Children's hospitals in the British NHS: commercial and international considerations

Patient mobility is a complex phenomenon, involving both outward and inward flows, and treatments that are more and less complex and where choice may be driven by quality and availability rather than solely cost. Public health systems in high-income and middle-income countries are facing increasing financial pressures given population ageing, a rapid rise in chronic and non-communicable diseases and fiscal restraint. In this context, the intersection of patient mobility and commodification of care provides opportunities for generating additional revenue, particularly for hospitals with a reputation for clinical excellence and innovation. The National Health Service (NHS) is often seen as an iconic public service in the UK, with primarily state funding and state provision of services. Over the past few decades, however, successive governments have introduced more market-style relations and commercialism into the NHS under new public management and more recently, public sector entrepreneurialism. Whereas historically there has been ambivalence around private activity, international patients and joint ventures are identified as a possible route to lessening pressure on NHS resources. Specialist NHS hospitals treat inward medical travellers with complex tertiary procedures (including paediatrics and heart surgery), maternity services and ophthalmic surgery. In this paper, we present documentary research on the case study of Great Ormond Street Hospital, a specialist NHS children's hospital in London which has a tradition of treating patients travelling from outside the UK. We review the practices around commercialisation in relation to children's services to offer a novel analysis on specialist children's services. In so doing, we expand academic and policy debates around commercialisation in public health systems and provide theoretical insights, drawing on Karl Polanyi's 'double movement' to help explain the apparent paradox whereby commercial income is increasingly justified by NHS organisations due to an apparent need to support NHS services.