The NHS must look outwards if it’s to become the envy of the world

Thomas Cawston
THE coalition has identified the NHS as the UK’s next big export. We have some form here: internationally renowned brands like the Royal Marsden Hospital in Chelsea, Moorfields Eye Hospital and Great Ormond Street have foreign campuses in the Middle East – with similar tie-ins to some of our leading universities.

And this outward-looking approach is to be encouraged. The global market for healthcare is already worth trillions of dollars, and it will only increase in size. The successful nations will be those that can export their healthcare services and not be forced to buy them from other countries. Hospitals in America, Europe, India and Australia are selling their expertise across the world and the NHS is quite right to try to get a slice of the action.

But we also need to be realistic. The NHS is not the envy of the world anymore, and there wouldn’t be buyers for many of our unreformed services.

Many of the most exciting healthcare pioneers are abroad. These innovators have performed tricks right out of the Harvard Business School playbook, reminding us that high quality affordable healthcare isn’t trademarked by any one country. As well as exporting, the NHS needs to import.

Browsing the global marketplace of healthcare innovations will quickly reveal the secrets of better for less. While NHS hospitals seek to provide every service to patients under one roof, the best hospitals in the world specialise in solving just one medical problem. A trip to India will uncover the Narayana heart hospital. This 1,000 bed heart specialist performs 35 surgeries a day on average, and a maximum of 60 a day in its 24 operating theatres. Practice makes perfect: such high volumes lower costs and improve outcomes. Narayana’s cardiac surgery operates at one tenth of the cost of NHS hospitals, with clinical outcomes at the same standard, if not better.

Another lesson the NHS should quickly take on board is that modern and rigorous management is essential to drive up performance. A proven method for innovative hospitals has been to rank staff to harness the competitive nature of doctors. The Cleveland Clinic in Ohio publishes outcomes data for every major disease area, which allows the hospital to set benchmarks for staff and creates the peer pressure to make better doctors. Unlike the NHS, where doctors still rule the roost, these hospitals also hold employees to account. Doctors at the Cleveland are on a one year contract: if they’re not up to the job, they walk.

Providing better care for patients with chronic diseases, like diabetes or Alzheimer’s, will be the central mission of the NHS in the years to come. New ways of organising services are sorely needed. Again, there is much to learn from the rest of the world. In the US, Kaiser Permanente is a household name for high quality, joined-up care. By measuring and monitoring patients closely, with doctors on standby around the clock, they are much better than we are at preventing people from becoming ill – and at giving people the best personalised treatments if they do get ill.

Another American success story can be found in Rhode Island, where a previously fragmented and confused assortment of mental health services meant patients often fell through the cracks and ended up in the emergency room – the worst place for them. A private company, Beacon Health Strategies, was brought in to get things organised. Working with the established providers, they coordinated services outside the hospital and in one year the cost of hospitalisations for children was cut by 20 per cent.

With healthcare costs set to rise inexorably in the years ahead, the NHS cannot afford to ignore the lessons from abroad. As the Olympics got under way the chancellor announced that “Britain has always been a country that is open to the world. In hosting the Olympic Games, we are showcasing that openness.” However, the NHS has remained obstinately closed to fresh thinking and innovative models from the outside. Opening up the NHS to competition would give patients new choices and the chance to demand excellent services that are shaped around their needs.

Better, cheaper healthcare is the next big global industry. If the NHS wants to be the envy of the world, it will have to start learning from the best in the world.

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