Intended for healthcare professionals


Hospitals will be able to earn 49% of their income from private patients from October

BMJ 2012; 345 doi: (Published 17 July 2012) Cite this as: BMJ 2012;345:e4823
  1. Zosia Kmietowicz
  1. 1London

NHS hospitals in England will be able to increase the proportion of money they earn from private patients to 49% from 1 October, the Department of Health has announced.

The change to how much money foundation trusts can earn from non-NHS work was introduced in the Health and Social Care Act.1 The original bill had said that there was nothing to stop a foundation trust from making all its money from private patients. But during its passage through the House of Lords peers voted in an amendment that said that most of a hospital’s work must be NHS, meaning that 51% of their income should come from treating NHS patients.

All of England’s 248 trusts are expected to become foundation trusts in the next couple of years. However, doubts have been raised that at least 20 will not meet the financial criteria to be granted foundation status,2 and many others may need to merge or be taken over to become foundation trusts.3

When foundation trusts were created in 2002-3, the amount of income they could earn from non-NHS work was capped at a level set at what they made from private patients at the time. However, some specialist cancer and children’s hospitals had caps of up to 30%.

In December a health department spokeswoman said that raising the cap to 49% for all foundation trusts would allow them to expand the range of services they offered.4 “This does not represent privatisation of the NHS,” she said. “Services for NHS patients will be safeguarded, because foundation hospitals will still have as their core legal purpose a duty to provide services to them. The amendment we are making provides further reassurance on this duty.”

Ron Singer, a retired GP and currently president of the Medical Practitioners’ Union, part of the union Unite, told the BMJ, “The setting of the date for NHS hospitals to be able to generate private income up to 49% of their budget is the clearest evidence yet that the intention of the government is to enable private sector involvement to interfere with the running of the NHS as a public service.

“It is inevitable that when an NHS hospital gets into financial trouble it will try to increase its income from private patients, putting NHS patients at the back of the queue – a retrograde and regressive step.”

In December Labour’s shadow health secretary, Andy Burnham, said that the move was the clearest sign yet of the government’s determination “to turn our precious NHS into a US style commercial system, where hospitals are more interested in profits than people.”4 “This free market NHS reorganisation opens the door to an explosion of private work in the NHS, meaning longer waits for NHS patients,” he said.


Cite this as: BMJ 2012;345:e4823


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