This second roundtable in our ‘Maximising commercial revenue for the NHS’ series brought together commercial directors and leaders from across NHS trusts, alongside representatives from the Department of Health and Social Care (DHSC) and the Imperial College Health Partners Health Innovation Network, to take stock of where the NHS stands in its commercial journey – and to have an honest conversation about what is working, what is not, and what support is still needed.

The session was co-chaired by Carly Caton, Partner in commercial healthcare at Browne Jacobson, James Thompson, Group Chief Commercial Officer at University Hospitals of Liverpool Group. 

The discussion captured a mixture of genuine appetite and acknowledgement over inexperience across key issues such as intellectual property (IP) protection and partnership structures, characterising much of the NHS's current approach to income generation.

Where trusts are on their commercial journey

The opening exchanges made clear that, even within this self-selected group of commercially minded NHS leaders, there is enormous variation in maturity and ambition.

Some organisations are approaching the limits of what their existing infrastructure can support and are actively planning structural transitions – including moves towards wholly-owned subsidiaries – to create headroom for the next phase of growth. Others have established private patient units generating significant revenues and are now looking beyond their initial models towards technology, infrastructure and international activity. One trust cited revenues of £63m with a target of £100m over the coming years.

Examples provided of commercial activities being pursued included:

• Private patient activity remains the most mature avenue, with several organisations investing in high-acuity, high-margin work including transplants and overseas referrals, and others preparing to open new specialist facilities with private revenue forming a significant part of the model.
• Education and training, including international programmes, are increasingly important, with the NHS's clinical expertise recognised as a genuine and monetisable asset.
• Industry partnerships, particularly with diagnostics and MedTech companies, represent significant potential, though procurement rules create real constraints. One notable example involved an exclusive regulatory sandbox relationship that has attracted strong industry interest but requires careful governance.
• For community and mental health providers, niche trust-to-trust services — including regional training and leadership programmes — offer a more accessible starting point, though aspirations around private clinical services require careful navigation of reputational risk.

Not everyone is at an advanced stage. Some are still consolidating ad hoc projects into a coherent operational vehicle; others have only recently recovered momentum lost during the pandemic. The specific challenges facing mental health and community providers were noted, with participants pointing to the reputational and cultural complexities that arise in those settings compared to acute care. 

There was a consensus, however, that the question is no longer whether the NHS should be commercially active, but how best to structure and accelerate that activity.

Role of Health Innovation Networks

Matthew Wyatt, Innovation Lead for Commercial and Partnerships at Imperial College Health Partners, which is one of 15 Health Innovation Networks (HINs), described HINs as honest brokers sitting between the health system and the private sector. 

A central theme was the shift away from "just throwing pilots at the system", a model that does not reliably work. The approach now is to understand what both sides genuinely want from a relationship before crystallising what a partnership should look like.

For smaller innovators, this means helping them thrive and scale within the system and ensuring trusts benefit appropriately. For larger companies, it means identifying genuine strategic synergies rather than transactional arrangements. 

One participant noted that innovations do not always fit the priorities of the health system nearest to where they were developed, suggesting that innovators should be encouraged to connect with HINs across the country rather than defaulting to their immediate geography – a point that speaks to the need for better national co-ordination.

From transactions to partnerships

One of the most substantive discussions concerned the distinction between transactional commercial relationships and the more embedded co-investment partnerships that many in the room are aspiring to. The consensus was that the latter are both more valuable and considerably harder to deliver.

A recurring frustration was the gap between genuine appetite on both sides and the practical ability to get a partnership across the line – on governance, shared costs and liability before a project reaches viability. 

The call from participants was for DHSC to consider mobilisation funding: support that kicks in once an organisation can demonstrate a viable, repeatable business case. Without it, there is a real risk of deepening the two-tier dynamic that is already visible across the NHS, where organisations with established innovation offices accelerate while those without that infrastructure are left behind. 

The importance of having governance conversations early, before ambiguity creates the conditions for a breakdown, was also strongly emphasised.

Getting a fair deal via intellectual property protection

IP ownership generated much discussion. The challenge begins with an organisation's own governance: many employment contracts are old and do not address modern innovation scenarios, and honorary or dual roles at the interface between NHS trusts and universities add further complexity. 

A key message was to start early and establish clarity about who owns what at the beginning of a relationship, not after the fact.

The most practically useful contribution came from Dr Michael Watts, CEO of Blum Health, who suggested turning the ownership question on its head. 

Rather than asserting from the outset that the trust owns the IP – a position that can immediately put an innovator on the defensive – the more productive question is how the trust can support the individual to get their innovation off the ground. 

A trust is a rocket booster, Dr Watts argued, as it can provide infrastructure, credibility and networks. But innovations may outgrow the trust over five to 10 years, possibly after the original innovator has moved on. 

Revenue sharing and ongoing commercial arrangements can allow a trust to maintain a stake in long-term value without needing to assert outright ownership – and going in hard on ownership is often the moment a project breaks down entirely.

How the Department of Health and Social Care is supporting NHS commercialisation

The growth and income generation team at DHSC outlined the Department's practical support for trusts across several interconnected areas: knowledge assets and IP, international healthcare partnerships, commercial sponsorship, financial structures, procurement and the development of dedicated commercial capacity within trusts.

During the discussion around DHSC's role, participants asked for better access to shared learnings and best practice, and real-time visibility of policy development to help de-risk commercial decisions in internal conversations with boards. 

The DHSC is developing a procurement sponsorship approach to signal to the market that the NHS wants deeper, longer-term supplier relationships. There was strong agreement that the NHS's collective spending power is significantly underutilised, and that demonstrating what leverage looks like in practice for one organisation opens doors for the rest of the system. 

A commercialisation playbook is also being developed to provide practical toolkits, building on existing IP guidance for NHS trusts.

Looking ahead: Key priorities for building NHS commercial growth

The roundtable closed with a shared sense that momentum is building, but that the structural and cultural conditions for NHS commercial activity to thrive at scale are still being put in place. Three priorities stood out.

• First, better knowledge-sharing mechanisms are needed – the DHSC playbook will help, but regional networks and partnerships between like-minded organisations were also identified as valuable vehicles.
• Second, early-stage funding support is needed to prevent the commercialisation agenda from being captured by the organisations already furthest ahead.
• Third, partnerships need to be approached with greater deliberateness – understanding what each party needs from a relationship, and structuring governance, funding and IP clearly from the outset, rather than hoping that goodwill carries projects through.

The NHS is ready to grow, and the task now is to give that growth the structure and support it needs to deliver at scale.

Read part one of our NHS commercial revenue roundtable series.