but also expand the NHS’ capacity to deliver high-quality care.

These efforts, combined with strategic operational improvements, can ensure the NHS remains resilient, and prepared to meet future healthcare demands. These efforts must be underpinned by a commitment to support circular migration, bilateral trade agreements and capacity-building incentives to help foster a sustainable global workforce, benefitting both the UK and countries from which talent is drawn.

Combined with strategic operational improvements, this approach can help ensure the NHS remains resilient and prepared to meet future healthcare demands.

Recommendation 7: Simplify NHS procurement processes

Simplify NHS procurement processes between NHS organisations to attract and streamline investor engagement.  

Rationale: Current NHS structures are highly fragmented, consisting of 232 trusts, 42 Integrated Care Boards (ICBs), and numerous other organisations, each managing procurement at a local level. This fragmentation leads to significant duplication of effort, creating barriers for investors.  

To address these challenges, it is crucial to simplify and standardise procurement processes across trusts and ICBs. A unified approach would enhance accessibility for investors, eliminate inefficiencies, and expedite decision-making.

Additionally, procurement reforms should incentivise social value by rewarding commitments to job creation, partnerships with local businesses, and investments in sustainable solutions. This aligns with the Government’s priorities of economic growth, high quality job creation, innovation, and delivering social and economic value in the National Procurement Policy Statement of 13 February 2025 (while the NPPS focuses on UK suppliers only the aims are similar and recognised).

These changes would not only attract investment but also ensure long-term benefits for communities and the environment.

Recommendation 8: Align inward investment with a UK health data strategy

Align inward investment with a UK health data strategy to unlock the value of NHS data assets and attract global investor.

Rationale: The lack of a national infrastructure for digital healthcare solutions and a clear strategy for leveraging health data as an investment asset limits the NHS’ ability to attract inward investment and scale innovative technologies. 

Positioning the NHS as a leading destination for inward investment requires a targeted focus on the integration of digital health and health data, and an ability to use and share this data, into its strategic offerings. MedTech, digital health, and health data represent lower-risk and high-growth opportunities, closely aligned with global healthcare trends.

The NHS’ vast health data assets should be a central component of its investment strategy, offering unique opportunities for innovation and development. To achieve this, the Government must implement the recommendations of the Data Saves Lives strategy and accelerate the aggregation and integration of primary, secondary, community, and social care datasets.

Removing the silos in which this data is held will support unlocking the full potential of these assets and drive inward investment, enhance patient care, improve the ability to prevent ill health and foster system-wide innovation while maintaining stringent privacy and ethical standards.

Additionally, the NHS must address regulatory and legal barriers to international data sharing, particularly with countries that lack data adequacy agreements. Establishing secure, ethical, and transparent frameworks for data exchange will enhance the appeal of the NHS to global investors, ensuring that its data strategy aligns with both national and international objectives. It will also allow the NHS to benefit from MedTech that it does not have but which can open up the understanding of difficult to treat health problems, such as cancer and long terms neurological diseases.

Aligning inward investment with a comprehensive UK Health Data Strategy will enable the NHS to fully leverage its unparalleled data resources to improve operational efficiency, patient outcomes, and system-wide innovation. By integrating health data into its investment strategy, the NHS can attract global investors, enhance its digital capabilities, and solidify its position as a global leader in healthcare innovation and data-driven care.