Tim Evans, Professor of Business and Political Economy, Middlesex University London
The National Health Service is loved across the UK and far beyond. Free at the point of delivery and founded by Aneuran Bevan in 1948, he envisaged a future in which the NHS would cost less once the initial backlog of people’s health needs had been met. While Bevan’s desire for more and better healthcare costing less has eluded successive governments, I believe history will eventually remain on his side.
For centuries, ordinary people struggled to travel beyond their own localities. But in the 19th and 20th centuries better transport and communications changed all that. Horse drawn carriages, canals, and railways. The internal combustion and jet engines. All helped to spur a revolution that has delivered the high quality, low cost, transport and communications we enjoy today.
The same is true in food. Canning, agrichemicals, tractors, combine harvesters, refrigeration, supermarkets and containerisation. All played their part in creating a world in which more and better nourishment are increasingly available at lower cost. Bevan knew that once we unleash innovation we can all enjoy the benefits of more for less. Yet innovation often requires initial, upfront investment and ‘new and better ways of working’. In healthcare systems, the key question is how can the NHS harness the ‘more for less world of innovation’ whilst keeping intact the service’s founding principles?
For me, the future requires the creation of ongoing and ‘virtuous cycles’ in which investment can be focused on specific clinical services using evidence-based best practice in collaboration with NHS clinicians. However, with the coming 4th industrial revolution, there are new challenges that mean traditional models of management and working will no longer satisfice. Change has Changed: it is accelerating, exponential and disruptive. We increasingly live in a world of Hyper Competition and Creative Destruction: a world of lower barriers to entry, disintermediation and adaptability. And Knowledge is becoming the new Commodity.
It is in this context that the key questions for the NHS and global healthcare systems are: how can they co-create and manage new information and knowledge? How can it build, lead and develop organisational structures that change as fast as change? And how can we encourage ways of working where innovation is the work of everybody?
Significantly, the NHS is going to have to maximise its clinical benefits for patients by finding new and innovative forms of funding which incentivise the replacement of those things that are sub-optimal and inappropriately expensive. While some of the savings generated by using best practice may be used to pay off risk-taking up front investors, subsequent and ongoing savings should remain within the NHS. It is only by capturing the proceeds of innovation that the NHS will be able to implement at scale the transformative forms of best practice that will ensure its sustainability. These approaches can be adopted across international health systems.
Clinically, organisationally, and in terms of consumer expectations, healthcare economies are a complex web of higher quality and lower cost ‘inverted U shaped curves’ crying out to be unleashed. It is why transformation must be clinically led, with bottom up incentivises and benefits built in for all. Politically, any such approach may if required stand in opposition to any form of privatisation, contracting out or private finance initiative. However, in handing investors upfront risk, while socialising the upside, the aim should be to preserve and enhance the a health system’s public sector ethos and ownership – in perpetuity.
Today, the choice facing many health systems is either to incentivise and emulate innovation in food, travel and communications – or go on lurching from crisis to crisis: managing decline. That is why I believe we should make real Bevan’s dream of more for less. Why we should explore innovative ways in which to make the NHS health systems the global envy of the 21st century in the coming age of the 4th industrial revolution.