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Carly Caton, partner in commercial health at UK and Ireland law firm Browne Jacobson, says NHS bodies must look beyond traditional funding.
The NHS faces unprecedented financial pressures at a time when demand for healthcare services continues to grow, amid a rising and ageing population with increasingly complex needs.
In this challenging environment, NHS bodies must look beyond traditional funding models to explore innovative commercial opportunities.
Successful ventures can generate sustainable revenue streams while maintaining their core mission of delivering high-quality patient care.
To explore these challenges, earlier this year we hosted a roundtable that 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.
We identified a number of opportunities for trusts, either going out to market on their own or working in collaboration with the private sector, covering everything from spin-outs and shared services to international partnerships and private patient units.
Private patient units
Private patient activity is a significant opportunity for NHS trusts, although implementation can remain challenging.
Some trusts have targeted high-value specialities where competition is limited, such as robotics, transplants and reconstructive surgery.
University Hospital Dorset (UHD), for example, has set a target of a five-fold increase in private patient income, identifying Dorset as an underserved market.
Investment in internal private patient units (PPUs) and independent sector partnerships is also growing, with a shining example found in the University Hospitals Birmingham NHS Foundation Trust and HCA Healthcare UK partnership at Harborne Hospital, a £100 million private hospital that opened in 2024. Alongside two floors ringfenced for NHS patients, it features dedicated private patient facilities that generate revenue reinvested directly into NHS services.
A key commercialisation opportunity we’ve identified is in expanding NHS PPUs via partnerships with the private sector. Analysis by Regent’s Park Healthcare found that combined NHS PPU revenues in 2024/25 were about £850 million, and these are expected to grow to at least £1.2 billion by 2030/31.
Given that capacity remains the primary blocker to successful PPUs, significant infrastructure investment and staffing costs may be required. This is why many NHS trusts may prefer to partner with independent providers to expand PPU provision.
Key legal considerations when expanding a PPU include identifying the right partnership structures, such as a joint venture, employment contracts, competition and subsidy control regulations, data security, insurance arrangements and potential procurement arrangements.
A clear communications strategy is vital to overcome any opposition against PPUs on the grounds it may be viewed as privatisation of the NHS.
International strategy
International partnerships represent a substantial but complex revenue stream requiring significant commitment and patience.
The NHS brand carries significant competitive advantage overseas, and international strategy has become a natural progression from domestic PPU development, with the Middle East identified by many trusts as a high-value market.
Imperial College Healthcare NHS Trust has developed an International Affiliate Network programme, which provides education and consultancy support around clinical pathways and quality to new hospitals globally. It reported that delivering healthcare to private patients and overseas visitors was worth £74.2 million in 2024/25, while research and development income was £55.8 million.
Great Ormond Street Hospital’s (GOSH) Learning Academy, which provides employees with continual support, education and training to enhance skills, has been leveraged to land contracts from countries including Qatar, the UAE and Saudi Arabia. It offers international fellowships – placements of up to two years – that are run at a profit, with salary and education costs met by host countries, while GOSH also delivers education locally in Middle East hospitals.
Trusts operating branded facilities in the Middle East have found commercial success – King’s College Hospital, operating through its wholly owned subsidiary, King’s Commercial, opened a Dubai facility in 2019 and a hospital in Jeddah in 2025. Some trusts are expanding further, alongside digital health work in Saudi Arabia. However, growth has begun to plateau, prompting exploration of new delivery models.
However, fragmented engagement allows the NHS to be picked off, with strong calls for a unified front, particularly in the Middle East. The King’s International Consortium, which brings together six NHS providers under a single co-ordinated offering, is one direct response to this challenge.
Any trust exploring international partnerships will need to consider legal issues such as partnership structures, risk assessment, governing law, intellectual property (IP) protection and anti-bribery compliance.
Innovation and intellectual property
While spin-outs have proven effective in higher education, the model has yet to translate as successfully into the NHS, which is a hotbed for innovation that remains an underexploited opportunity.
Data and intellectual property from research and development frequently leak out without capturing commercial value.
However, there are good examples among leading trusts in commercialising research via spin-outs, industry partnerships, software licensing and digital health ventures.
Moorfields Eye Hospital has an ongoing collaboration with Google DeepMind to investigate how AI-driven retinal scanners can give clinicians a better understanding of eye disease, leading to earlier detection and treatment for patients while also helping to avoid cases of preventable conditions.
Meanwhile, Great Ormond Street Hospital For Children has an innovation pipeline that includes partnerships with major technology companies and a broad range of opportunities across AI deployment, data commercialisation and drug development, all led by its internal innovation unit GOSH DRIVE.
Since rolling out its AI-scribing tool TORTUS for automating clinical documentation during consultations with patients, the trust has received interest from other public sector organisations to use this in their workplaces, bringing potential revenue generation.
Public-private partnerships in healthcare are also driving cloud and data infrastructure investment, while joint ventures with pathology and other specialist service providers present further potential.
Synnovis, a partnership between Guy’s and St Thomas’, and King’s College Hospital NHS Foundation Trusts, and international medical diagnostics provider Synlab UK & Ireland, is the most established model of this kind. Operating as an integrated hub-and-spoke pathology network, it features a hub laboratory and on-site hospital laboratories as “spokes”, releasing more than 7,000 square metres of NHS real estate.
However, another DeepMind partnership – one signed with Royal Free Hospital NHS Foundation Trust in 2016 – remains a defining example of NHS data generating commercial value for a private partner without an equivalent return to the NHS.
The organisations collaborated on the development of Streams, a mobile app designed to instantly alert clinicians to patients at risk of acute kidney injury, but the trust retained no intellectual property rights. There is also an ongoing class-action lawsuit filed by 1.6 million patients against Google and DeepMind regarding how their private medical records were originally accessed and processed.
This underscores the importance of trusts taking proactive steps in the early stages of any commercial partnership to protect IP and data, while establishing revenue distribution from the outset of any contract negotiation.
Diversification beyond clinical services
Some trusts have looked beyond traditional healthcare delivery to develop new commercial models.
Northumbria Healthcare NHS Foundation Trust created NHS Fleet Solutions, a salary sacrifice car leasing scheme specifically for public sector workers. Over two decades, it has processed more than 100,000 vehicles across 300 public sector organisations. It also runs Northumbria Healthcare Textile Manufacturing, which operates a factory that makes personal protective equipment for staff across the UK, boosting supply during the Covid-19 pandemic. Other trusts rent out underutilised space for training, education and recreational purposes.
There is an increasing recognition among NHS commercial teams regarding the urgency of developing sustainable revenue streams.
While private patient care and international partnerships represent the most mature opportunities, there are many avenues to explore across a diverse range of revenue streams, with innovation a particularly underutilised area for commercialisation.
Success requires fundamental cultural change, sophisticated stakeholder management, co-ordinated 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.
