The history of the private patient income cap

  • March 2006 - Monitor publishes the NHS Foundation Trust Financial Reporting Manual for 2005-06. Private patient income is interpreted as income from charges on goods and services provided for purposes other than those of the NHS, excluding income received from associates, joint ventures, or investments. The guidance is consolidated by section 44 of the 2006 Health Act.
  • 20 September 2007 - Unison writes to Monitor objecting to their interpretation of private patient income.
  • 6 December 2007 - Monitor tells Unison it will reconsider its interpretation of private patient income, and the following month the 2007-8 NHS Foundation Trust Financial Reporting Manual is published, with a blank space where the private patient income guidance would normally be.
  • 1 February 2008 - Unison launches a judicial review.
  • 20 February 2009 - An amendment to remove section 44 from the 2006 Health Act is moved by crossbench peer and chair of East London Foundation Trust Baroness Meacher, developed by the Foundation Trust Network. It introduces a responsibility for hospitals to “demonstrate the benefit to their NHS patients” of their private income. This is later withdrawn after the government whip Baroness Thornton says it is unworkable.
  • 11 February 2008 - Monitor starts a consultation process.
  • 26 November 2008 - Monitor’s board admits its interpretation was “too permissive” and amends its guidance for private patient income to include income from joint ventures or associates of the trust. The revised text is published in 5 January 2009 in the NHS Foundation Trust Financial Reporting Manual for 2009-10.
  • 13 May 2009 - The House of Lords votes to allow the government to make “exceptions” to the cap, provided it is “in the interests of the NHS”, passing a new amendment moved by Baroness Meacher.
  • 21 May 2009 - An HSJ investigation reveals that up to 30 per cent of private patients are getting hundreds of thousands of pounds of treatment subsidised by the NHS each year.
  • 12 October 2009 - The government announces a rapid review of the private patient income cap. Health minister Mike O’Brien says the cap is “not fair” and not operating “in the way we want to see it operate”. A clause is introduced in the Health Bill 2009 to increase the cap from 0 to 1.5 per cent for mental health trusts only.
  • 3 November 2009 - The judicial review begins.
  • 9 December 2009 - The High Court rules Monitor has been unlawful in its interpretation of the private patient income cap.