HSJ’s revelation that the NHS is spending in the region of £2m a year subsidising private patients raises serious questions about how some trusts manage them.

Up to a third of private patients in NHS hospitals are being undercharged, with some being billed for only about 30 per cent of the average cost of a major operation.

This bizarre twist in the continuing controversy over private patient income comes as the Foundation Trust Network has had an amendment to the Health Bill passed by the Lords allowing the health secretary to permit exemptions to the private patient income cap where it is deemed to be in the interests of the NHS.

Great Ormond Street, heavily dependent on private income, will no doubt be at the front of the queue for securing derogation.

But HSJ’s investigation shows trusts need to get a grip on their handling of private patients. One senior manager admitted their trust simply did not have the commercial acumen.

The problems tend to be focused not on the big beasts of the acute sector, who are more likely to have effective systems in place for milking private patients, but at hospitals which are not seeking private income but are pushed into it by their consultants. The reason is often that the local private hospital cannot cope with a complex patient.

So the private hospital is let off the hook, the consultant gets paid handsomely and the NHS is out of pocket.

As the Department of Health points out, using public cash for the benefit of private patients is in breach of the NHS constitution. At a time when money is becoming scarcer, the failure is even more lamentable.

As the acute sector stumbles into the era of competition it needs to be honest with itself about the skills it will need to succeed. If a hospital is failing to work out something as simple as the cost of a private patient’s operation it is in danger of making far more expensive mistakes.