In January 2021, as London buckled under the weight of treating thousands of Covid patients, the medical directors of the main NHS hospitals wrote to their medical consultants, pleading with them to stop doing non-urgent private work and to turn their attention to high-priority NHS cases. Under the 2003 NHS consultant contract, there should have been no reason to issue such a plea. NHS consultants can only do paid work in the private sector with the permission of their NHS employer and only if it does not cause a detriment to NHS care. In doing so, the medical directors publicly acknowledged something many people have long suspected, namely that the lure of highly lucrative private work, particularly in large cities, can pull a sizeable number of NHS consultants away to focus on those who are prepared to pay. As NHS waiting lists have soared during the pandemic, so has the demand for fee-paying private work, with waiting lists for treatment now also occurring in the private sector, a further pull on the loyalties of NHS medical consultants. In 2021, for the first time since 1948, more orthopaedic activity – such as hip replacements – took place in private hospitals than in the NHS. This fact can only mean that last year a significant number of consultants were doing more hip and knee replacements privately than for their NHS employers, since there is only one pool of (mainly) NHS consultants to treat both NHS and private patients. It also means that since the pandemic hit, access to certain operations is being determined not by need, but ability to pay. The private hospital companies have for many years clocked the need to keep NHS consultants close to them, showering them with lavish corporate hospitality and offering them financial incentives, such as share ownership schemes and joint ventures to encourage them to do work in their hospitals. Under such schemes the more private work they do, the more the business benefits and the greater the dividend pot which the consultants can draw from. Similar schemes are also in operation in the more controversial area of private cancer care. The current strategy of many of the healthcare multinationals operating in the UK is to exploit the dire state of NHS cancer services and to use financial incentives to lock in NHS consultants to do work for them. It is a strategy that is succeeding – in 2017 cancer care became the biggest earner for private hospitals in London for the first time. Yet the growing role of for-profit cancer care in the UK is something parliament and the public are yet to engage with. As cancer treatment is given to patients who are often very vulnerable, the existence of the profit motive in this form of care requires a robust system of regulation to protect patients from harm. The very worst form of abuse happened in for-profit cancer care when the now jailed breast surgeon Ian Paterson deliberately misdiagnosed cancer in hundreds, potentially thousands of mainly female patients and as a result carried out mastectomies and other surgery for financial gain. However, to date, the government has made only the very scantest of efforts to reform private healthcare in the light of this scandal by failing to act on the Paterson inquiry recommendations. That NHS consultants are benefiting financially from the demand for private treatment caused by the pandemic is a highly sensitive issue the medical profession too often dodges. But the backlog of NHS care can only be addressed if NHS consultants are compelled to give priority to NHS patients and if the financial incentives used by multinationals to encourage them to do private work are fully disclosed with any potential conflicts of interests affecting patient care firmly prohibited. David Rowland is director of the Centre for Health and the Public Interest