The NHS navel-gazes. The world moves on05 June 2012
“The patient will see you now” ran the tagline of a memorable advert a few years ago. For most of us, that shift in power is merely a dream — booking a GP appointment can be absurdly difficult; weekends are “out of hours” — and on June 21 doctors definitely won’t see you because they’ll be on strike. The decision by the BMA to down stethoscopes over a generous pensions deal is misjudged: not just because they often seem to block progress, but because they’re out of touch with their patients and the public — and with a healthcare revolution sweeping across the world.
A recent summit in Washington DC for healthcare investors and innovators showed that some of the most exciting innovations are coming from poor countries where, because money is tight, necessity is the mother of invention. They are creating a new kind of doctor and patient and defining global standards.
Healthcare is becoming both more specialised in centres of clinical excellence, and more personalised and convenient; that is, diffused through communities and into homes. The quest in complex surgery is to make operations resemble industrial production lines with doctors acting like robots. At Narayana Hrudayalaya cardiac centre, a heart “factory” in India, surgical outcomes are world-class yet cheap (a tenth of the UK price). Narayana’s track record has a lot to do with its specialist focus (the doctors only deal with hearts) and its scale. Last year, the 42 surgeons performed nearly 9,000 operations, a volume unheard of in developed countries. Because in medicine as elsewhere in life practice makes perfect, a surgeon who does three operations a day nears machine-like perfection; and as volume and quality rise, costs fall.
Some in the UK argue that Narayana is a freak that cannot be replicated, but the good news for patients is that it is opening up a chain in other countries. In Washington, one of the senior consultants told me why the Cayman Islands is top of the list: “Because it is the next best thing to parking a boat with one of our hospitals just off the American coast.”
In Washington I also met a Mexican entrepreneur whose clinic, salaUno, copies the industrial processes of Narayana and others like it. The surgeons carry out five times more cataract surgeries than the average ophthalmologist in Mexico. Quality is as good as the NHS at a third of the price. “People said it would be impossible, but we’ve streamlined everything we do and focused on identifying problems and fixing them,” he told me. “Getting more for less is not about working harder: it’s about working smarter.”
With a tide of chronic diseases rising, another challenge is to make care “integrated” seamlessly. This means getting hospital doctors, GPs, nurses and community carers to work together more effectively and flexibly. Kaiser Permanente, an insurance plan with nine million members across the US, has spent years pioneering outbound medicine for patients with chronic conditions. It makes sure that if you have diabetes your GP will be a specialist in that condition. At any time of the day or night, you can go into any pharmacy and have a test done. The computer will analyse the data and if there’s a problem a red risk flag comes up. Your doctor will be sent an e-mail and then give you a call to check whether, for instance, you’re still taking your drugs. This has made Kaiser a world leader in preventing unnecessary and expensive visits to hospital, giving better value for money than the NHS.
Kaiser is run by doctors, but the patient rules. Doctors are held to account for their performance, ranked against each other on everything from how fast patients can book appointments and how swiftly they respond to e-mails, to how good they are at monitoring and reaching out to patients, and the outcomes of treatments. All of this data is available online, in real time, all the time.
All of this calls for a new kind of patient who thinks differently about healthcare. For instance, we shouldn’t always expect to see a doctor face to face. Compassion and technology aren’t necessarily incompatible; indeed, they can be mutually reinforcing. From the Far East to Africa, Latin America to Asia, patients are being given the tools to take charge of their own healthcare. Mexico boasts a sort of turbo-charged NHS Direct:
$5 a month added to the phone bill allows patients to access Medicall Home’s doctors 24/7. Patients have their calls answered within three seconds, and nearly two thirds of callers have their health queries resolved over the phone. With English GPs facing increasing pressure from the worried well — and new responsibilities to manage NHS budgets — this is the kind of idea that could help them out.
After all the reorganisations of NHS structures, and the frantic cobbling together of organisational shantytowns, the task of reforming the NHS has hardly begun. It still has to make eye-watering efficiency savings. Most of the controversy surrounding the NHS reforms has been due to our hang-ups about the private sector, but many of the most brilliant organisations around the world are business people seeking to grow their companies for the benefit of patients. None were from the UK. There are people out there who want to spend money on healthcare for the next generation, but they won’t put it in the UK until providers are given the freedom to change, the opportunities to compete and the rewards for doing things differently.
Like the Mexican entrepreneurs, we should be copying world-class innovations — and even inviting the Narayana boat to moor on our shores.