The must-read stories and debate in health policy and leadership.

Is it right for the NHS to generate income from private paying patients? That’s the question raised by leaked NHS England draft guidance, which encourages trusts to tap into what it says is a “significant source of material opportunity in the NHS”.

The practice is most common in London, where some of the country’s most well-known trusts generate substantial income from privately paying patients, some of whom travel from overseas.

Supporters say the controversial practice can be done without affecting core NHS work and generates much-needed revenue that can be re-invested to benefit patients, while critics argue it inevitably diverts attention from health service waiting lists.

There’s also the optics: as the Nuffield Trust put it, it’s hardly a good look for trusts to be promoting opportunities for private payers when the waiting list for NHS care could hit a record 14 million. The think tank’s Sally Gainsbury told HSJ: “Scarce NHS capacity should be focused and prioritised on treating NHS patients and bringing these unacceptable waits down, not capitalising on the growth in the private treatment market on the back of this unprecedented backlog of care.”

Enough is enough

Almost every trust in the country is extremely busy at the moment, juggling high covid admissions, emergency pressure and elective recovery targets, so it may come as no surprise this is having a disruptive effect on training and education.

This has been the case throughout the pandemic – from the beginning, covid has had a profound impact on the experience of trainees, particularly junior doctors, who need to hit a certain number of competencies to progress in their career.

NHS England has decided enough is enough and last week wrote to trust leaders, urging them to prioritise training and clinical supervision, despite the pressures they are facing.

HSJ has understood this letter was prompted by concerns from senior sources that trainees are being messed about and in some cases used as an extra pair of hands.

But with the best will in the world, do trusts have capacity to prioritise training? And are trusts being given mixed messages? They shouldn’t be in a situation where operational recovery and training recovery are at odds, but it seems they are.

Also on today

In our comment section, Georgia Butterworth says trusts must resolve tensions between local and regional priorities if we are to avoid a return to centralisation, and in news we reveal that two national reviews are taking place into hospital discharge policy.