Maximising commercial revenue for the NHS: Post-event summary

This roundtable brought together commercial directors from NHS trusts and sector experts to share experiences and explore opportunities for generating additional income for trusts from commercial activity.

What was once considered optional has become essential for long-term financial sustainability, with the 10-year health plan and ongoing reforms requiring trusts to shift from short-term crisis management to sustainable revenue generation.

The discussion covered private patient units (PPUs), international partnerships, spin-outs, digital innovation, and shared services amongst other things, with participants sharing practical insights on overcoming barriers to commercial success.

Key themes

1. Private patient care: Untapped potential

Private patient activity emerged as a significant opportunity for NHS trusts, though implementation can remain challenging.

Strategic opportunities

• Some trusts have transformed from historically non-commercial organisations to ones with substantial ambitions following market research that identified untapped potential.

• Trusts benefiting from minimal local competition are prioritising high-value specialties including robotics, transplants, and reconstructive surgery where unique selling propositions are strongest.

• Trusts are increasingly investing in internal PPUs while exploring partnerships with the independent sector to help them expand.

Critical challenges

• Capacity constraints remain the primary blocker across all trusts.

• Private medical insurance (PMI) negotiations create significant frustration for PPU leaders, with participants discussing whether NHS PPUs could form a consortium to negotiate collectively (though competition law concerns were raised regarding potential cartel behaviour).

• Political and cultural sensitivities around privatisation require proactive communications with councils, MPs, the public, and internal stakeholders to ensure the narrative is clear - we are making extra money to be reinvested in NHS care.

• Scaling barriers: Achieving meaningful growth requires substantial infrastructure and staffing investment that can prove prohibitive.

2. International commercialisation: Long-term opportunity

International partnerships represent a substantial but complex revenue stream requiring significant commitment and patience.

Established models

• Trusts are operating branded facilities in Dubai (with some expanding with a second wing) and Jeddah, focusing on sustainable private patient revenue.

• Some trusts have developed work in Saudi Arabia alongside digital health initiatives.

• Trusts with successful international private care units have seen growth plateau, prompting exploration of different delivery models.

Strategic considerations

• Market evolution: International hospitals are developing in-house / in-country capacity and capability, but referral pathways will still persist for patients preferring treatment outside their home countries from some jurisdictions.

• The NHS brand carries substantial power overseas, creating competitive advantage.

• Trusts in competitive private healthcare markets (such as London) have found international strategy to be a natural progression from domestic PPU development.

• Participants emphasised that the NHS allows itself to be "picked off" through fragmented international engagement, with calls for presenting a unified front, particularly in the Middle East.

Regulatory and partnership opportunities

• UAE-UK Business Council identified as effective for opening doors.

• Discussions with regulators about fast-tracking medtech and AI regulation, plus leveraging the UK's diverse population for clinical trials.

• Consultant-to-consultant learning programmes alongside patient care to deepen partnerships.

3. Stakeholder engagement and cultural change

Successfully implementing commercial activities requires sophisticated internal communications and cultural transformation.

Effective messaging strategies

• Frontline engagement: Ward-level discussions identified as most effective communication method.

• Transparent revenue allocation: Demonstrating that revenue from each service returns directly to that service creates clinician buy-in and incentivisation.

• Myth-busting exercises: Team meetings addressing misconceptions (e.g., clarifying that staff working on commercial activities remain NHS staff under the contracts of employment (unless a different model is agreed / implemented).

• Public benefit narrative: The message that NHS private patient activity supports the NHS rather than shareholder profits resonates powerfully with both staff and patients who might otherwise avoid using private medical insurance. And the optics of ensuring it is clear that all commercial activity is for the benefit of the NHS core purposes is also key.

Leadership requirements

• Board buy-in essential but can involve "walking through treacle" to achieve.

• CEO communication at town hall meetings explaining how additional revenue supports job retention proves valuable.

• PPU leadership requires commercial acumen combined with NHS cultural understanding.

• Governors often prove "most tricky," requiring careful explanation that private work occurs at the margin without affecting NHS patients.

4. Risk appetite and organisational mindset

Risk aversion and cultural mindset represents a fundamental barrier to commercial growth across the NHS.

Current state

• Trusts noted that commercially-driven decisions have been conservative, with organisations needing to understand that low-risk opportunities become riskier over time without bold action.

• Participants highlighted the challenge of getting trusts to see themselves as both commercial organisations and NHS providers simultaneously.

• Taking on risk remains "the biggest challenge in NHS" - partnerships may be less risky but potentially less fruitful.

Structural solutions

• Wholly-owned subsidiaries can provide flexibility for innovation separate from joint venture constraints, though patience is required.

• Market trend towards partnerships for rapid PPU expansion.

• Need to shift boards into "start-up mode" thinking to deliver 10-year plan objectives.

5. Innovation and intellectual property

Protecting and capitalising on NHS innovation emerged as an underexploited opportunity.

Challenges

• Spin-outs work well in higher education but not as effectively in the NHS yet. But there is a lot of opportunity here.

• Data and intellectual property from research and development frequently "leak out" without captured value.

• Legal complexities around IP ownership in international partnerships.

Opportunities

• Leading trusts are successfully commercialising research through spin-outs and industry partnerships.

• Software-as-a-service businesses and digital health initiatives showing promise.

• Public-private partnerships important for cloud investment and data infrastructure.

• Joint ventures with pathology partners and other specialist services.

6. Diversification beyond clinical services

Participants shared examples of innovative revenue streams beyond traditional healthcare delivery.

Proven models

• Car leasing businesses serving the wider public sector.

• Manufacturing: Factories initially built for PPE have become significant revenue sources; acute LLP projects across multiple trusts for septic medicine manufacturing combining supply chain consolidation with efficient manufacturing.

• Commercial space utilisation: Generating £60,000 net profit in some instances.

• Training and education suites: Monetising expertise and facilities.

• Shared services: Still in infancy but offering substantial commercial opportunities.

Common barriers to commercial success

1. Capacity and resource constraints affecting ability to deliver on commercial ambitions. 
2. Organisational culture resistant to viewing NHS trusts as commercial entities. 
3. Political sensitivities around privatisation accusations. 
4. Risk-averse decision-making at board level. 
5. PMI negotiations creating frustration and limiting private patient growth. 
6. Fragmented approach to international markets rather than coordinated NHS positioning. 
7. Competition between trusts rather than collaboration. 
8. Scaling barriers requiring substantial capital investment.

Recommendations for further exploration

Participants identified several areas warranting deeper investigation:

• Neighbourhood health models as a commercial opportunity.
• Improving NHS spin-out mechanisms to match higher education success.
• International private care delivery models and coordinated market approach.
• Data commercialisation and IP protection strategies.
• Innovation hubs and maximising benefits through private sector partnerships.
• Shared services commercial opportunities.
• Board engagement strategies to increase risk appetite and adopt start-up thinking.
• Contracting expertise when dealing with large-scale commercial organisations to minimise risk.
• Challenging public perceptions on NHS commercialisation versus privatisation.

Conclusion

The roundtable demonstrated that NHS commercial directors recognise the urgency of developing sustainable revenue streams, with private patient care and international partnerships representing the most mature opportunities. 

However, success requires fundamental cultural change, sophisticated stakeholder management, coordinated rather than fragmented approaches to market, and boards willing to embrace calculated risk. 

The shift from viewing commercial activity as a "nice to have" to a strategic necessity is underway, but significant barriers remain around capacity, risk appetite, and organisational mindset. 

Those trusts achieving success emphasise the importance of consultant engagement, transparent revenue allocation, and leveraging the unique power of the NHS brand both domestically and internationally.