Apart from the Olympics (about which I will offer my own two penn’orth later this week) one of the more interesting NHS stories in August was the attempt, yet again, to create an organisation that would help to sell NHS practice abroad. This year’s version of what is a regularly occurring story, saw the advertisement of a senior post to try and organise this international sales pitch for the NHS.
For me there were two points of interest – how some supporters of the NHS reacted to the announcement and why – since this initiative is regularly announced – it doesn’t seem to work very well.
Some NHS supporters reacted against this announcement. The Patient Association seems to believe that any minute spent away from the bedside of NHS patients by those it employs increases the pain and distress of all its patients. For them the 1.4 million NHS staff should be committed only to helping patients and, given they have a limited amount of time, trying to sell any aspect of the NHS abroad would limit their time with those patients. We cannot – so the argument appears to go – spare an hour of time to build NHS activities in the rest of the world without in some way letting down NHS patients.
In a summer defined by international Olympic experiences this is a rather sad and “Little Englander” view of one of our major institutions. At the moment millions of NHS staff hours are spent on issues such as research into diseases, their remedies and the organisation of health services. Some of the aims of this research are within disease patterns, remedies and their organisation that are confined to England, but nearly all of it reflects world concerns. Indeed some of it is carried out in diseases and their remedies that are barely the concerns of either England or the NHS.
But taken as a whole this research is a vital part of the way in which the NHS contributes to the world and only a very few people begrudge the time and effort NHS staff spend on world issues. Whilst we gain a great deal from other nations and their health services’ research, we almost certainly contribute more than our fair share to those developments. It’s a good thing – and by and large nobody is looking at the national profit and loss account in a grudging way.
But it is that mention of profit and loss that is the problem that some NHS supporters have with the whole idea of selling it abroad. It is the notion of selling per se that is the problem for some. Selling NHS services in this country, selling them abroad.
This brings us back to the difficulty that some NHS supporters have with the very idea of a business venture being built out of an organisation which has collective, tax funded provision – free at the point of need – at its core. Given that we don’t sell NHS services to patients in this country; to suggest that we can sell them to non-NHS patients abroad worries some people a lot. They believe that the NHS principle of providing healthcare to patients – free at the point of need – in Accrington would in some way be compromised if we were to charge for those services in Abu Dhabi.
Given time during a month off I was thinking through what separated me from this worry. It comes back to my belief that the NHS is a big strong institution based upon big powerful history and principles (thank you Danny Boyle for your Olympic opening ceremony). One that can stand up for itself in the field of history.
For others the NHS seems to be a delicate flower that needs to be kept safe and separate from all other health services and sets of principles because if it were to come in to contact with them it might somehow become infected and die.
Obviously this debate goes beyond the idea of this international venture to some of the discussions of the last two years as to whether the NHS can learn and take some ideas from other systems to improve the development of NHS principles in England.
For me involvement and interaction with other systems is a good thing because it demonstrates our strength, but for others – who believe in the same NHS – there is anxiety about whether contact with ideas from other countries or NHS ventures abroad, will cause it to keel over and die.
So I welcome this initiative but worry for its success. And my worry comes from this same problem of how do you sell the NHS? I don’t have problem with the principle, but I do worry for the practice.
Over the last couple of years the problems for the wider economy have clearly become problems for the NHS. The economy has stalled. As a small country off the coast of Europe we depend upon trading success to create the economy that will provide resources for the NHS. We need to be good at creating and selling things. (Again thank you Danny Boyle for the opening and closing Olympic ceremonies which showed how creative we are and how much the world loves to buy our creations).
One of our major industries at the moment is the NHS. We spend about 8% of GDP on it and both as an organisation and a set of practices it generates some interest in the rest of the world. We could, as a nation, say that this is not an industry like others, it cannot be exported in the way that music or culture can. If this is the case the NHS has to become a part of the deadweight of our economy, something that cannot gain resources from abroad but must just spend money here.
Other countries disagree with this. Many are interested not only in buying the day to day practices of the NHS, but are even more interested in buying aspects of the organisation of those services. For example our primary care system is an important part of the NHS. Whilst it is very unlikely that it could ever be simply lifted from here and applied to an emerging economy, the application of a free universal primary care system could be very very useful to a number of nations and they will want to buy aspects of the NHS to make this happen.
But in the past the problem has been that when the NHS has tried to organise these sets of commercial relationships centrally, it has learned the wrong lessons from NHS structure. It has tried to use the old model of ‘top down’ bureaucracy which stifles the very individual innovations that it is trying to facilitate.
Therefore most of these NHS international initiatives fail because they take from the NHS the one thing that nobody wants to replicate – a central neurotic bureaucracy which is anxious about entrepreneurship and ‘difference’ – and which tries to organise the life out of any possible international organic relationships that might make them work.
Our economy – and our NHS – need this initiative to succeed.