NO SPECTACLE is “so ridiculous as the British public in one of its periodical fits of morality”, harrumphed Thomas Macaulay, a Victorian historian. Today there is no spectacle so ridiculous as the British public in one of its periodic fits of panic about the National Health Service (NHS). Every decade or so the government tries to reform the NHS—and every decade or so the NHS masses its forces to work the public into a frenzy.
Doctors threaten to strike against “privatisation”. Bishops bleat that anxiety stalks the land. The BBC waves blood-stained sheets. And the government eventually backs down. Thus it was with Margaret Thatcher and (more mutedly) with Tony Blair. And thus it is with David Cameron, who came to office promising to reinvent the welfare state but now promises that the NHS of the future “will be much like what we have today”.
This is a mind-boggling statement. The internet and the mobile phone are revolutionising social life. New drugs and surgical techniques are revolutionising treatment and prolonging life. Entrepreneurs and innovators are demonstrating that you can use new technology and clever business models to deliver better health care for less money. As Britain ages and its medical bills soar, the NHS must experiment or die.
The NHS was built on the idea that patients are passive recipients of medical wisdom, most of it delivered face-to-face. This is beginning to change: doctors now advise patients to take exercise and eat their vegetables. But it has a long way to go. The private sector has revolutionised productivity by getting customers to do more things for themselves. Rather than waiting for a butcher or baker to serve us, many people now choose their own groceries and scan them themselves at the checkout. This model is now reaching health, too.
Several American organisations encourage people to monitor and manage their own health. The Centre for Connected Health, which works with Harvard Medical School’s hospitals, urges patients to wear tiny sensors that generate data about their well-being. This not only allows doctors to call them if something is amiss; computerised “lifestyle coaches” also send them e-mails telling them to modify their behaviour if their indicators grow worse. Kaiser Permanente, a health-care firm, allocates diabetes sufferers a diabetes specialist and then encourages them to get their blood tested at a local pharmacy. The results are analysed and the specialists call their patients if a red flag pops up. The Montefiore Medical Centre in New York has reduced hospital admissions for older patients by more than 30% by using remote monitors which allow doctors to manage them at a distance.
Much of the pressure for a more collaborative approach to health care is coming from the bottom up—from patients themselves and from what David Cameron calls the “big society”. Voluntary organisations such as Alcoholics Anonymous have a better record than the NHS at teaching people to look after themselves. People who suffer from rare or debilitating diseases form online groups such as PatientsLikeMe and WeAreUs to swap advice and support each other. There is a growing community of “quantified selfers” who monitor their own bodily functions and hold meetings to discuss their results. This combination of monitoring and self-help holds the key to cost control as well as improved health: about 75% of NHS spending is devoted to 17.5m people who suffer from long-term problems.
The NHS was also built on the assumption that general hospitals are the flagships of the system. (Mr Cameron promises to defend them.) But across the developing world entrepreneurs are demonstrating that “focused factories”, to use the jargon, can use economies of scale and intense specialisation to improve productivity. The Narayana Hrudayalaya Hospital in Bangalore has reduced the cost of heart surgery to $2,000 (60% cheaper than most Indian hospitals). Its 42 surgeons perform an impressive 3,000 operations a year. They become virtuosos in their sub-specialisms. LifeSpring Hospitals, an Indian chain, has used standardised procedures, borrowed from manufacturing, to reduce the cost of delivering a baby to $40, a fifth of the cost at comparable local hospitals. Every year the Aravind Eye Hospital performs 70% of the number of eye operations performed by the entire NHS for just 1% of the cost.
Entrepreneurs are using new business models to revolutionise routine care as well. Franchising, for example, allows entrepreneurs to piggy-back on other people’s infrastructure (particularly retailers) while at the same time fitting in with the rhythms of everyday life. VisionSpring, a social enterprise, provides entrepreneurs in 13 countries with a “business in a bag”: all the equipment they need to diagnose and correct long-sightedness. PDA, a Thai social enterprise, distributes condoms and contraceptive advice through a network of restaurants. America’s MinuteClinics, which operate in stores, offer health screening and treatment for common ailments under the motto “You’re sick, we’re quick”.
The struggle for NHS reform has not been completely lost. On June 8th Reform, a think-tank, staged a conference on “disruptive innovation” in health care. NHS veterans repeated the old saw that the NHS is the closest thing Britain has to a national religion. But they also listened excitedly as Indians and Mexicans told stories of innovations back home. And they produced numerous examples of innovations of their own. NHS Direct, a hotline, dishes out medical advice by phone and the internet to 8m people. Boots and Specsavers, two high-street stores, apply something like the franchise model to the distribution of spectacles. Pointing out flaws in a nation’s religion will seldom win you friends. But sometimes it takes a Reformation to save a church.