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Enterprise in the NHS given a freer rein


"Ten years ago everyone warned that NHS foundation trusts that have greater independence from central Government control - were the start of privatising the NHS. How wrong they were.

"On1st of October, the arbitrary and absurdly tight restraints on the income that these organisations can earn from beyond the NHS were lifted. The Government used to prescribe how much non-NHS income these organisations could earn and, for the vast majority, this amounted to one per cent of their income or even less.  These restrictions were put in place to ensure that NHS organisations, funded from the public purse, supposedly stayed true to their core public purpose and weren’t seduced into prioritising private healthcare over public medicine. In practice, this was always a false argument.
"The restrictions have now been dropped and, in their place, we  have a 49 per cent non NHS income limit – a safety catch to show that the majority of these organisations’ work is firmly rooted in the NHS. Given the unique governance arrangements for Foundation trusts, they will also need the majority approval of their governors – elected from staff, patients and the public – to approve an increase of 5 per cent or more in non NHS work. And they have to set out how their non-NHS income has benefited NHS patients in their annual report. This is something that these organisations will willingly and proudly do because so much of their non-NHS work shows excellence, expertise and enterprise that benefits all patients.
"Non-NHS income does not always equal private patient work – although it can do. And it is certainly not a backdoor privatisation of the NHS. Indeed, these Foundation Trusts are at the very heart of the NHS. Non NHS activity covers all sorts of activity where someone else pays – this could be employers wanting to pay for their staff to have counselling or other psychological support; trusts providing medical services for British troops abroad for the Ministry of Defence; or specialist care for foreign patients being funded by their own governments.
"The Foundation Trust Network (FTN), which represents these trusts, argued long and hard that the cash strapped NHS needs all the income it can find and that NHS Trusts should be allowed to compete with the private sector for this valuable income.
"Some of the beacons of the NHS such as Moorfields eye hospital, the Royal Marsden cancer hospital and Great Ormond Street hospital for children are those that bring in the most income from beyond the NHS. That is because they have an international reputation and first class specialist services that are valued around the world. That expertise is also fully available to NHS patients. No one would think that these centres of excellence are anything other than fully committed to the values and ethos of the NHS.
"The government is keen for the NHS to spread its expertise around the world, for instance, by training doctors abroad and setting up specialist clinics or services. The Moorfields branch in Dubai is staffed by doctors from overseas trained in London. This is not a drain on NHS expertise and  has no impact on patient care in the UK, but it does allow Moorfields to earn valuable income from abroad.
"Salisbury NHS Foundation Trust has launched Odstock Medical Limited - the first NHS owned limited company in England-  to market its specialised service worldwide. So income from its electrical stimulation devices used to treat non-NHS patients with ‘dropped foot’ brought about by stroke, multiple sclerosis or cerebral palsy can be used to develop further leading edge technologies that benefit NHS patients.  
The private maternity unit at Chelsea and Westminster NHS FT has a 24-hour consultant anaesthetist who helps out with NHS care when there are out-of-hours emergencies. The private maternity unit generates £2 million a year that is reinvested to help the trust provide excellent care for all NHS patients. Some of the income from the private unit has been used to pay for a consultant and an academic working on pioneering research in neonatal medicine.
"There are a number of Foundation Trusts who would not have been able to offer leading edge technology to NHS patients without the subsidy from their private patients, as there is insufficient demand from the NHS alone. For example, one Trust has spent £6m of its non-NHS income on tomotherapy equipment providing an advanced form of radiation treatment for cancers. Others have bought a gamma knife to deliver sharply targeted radiotherapy for neurological disorders like brain tumours, and lasers for eye surgery with funds from non-NHS income.
"And when the health service does impose a ceiling on the amount of treatment the NHS can supply to individual patients, such as the number of IVF fertility treatments, trusts can offer those patients continuity of service through their private work.
"Lifting the cap is not about a wholesale expansion of private patient care in the NHS. But it is about allowing trusts to innovate so they can bring in much needed resources to improve care for NHS patients."              

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