From commodification to entrepreneurialism:how commercial income is transforming the English NHS

IMPACT The authors explore the way in which National Health Service (NHS) organizations in England are becoming more entrepreneurial through seeking more commercial income. As a form of commodification, commercialization has become more salient because of tightened public spending and the relaxation of regulations governing the scale of commercial income that the NHS could earn (since 2012). In turn, a stronger entrepreneurial ethos and practice has developed. The purpose and impact of commercialization is examined using secondary data from six NHS organizations (narrating developments post-2012), demonstrating the extent of and their justifications for commercialization. Recent and planned changes are explained. These income-generation activities, which are often set up to support or maintain existing NHS services, may unwittingly accelerate further commercialization—particularly in post-pandemic recovery. The authors conclude that the NHS risks becoming predicated upon commercial logics, thereby undermining public service logics. ABSTRACT Commodification of health services involves objects that can be traded—private patients’ facilities, treatments for international patients and the development of joint ventures and trading entities. This article explores the extent to which the NHS in England is becoming more commercial in its aims and practices, and how this is being justified. The authors focus on the commercial income of six NHS trusts who are thought to be at the forefront of this development. The income the trusts are generating is examined using the lens of competing institutional logics and of Polanyi’s ‘double movement’ thesis.