If you’ve been following the UK health pronouncements on telehealth, you’ll be aware of the policy of recruiting 3 million patients to become telehealth users by 2017. And if you’ve been following the industry analysts you’ve probably spotted the recent report by InMedica, suggesting that by 2017 there will be 1.8 million patients using telehealth worldwide. In other words, the UK’s program will be responsible for around 200% of telehealth patients. I know we did well at the Olympics, but that’s setting the bar rather high.
It suggests that either our ministers in the Department of Health are doing a Chris Huhne, or else the analysts are being uncharacteristically understated about the future.
A couple of years ago I wrote a somewhat tongue-in-cheek article about how much the NHS could save each year by implementing some fairly basic mHealth initiatives. Nothing very complicated – mostly simple stuff like appointment reminders, but with the help of some silly projections from NESTA I reckoned there was potential to save almost £13 billion a year from the NHS budget.
A few weeks ago I came across a much more sensible proposal in the form of Transform’s Digital First report for the NHS. Whilst my effort was largely based on fanciful numbers from corporate PR departments and think tanks trying to get noticed, the Digital First report uses real examples of current practice within different parts of the NHS. It looks at ten easy-win initiatives which, if they were to be implemented across the wider NHS, could release funding of £2.9 billion per year.
These are not high tech; they don’t require massive capital investment, they’re just ten good ideas which have been developed and deployed locally and which can be copied throughout the country. Most are centred on GP practice. In each case, the report describes the current implementation, the degree of difficulty (or in many cases the ease) of attempting each project, and details of how to do it. There’s even a Digital First website “designed to help NHS staff implement Digital First”. The report is essentially an instruction manual for every GP surgery. I’d recommend downloading and reading it. And the next time you see your GP, give them a copy or ask them how they’re getting on with it.
While most of the world was scratching its head about the London Olympics’ opening ceremony, Danny Boyle managed to do something that successive UK Governments have failed to do for over sixty years. The world watched as he promoted the NHS as a Global Brand. For five years we’ve had debates about what the lasting legacy of the London Olympics would be, a lot of which has concentrated on what to do with the buildings. The rest has been about whether it will persuade more people to become more active. Whilst I’m not belittling the positive effects that it may have in reintroducing people to sports and providing renewed support for sporting facilities, I’d like to put forward a much more important legacy – we should follow on from Danny Boyle’s tribute and start making the NHS a Global Health Service.
Readers of this blog will know I’ve been espousing the need to turn the NHS into a Global Brand for many years. But with the Olympic coverage disappearing from the front pages of our papers, that idea seems to be catching on. Recently the Independent ran the headline that the Government was considering a Global NHS. We now have the best opportunity to make that a reality – quite possibly a once in a lifetime chance to transform healthcare in theUK, and improve access to it around the world.
So Jeremy Hunt, here’s a challenge for you. If you want to go down in history, here’s you chance. Take this opportunity to show the world that the UK is great at healthcare as well as sport by making the NHS a truly global brand.
I’ve always thought that the music for the opening chorus of Rigoletto foreshadowed the modern party political conference. It is a piece about court sycophancy and conspiracy which says everything about political intrigue.
There’s a long tradition of resetting opera to make satirical points. Ned Sherrin and Alistair Beaton did it in the Kinnock and Thatcher era with the Metropolitan Mikado and the Ratepayer’s Iolanthe. More recently Music Theatre London set the trend for pithy new translations which led to a resurgence of exciting new small scale opera productions. But we seem to have lost the politics.
Rigoletto feels as if its authors had anticipated our most recent political incumbents – the powerful, confident stride of Blair the leader, imperiously parting the faithful as he strides with his sycophantic train to the dais. And in the shadows the poison dwarf, reviled by the rest of the party, who will ultimately aid his leader’s downfall, played by Alistair Campbell. I often thought there was great scope for a New Labour Rigoletto with that pair and possibly Prescott as a lumbering Sparafucile. But the opportunity passed by.
However, when Andrew Lansley started putting forward his health reforms, with the Lib-Dems performing U-turns on a daily basis I realised that the music and story fitted the current administration just as well.
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.
Governments like change, so when the UK acquired its recent coalition government, it didn’t take a genius to predict that change was on the way for the National Health Service. The NHS holds a rather special place in the hearts of the UK electorate. Although the UK media loves to hate it, and most people gripe about it, the bulk of the population have a great affection for what it does. Few realise that outside the UK most people involved in the medical industry view it with admiration. Because of its popularity, the incoming government mollified public concern by announcing that they would “ring-fence” spending on the NHS, but then promptly started to change it.
That change was heralded by a consultation on “Liberating the NHS”, which was slipped out before the summer holidays, probably in the hope that few would notice or respond to it before the deadline at the end of September. It signalled a major change in direction, where control would be moved from the current Primary Care Trusts (PCTs) to consortia of General Practitioners (GPs).
That raises some concerns. The first is that we don’t train GPs to be managers. We still train them in much the same way we did a hundred years ago. So the most likely effect is that all of the managers who get made redundant from PCTs will simply go and work for GP consortia. And as there are far more of these, it just results in an even bigger set of people micromanaging.
The more worrying concern is what effect this will have on prescribing practice. The consultation document keeps on trotting out the phrase “clinical evidence”, implying that the NHS and local GP practices base everything they do on good clinical evidence. It’s a nice theory, and it would be nice to think that those developing this policy change believed in and supported it. It should be possible – we have a body called NICE (The National Institute for Clinical Excellence) whose job is to promote it. But as soon as everyone got back from their summer holidays, Andrew Lansley – the new Minister for Health, got out his rusty shears and castrated NICE. It’s difficult to understand why, but the implications for the NHS and GPs are disastrous. It’s goodbye to clinical evidence, and hello to whoever can get the most publicity for their favoured drug of the month.