The current debate about the future of the NHS starts with a correct observation, which is that continuing in its current form is untenable. As the population ages and we get more complex treatment regimes, then, unless we change our approach to healthcare, the numbers don’t add up. But all the Government’s proposed reforms are doing is rearranging the deckchairs on the Titanic. I’d like to suggest something more radical, which is to think about how to make it self-funding, without increasing the strain on the public purse. Not by privatising it, but by extracting value from it and then exporting that value. In other words, let’s see if we can make the NHS a global brand and turn it into something that can generate revenue.
Before you dismiss it, stop and think. We’ve already done it with the BBC, which Superbrands rates as the fifth strongest brand in the UK. The BBC is respected and earns money around the world. Why don’t we think of the NHS in the same way? It doesn’t feature in any list of brands because nobody thinks of it like that. But there are some very good reasons why it should, particularly if we want it to be affordable in the future. The current Government (and every one before it) is missing a trick.
The NHS probably contains more data about treatment and outcomes than any other medical institution in the world. And so it should. For much of its life it’s been one of the world’s largest employers, accumulating detailed information on generations of the UK’s 60 million citizens. That’s an awful lot of “big data”. So here’s the question – “If we could extract and monetise that value, could we make the NHS pay for itself?” We need to extract that value and use it, then export the resulting expertise to make money from the rest of the world.
The crux comes down to the way we think about the NHS. As it has evolved, there has been a parallel evolution of a culture of entitlement, generating a widespread view that the NHS should meet every demand of every person. That has helped feed into the demand for more and more. Whilst that is significantly different from the initial view of the NHS, generations of politicians of every political persuasion have been loath to be seen resisting this expansion. Every time they do, the spectre of privatisation is raised, heralding frenzied wails from the media about the impending death of the NHS. Hence we are where we are today.
And that’s the way everyone involved with it now sees it – as an ever greater consumer of resource. Which blinds everyone from thinking about how to make the NHS a source of revenue itself. There’s been a lot of talk and money put into trying to make it more efficient, but never really from a business viewpoint. That would mean considering how to run the NHS as a business, rather than a service, but is that a bad thing? Anyone who saw the BBC documentary “Can Gerry Robinson fix the NHS” will remember his amazement at seeing the operating theatre left idle most of the time. That’s not an imperative to privatise, but a recognition about how to make the most if its assets.
One of the NHS’ key assets is its data. If it could be assembled into one database and mined for its value it would have the power of life and death. Quite literally. That data may well contain enough information on actual drug usage to put one pharmaceutical company out of business and double the value of another. It could bring an additional level of data into NICE that they would die for. And let’s not forget that NICE is one of the UK’s greatest assets, not the undeserving butt of every media attack on access to medication. We need to start respecting our sources of value.
The problem about “big data” is that it’s something that so few people comprehend, particularly those in Government. Rather than being promoted for its value, it is more regularly demonised for its Big Brother associations. But in the UK we’re good at working with it.
Not many people know that the UK leads the world in the use of data analysis, where financial services organisations in the City and Tesco on every High Street have transformed the way that data can add value and competitiveness to an industry. If we could only generate a data culture within the NHS we could apply that power to make money to help fund our healthcare. Properly used and directed, it has the potential to transform the NHS and elevate the associated medical industries to the position of global leadership.
The McKinsey Global Institute recently published a report on Big Data. They call it the next frontier for innovation, competition and productivity. In the report they look at the productivity gains that can come from a culture of analysing and using data. They estimate the US has the potential to save $300 billion every year from their healthcare budget by making more use of healthcare data. That’s largely in productivity, before you start to realise its wider value.
McKinsey cite positive moves that are already happening within the UK, notably the work being done by Dr. Foster Intelligence, who trade under the banner of “better information, better health”. And there are signs of a wider understanding already starting to percolate in the recent NHS proposal on Innovation, Health and Wealth. In this document, there is an acknowledgement that the UK can develop best practice and export it. However, it accepts that the NHS has not always responded systematically to requests from abroad. It points out that “the international healthcare market is worth more than $4 trillion a year, and NHS must do more to exploit the commercial value of its knowledge, information, ideas and people”.
The same document announces the desire for the NHS to accelerate the use of assistive technologies, aiming to improve at least 3 million lives over the next five years. That’s possible because of the largely unnoticed work that has been taking place here in the UK by moving telecare to scale, notably the Whole System Demonstration Program, which is one of the leading examples of large scale telecare deployment anywhere in the world. Its successor – the Dallas Program, taken alongside this call for the deployment of telecare to three million patients, places the UK ahead of the rest of the world. We need to understand how to profit from that knowledge.
There is a recognition of this in the announcement of a new £180 million fund from the Government to support the “next brilliant medical breakthroughs”. However, this still shows a limited understanding of the true value of patient data. A similar sentiment was obvious in the proposal for the UK’s Strategy on Life Sciences published last December, which acknowledges the potential for using patient data to enhance the UK’s in vitro diagnostics industry to establish the UK as the global leader. David Cameron was correct in talking about the opportunities from the Open Data Agenda when he pointed out the value of this data to the life sciences market. Life Sciences is the third largest contributor to UK economic growth, with an annual turnover of £50 billion. We should be aiming for an even more efficient partnership.
That’s because medicine is beginning to change. Eric Topol has been a advocate for this new paradigm of personal medicine for many years, cogently explaining it in his recent book “The Creative Destruction of Medicine“. Once again, it’s an evolution that will be built on data, where better knowledge of each individual will allow medicines to be targeted, rather than applied with the traditional broad brush. The country with the largest medical database to share with the next generation of emerging personal pharmaceutical developers will reap enormous rewards. The NHS is ideally placed to dominate this evolution as well.
However, as the McKinsey report points out, one of the key problems in getting there is the shortage of people who understand data. The biggest challenge for the NHS is in how to access it. It is sobering to consider that we are not pioneering paperless hospitals – that’s being left to countries like Pakistan.
This highlights a problem which the current reforms are side-stepping – how do we bring innovation into the NHS. As Clayton Christensen points out in “The Innovator’s Prescription“, we are still training medics for a healthcare system that disappeared fifty years ago. The Guardian recently wondered what happens to all the bright IT-literate junior doctors, lamenting the way they change from technology champions into good ol’ hospital boys resisting change. Our inability to change the way things are done is the biggest obstacle we face. Returning to Clayton he is succinct in his analysis: “Breaking an old business model is always going to require leaders to follow their instinct. There will always be persuasive reasons not to take a risk. But if you only do what worked in the past, you will wake up one day and find you have been passed by”.
What the NHS needs is more innovation, not shuffling its ownership from one group of technology deniers to another. The current reforms don’t tackle innovation, they merely move the chairs around. We should all be justifiably proud of what the NHS has achieved, but set our sights higher to envisage how much more it could become. With its wealth of data it could fund innovation, providing a true evidence-based system to provide the knowledge for more effective healthcare and the data insight to feed a global medical industry based in the UK. But to achieve that we need to think on a grander scale. Today too much happens without scale – it’s “local innovation for local trusts”. We need a culture that quickly moves through national to international.
The NHS desperately needs visionaries who can think on a broader scale and embrace the concept of the NHS as a global brand. Healthcare is a global problem that is not going to go away. In most of the world it is far more fragmented than it is in the UK. Which means that we are well placed to deploy at scale to take on the world. That needs the NHS to evolve a global vision. Let’s not miss this opportunity, but seize it. If we get it right we can sell it to the world and make the NHS a global brand. So let’s set out sights on excellence, with the vision that we can achieve something that others will pay to take advantage of. The goal should be no less than creating an NHS healthcare system so good that the likes of the Mayo Clinic and Kaiser Permanente would queue up to buy a franchise. That’s what reform should be about.