Our healthcare system will only survive if it allows private companies and others to innovate, increase quality and drive down costs
The health and social care bill will be the subject of heated debate at its report stage in the House of Lords today. Yet the real healthcare issue should be less about the NHS landscape in the next three years, and more about the survival of our universal and equitable healthcare system for the next three decades.
The £20bn deficit facing the NHS in the next three years is undoubtedly important, but the elephant in the room is the sustainability of the sector.
In Britain, we spent about £40bn on healthcare in 2000. Around 10 years later, we are spending near to £120bn. Economic value is defined as quality divided by price. We have tripled the denominator of the value equation. Yet it is hard to claim the nominator – defined as clinical results and patient experience in healthcare – has kept pace.
We have been here before in Britain. When any sector has become unsustainable, we have brought down barriers to entry, stopped artificially pumping up the outdated, and allowed new entrants to come up with new solutions and flourish ahead of our global competitors. As a result, we have in our small country of 60 million people some of the world's most successful telecommunication, retail, financial, creative and professional services.
The NHS, too, is a professional service now ripe for re-engineering. By contrast, manufacturing teaches us a salutary lesson. When we protect our old industries with subsidies and inflexible legislation, we risk losing all. British factories are now predominantly foreign-owned.
When innovation is needed in a sector, it is understandable that those involved in the current system feel insecure about their future. Yet neither incumbent organisations nor employees should fear the opening up of their sector to new ideas, because both tend to do better in sectors where Britain stays ahead of the global rejuvenation curve. Just contrast the fate of the British telecommunications industry and its participants with that of the once-mighty British Leyland.
Liberating a sector is simply about giving professionals the liberty to create a new chapter in their profession. In healthcare, the future will be created by people who are delivering the services today. We should therefore spend less energy safeguarding existing structures and institutions and focus more on freeing their participants to create the new.
Of course, with freedom comes responsibility. Concerns over independent companies competing with the public sector often centre on accountability and profit. It is true that some lost their way in recent years in the quest for profit. Profit for an enterprise is like oxygen, food and water for the body: necessary to sustain life, but not the point of life. Just as the entire public sector can not be condemned for the failure at Mid Staffordshire hospital, it is wrong to judge every non-state operator according to the actions of a guilty few. The key here is the accountability of all operators to public scrutiny.
In fact, the search for new solutions in healthcare gives us a great opportunity to create a fairer society. At the moment, two single square miles – the City and Whitehall – control over 90% of our productive assets. This concentration of ownership is unique among developed countries, and has produced unacceptable consequences. For instance, the richest region in Germany is two times more prosperous than the poorest; in France this ratio is four times; in the United States five times; in Britain it is a shameful 10 times.
Healthcare professionals must be empowered to set up their own alternatives. GPs provide a great example of how healthcare professionals can be freed to own and deliver their own services. They set up and own their practices, and sell their services back to the NHS as single-handed practitioners or small partnerships. This model could be expanded to nurses, midwives, hospital consultants and countless others, so that many more professionals could come up with new solutions that they control for their patients.
Our healthcare system is on an unsustainable trajectory. The solution is fundamental innovation that increases quality and reduces costs. We need charities, mutuals, private companies and public sector organisations all to participate to give us the greatest chance of rejuvinating our NHS for future generations. The country that pioneered the first antibiotic, the first blood transfusion and the first universal health service should still be a place where the brightest minds can create the boldest solutions. The Guardian