To deliver the best care possible, any health system must look to its neighbours, says Layla McCay
The N in NHS stands for national. So, it’s no surprise that the latest NHS long-term plan for England is focused on England.
But it’s still a shame that at over 136 pages, the plan barely mentions the rest of the world. When thinking about how to deliver the best care possible, any health system must look to neighbours.
All over the world, health systems share similar challenges: rising demand, rising costs, rising use of technology, and ageing populations. If we don’t look far and wide for effective innovation, we may be missing a trick.
The Commonwealth Fund in 2017 ranked 11 international health systems in terms of their performance – and according to their measures, the UK has the best, safest and most affordable healthcare system.
Even though the UK has experienced a rapid reduction in deaths from treatable causes, we rank a dismal 10th out of the 11 countries for health outcomes
This is a fantastic achievement for the UK NHS. In a world where universal health coverage is the aspiration – not to mention one of the Sustainable Development Goals adopted by the UN in 2015 – other countries have much to learn from the UK, as we have from them.
We rank as the best for delivering safe, coordinated care accessible to everyone, no matter their income. We were also ranked highly for access and administrative efficiency. But on the other hand, we are much less impressive in terms of our health outcomes.
Even though the UK has experienced a rapid reduction in deaths from treatable causes, we rank a dismal 10th out of the 11 countries for health outcomes.
The NHS long-term plan seeks to remedy this by further improving how care is delivered.
Learning from the best performers
Designing these changes should bring in lessons from health services operating in countries that shine at the top of the table for health outcomes.
If people are living longer from diseases like breast or colon cancer in other countries, we need to know why – and harness their lessons so we can apply them to patients in the UK.
We need to especially look at countries like Australia, Sweden and Norway, which respectively rank first, second and third in the Commonwealth Fund ranking.
At the other end of the spectrum, we can’t be complacent – even where we currently excel. Being best in class on most performance measures is a welcome advantage for people living in the UK, and for UK trade and soft power.
But other health systems are catching up and we need to learn how they are improving care.
For instance, to deliver more joined-up care for the public are we looking to Israel’s system of incentives to help the NHS work together to keep patients out of hospital?
All over the world, health systems share similar challenges. If we don’t look far and wide for effective innovation, we may be missing a trick
For efficiency, are we looking enough to developing health systems like in India where scare resources have created a hotbed of innovation?
And where health and social care link up, are we learning from the challenges and successes of Japan’s fast-ageing population?
And we’re far from the only ones to think about integrated care systems – where NHS bodies and local councils share responsibility for improving the health of the area they serve.
One example of far-reaching collaboration saw researchers from UK health think tank The King’s Fund look at sweeping health measures undertaken in New York’s deprived Bronx neighbourhood.
The measures saw doctors and nurses set up mobile paediatric clinics in poor areas, health facilities in homeless shelters, counselling services at doctor’s practices, and eye tests, dentistry and mental health clinics in schools – reaching 40,000 children that might not otherwise get any help.
Differences can be overcome
While we need to be mindful of the many differences we see in international approaches to healthcare, we should always avoid the temptation to say: “that sounds great but it wouldn’t work in our context.” The differences between the NHS and other international systems should not be overestimated.
Often, insurmountable difference is a misconception that can be solved by simply connecting with people.
Speaking directly with teams that successfully implemented an innovation has been found to work, as US health think-tank chief Maureen Bisognano noted at a recent conference in Qatar.
We must find more ways to spot and leverage proven ideas and insights that help other health systems to excel.
Wise health leaders know that even the best health system in the world can become better.
Care must be taken to identify the most relevant examples, and to understand how they would work in the UK. That’s a good long-term plan for the NHS.