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'NHS must grasp a world of opportunity'


From India to Brazil, other nations are creating cost-saving innovations that our own health service could embrace.

The creation of a national health service in this country was one of the finest achievements of the last century. But now, as we grapple with the very different needs of the 21st century, we have to be international in our outlook.

The big health challenges of today, such as an ageing population prone to chronic illnesses like heart disease and diabetes, are ones that are shared worldwide.

Big challenges need a big response. Using the expertise of the Imperial College London-based Global Health Policy Forum and the enabling support of the Qatar Foundation we are leading an international effort to pool expertise and develop practical solutions to our common problems.

While the eyes of the world are upon the UK as we host the Olympics we will bring together the world’s leading health practitioners and decision-makers at our launch summit. We will showcase and drive the next steps for international healthcare innovation.

It is striking that many of the most innovative ideas are coming not from Europe or the US, but from lower income nations. For instance, social entrepreneur Sala Uno Salud in Mexico is able to do high-quality eye surgery at a third of the market price by only using highly skilled (and therefore highly paid) ophthalmologists for the most complex parts of the procedure, whilst junior staff carry out the repetitive elements. Such “task-shifting” has huge potential. The NHS has “task shifted”, for example enabling nurses to prescribe drugs, but to get the most from its staff it will need to do more.

In another example, the town of Recife in Brazil has established “city gyms” for people with chronic diseases. Thirty thousand people are involved in physical activity classes that are provided before and after the working day to maximise participation.

Getting a similar culture of activity in every city in the UK would certainly help to tackle our longer-term health problems that threaten the sustainability of the NHS.

One of the reasons that innovation is prominent in countries such as Brazil is that they have to meet rising expectations and need from an even more limited health budget. They are also less restricted by existing ways of providing healthcare. As experts on innovation, such as Harvard Business School’s Clayton Christensen have argued, it is difficult for incumbent organisations to radically change their approach.

Admittedly, having a blank canvas can help - something which was provided by the 2008 earthquake in Sichuan province in China. But, rather than simply rebuilding destroyed facilities, a partnership between the Chinese government and IT giant Cisco has led to the introduction of digital technology to enable more remote care. Now, instead of travelling to hospital, people can access care and advice via video conference.

The NHS reforms have not literally flattened hospitals. But the reorganisation that brings new people centre stage creates an opportunity to think creatively about new ways of providing care.

The newly forming clinical commissioning groups need to learn from the best of international innovation as they decide how to spend most of the NHS’s precious budget.

Greater use of competition can also be a stimulus to healthcare innovation. It helps us focus on what matters to patients, which can be lost in more monolithic organisations and systems but it should be used with precision.

India has a highly competitive healthcare market that has stimulated new approaches with better outcomes for patients. In the state of Andhra Pradesh, local healthcare provider HMRI has been able to manage 40 per cent of healthcare needs over the phone. In doing so it has used and adapted the very best of business improvement methodologies.

The challenge is to bring some of the innovative energy of India, Mexico and Brazil to the UK, whilst maintaining the equitable healthcare for which we are rightly, and internationally, renowned.

Alongside the Olympic legacy that we will build this summer the Global Health Policy Summit gives us the chance to strengthen international co-operation, to improve healthcare and life chances around the world. London 2012, in more ways than one, is the beginning, not the end, of reform and innovation.

Professor Lord Ara Darzi of Denham is director of the Institute of Global Health Innovation, Imperial College, London. Peter Howitt is senior policy fellow, Institute of Global Health Innovation, Imperial College London. The Global Health Policy Summit takes place on 1 August in London.


Readers' comments (3)

  • "For instance, social entrepreneur Sala Uno Salud in Mexico is able to do high-quality eye surgery at a third of the market price by only using highly skilled (and therefore highly paid) ophthalmologists for the most complex parts of the procedure, whilst junior staff carry out the repetitive elements."

    That will never be allowed in the NHS. Jealousy and other petty clinical hierachical turf wars make such a system of a supreme clinical skill being rewarded and respected, even revered, a complete non-starter. The last few decades have been marked by a systematic denial of the clinical authority of doctors, let alone highly skilled surgeons. Reduction to the lowest common denominator rather than celebration of the exceptional individual has been the order of the day. We now reap what has been sown, whilst the Third World teaches us lessons in more areas than just healthcare. Until NHS managers of the type that read HSJ abandon the bullying control of Whitehall and start respecting, really respecting, the clinical abilities of their local staff, nothing will change. By the way, why are there almost no clinicians on the boards of NHS Trusts? Would you expect a large successful engineering firm to have almost no-one with a background as an engineer on the board?

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  • I don't think you can compare large third world countries with a mixed market with a small first world country with state run services.

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  • I thought this was an April Fool until I saw the date. Is August the new April?

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