The Harkness Fellowships, launched in 1925 as the ‘Commonwealth Fund Fellowships’ by Edward Harkness, were designed as a reciprocal programme to the Rhodes Scholarships. Fellows came from a broad sphere of professions to spend a year in the US studying and learning from each other. Since June 1997, the activities of the Harkness Fellowships have been limited to the field of ‘healthcare policy and practice’.
The Commonwealth Fund aims to promote a high performing healthcare system that achieves better access, improved quality, and greater efficiency. Fellows undertake a research project on a health policy issue that is relevant both the US and their home country.
US healthcare reform
From the Fellows’ perspective, the timing of the Fellowships could not be better. It is six months since Congress passed Obama’s controversial healthcare reform bill by 219 votes to 212.
The Patient Protection and Affordable Care Act (PPACA) broadly has three goals: expanding health coverage to the uninsured, improving healthcare quality and access, and stemming the growth in healthcare costs. The NHS is, of course, very familiar with the latter two goals, which are the focus of the QIPP initiative.
The mid-term elections will be held in November to appoint 435 members of the House of Representatives and around a third of the Senate members. In recent polls, the Republicans, all of whom voted against the healthcare reform bill, stand to make big gains. Perhaps echoing the rise of the Liberal Democrats in the UK, the US has seen the emergence of the ‘Tea Party’, which appears to oppose both the Obama administration and the Republican establishment. A prominent member is Sarah Palin, who many Brits will remember for her vivid rallying cries against a move towards the NHS system of ‘socialised medicine’. This was seen as just one step towards health service communism reflecting the media portrayal of the NHS. The prospect of gridlock in Washington is high and there is great potential for challenge to healthcare reform.
Letters from America
When the Harkness Fellowships were established, they were not focused just on health. In 1932 Alistair Cooke set sail for the United States to study American theatre direction at Yale and wrote what became known as ‘Letters from America’, nearly 3,000 of which were broadcast to the UK from 1938 until his death in 2004. The letters gave his insights into American life and politics and used humour to illustrate the cultural differences, often ending on a poignant note. The aim of Cooke’s Fellowship was to return to the UK and, in his words, ‘to revolutionise English drama’. America’s impact on Cooke was so significant that it changed the course of his career and he emigrated in 1937.
One of the ‘obligations’ of Cooke’s fellowship was to be given a car, and in the summer vacation to tour as many of the States of the Union as possible. The idea was to learn about the country, in Cooke’s words, “by digging it out of the landscape”. This is still the aim of the Fellowships - individuals are placed with an appropriate mentor in order to learn by experience about their chosen subject. Over the next year the Harkness Fellows will share their insights into the US healthcare system and reflect their learning for the UK. Sadly for us, the road trip is no longer included.
The 2010 UK Harkness Fellows
This year, the Commonwealth Fund has chosen four UK Fellows with expertise in four very different aspects of the UK health system. The UK programme is co-sponsored by the Nuffield Trust.
Sarah Garner, a PhD pharmacist, is the Associate Director of R&D at NICE. Sarah will be based at Tufts University in Boston exploring value-based insurance design, focussing on identifying and withdrawing low-value technologies. She will also be looking at Comparative Effectiveness Research from the consumer perspective and exploring the ethical and macroeconomic aspects including on innovation.
Emma Stanton, a Psychiatry Specialist Registrar and former Clinical Advisor to the Chief Medical Officer, is based at Harvard, Boston. Emma is looking at what constitutes value in mental healthcare; how value can be defined, measured and improved both as a co morbid condition, and as a primary diagnosis.
Diane Gray is a public health physician and, when she started the Fellowship, was Director of Strategy & Planning for NHS Milton Keynes. Diane’s based at Weill Cornell Medical College and is studying two examples of integrated delivery systems (the New York Health & Hospitals Corporation and Kaiser Permanente in Southern California) to exemplify how integration improves quality whilst maintaining affordability.
Martin Connor was Director of Integrated Care in the Trafford economy before taking the Fellowship and is based at Stanford University in California. His main research is into the logic of integrated delivery systems and the question of how integration might be spread (a significant issue for any practice or approach) as well as continuing work on physician accountability and leadership development.