The NHS is at a crossroads. Faced with mounting financial pressures, trusts are being forced to explore bold and sometimes controversial strategies to survive. Two announcements this week capture the starkly different paths on offer: one trust is turning to private patients to generate income, while another is embracing community-led models to reduce demand on hospitals. Together they illustrate the choices NHS leaders must weigh as they try to balance books and improve care.
In Dorset, University Hospitals Dorset Foundation Trust has gone to market seeking a partner for a £150m, 10-year joint venture to grow its private patient services. Currently worth £3.1m annually, its private wing lags behind peer trusts. Leaders see expansion as essential to offset the “significant” capital charges tied to a £550m hospital redevelopment, including a new site at Bournemouth.
The trust insists this venture will not reduce NHS capacity. Bidders must meet strict criteria: profits must flow back to the NHS, private activity must be in addition to planned NHS care, and staff time must be transparently reported. Still, the move raises questions about direction of travel. Does building out a commercial arm risk blurring the line between public and private, or does it offer a pragmatic way to stabilise finances and reinvest in core services?
Contrast this with West Hertfordshire Teaching Hospitals Trust, which, with Macmillan Cancer Support and Social Finance, is investing £10m in what they describe as a “neighbourhood health” model. Rather than raising income through private patients, this scheme seeks to reduce demand altogether by supporting 2,000 older people with multiple conditions, including cancer, to stay well at home.
The model starts small, 500 patients in Decorum from November, then scales to four neighbourhoods over three years. Teams of GPs, geriatricians, pharmacists and Macmillan workers will provide proactive interventions: medication reviews, home adaptations, and community support. Crucially, outcomes will be measured not only in health and cost terms, but also by patient experience. Any savings generated for the hospital will be reinvested through a community interest company, creating a cycle of preventative funding.
For chief executive Matthew Coats, this is about targeting the 4% of patients who consume half the trust’s resources. If successful, it could prove transformative. It also aligns with national ambitions to move care closer to home, reduce admissions and free up hospital capacity.
So which is the better future? In truth, both are responses to the same problem: an NHS struggling to sustain itself under rising demand and shrinking margins. Private patient ventures promise revenue. Neighbourhood care promises efficiency and resilience. Neither is risk-free. Private partnerships must guard against inequity. Neighbourhood models must prove they can deliver sustained savings.
But the contrast is telling. One approach leans on market logic, the other on community care. The choices NHS leaders make now will shape not just balance sheets, but the very identity of the health service in years to come.
