The NHS is losing global arms race to offer better healthcare for less

Thomas Cawston
THE Francis Inquiry into failings at Stafford Hospital has put the NHS under the spotlight once again. Just yesterday, NHS chief executive Sir David Nicholson was grilled by MPs over his role in the scandal. All too often the service fails to deliver the quality, compassionate and patient-centred care the public expects. International comparisons are also concerning. Evidence, published in the Lancet, suggests the UK lags behind similar countries in tackling preventable disease. Health secretary Jeremy Hunt says 30,000 lives could be saved annually if England performed as well as its neighbours.

Given the state of the public finances, throwing money at the problem is no longer the solution. Game-changing ideas that will fix healthcare for the future are sorely needed. The NHS has remained obstinately closed to outsiders, but it’s now time to open its doors to the sharpest minds in business.

The global marketplace in healthcare innovation is big business. From Bangalore to Boston, a new generation of entrepreneurs is leading the next great revolution: making better, cheaper healthcare. Many of these pioneers have no background in medicine, but have brought lessons from other industries to take on the old ways. They have harnessed the potential of modern technology, modern management practices and an absolute commitment to the consumer to transform healthcare.

Many of the most exciting models are coming from emerging economies where, because money is tight and need is great, necessity is the mother of invention. In Mexico, there is growing demand for cataract surgery, yet safe care is out of reach for most of the population. A group of ex-bankers and fund managers saw a business opportunity to deliver quality surgery to the masses. Their company, SalaUno, provides sight-restoring cataract operations at a third of the cost of their competitors, with quality equal to the NHS. To deliver high quality at low cost, SalaUno adopted the lessons of “lean” management from Toyota and customer service techniques from Disney. Data is used to track quality, rigorous performance management holds staff to account, and bonuses are used to encourage excellence.

Another success story comes from India, where a gap in the market emerged for high quality yet affordable maternity care. With many women having to choose between poor standards in public hospitals and high costs in private clinics, there was an urgent need for an alternative. That was the business case for LifeSpring, a for-profit chain of maternity hospitals now spreading across India. The secret has been the standardisation of every process through protocols regularly used in other high-risk industries, like airlines. By creating a standard set of guidelines for all clinical procedures LifeSpring has been able to deliver a consistent quality of service to its patients. LifeSpring’s relentless focus on improving efficiency means its prices are a third of its competitors.

While healthcare has been dependent on clinicians to create value for patients, other industries have started to get the customer to do more of the work. Just as banking has moved online and supermarkets have introduced self-checkouts, the future of healthcare will see patients taking a more active role in care.

In 2004, three engineers from MIT in Boston set up PatientsLikeMe, a healthcare version of Facebook. Patients are encouraged to post their experiences of their conditions and treatments online so they can learn how to manage their care. Today the website has over 100,000 members and covers 1,200 different conditions. In Mexico, a mobile phone company saw an opportunity to provide healthcare to patients who couldn’t get to a doctor. For $5 a month Medicall promises 24-hour healthcare advice to over 1m households. Calls are answered in three seconds by a doctor, and nearly two thirds of cases are resolved over the phone.

The NHS must not be left behind in this global arms race. The UK needs to look beyond its borders to see what is possible. While the NHS still relies on technology from the last century, emerging markets are creating modern health systems. Quality, compassionate and affordable healthcare is the next big global industry. Rather than shutting up shop to private sector expertise, the NHS needs to embrace creative thinking, innovation and a focus on the customer experience. If the NHS is to truly become the envy of the world, it must first the embrace the power of entrepreneurship.

Thomas Cawston is research director at the independent think tank Reform.