Could holding the NHS dear be stifling innovation?

A few weeks ago I attended the annual conference of the International Partnership in Innovation in Healthcare Delivery. The conference brought together over 30 entrepreneurs meeting the health care needs of populations that have traditionally had limited access to health care services. Coordinated by the Innovation Unit at Duke Medical School, and with partners from the health care industry and the charitable sector, the initiative seeks out innovative models of health care delivery and supports knowledge transfer between participants.

Many fascinating service models were presented, but I was left with the strong sense that if we want to innovate more within our own health care system, we should perhaps pay less attention to the specific innovations themselves and more to the context in which they are being generated. Looking through this lens made me realise that many of the foundations of the NHS which we hold so dear can, in fact, become barriers to innovation.

Four things stood out from the conference:

The founding principle of ‘free at the point of need’ perhaps, more than anything, leads to the NHS being likened to a national religion. For those of us that have grown up in the NHS, it’s very hard to imagine what it must be like to have to make choices about the care your family receives based on your ability to pay. Against this backdrop, any attempt to discuss the future affordability of our health care system can start to sound like heresy.

However, most of the innovations I saw came from countries where there is no universal coverage and where costs of health care are often a cause of poverty in their own right. In this context, driving down costs becomes a noble purpose – a means to achieving greater coverage. Organisations such as salaUno and Clinicas del Azucar are able to reach more people by reducing unit costs and bringing it into people’s affordability. We rarely think in these terms in the NHS but the same principle applies: for every pound that could be spent more effectively we are denying someone health care benefit.

The NHS’s unfailing ability to respond in a crisis leaves those that are touched by it in this way emotionally indebted. As great as this is, there is an unintended consequence: as a society we tend to place less value on low-tech care, where there is much scope to maintain healthy lives and reduce longer term dependency.

Many of the innovations at the conference were focused on the delivery of community-based services such as BasicNeeds (an innovative community based model for mental health care) and Medica Santa Carmen (a provider of community-based renal services). As budgets are squeezed in the UK we will need to make hard choices about where investment can be made for greatest value, and this may mean shifting our focus from the acute end of care to services that focus on keeping people well. Our Star tool can help with this – designed to help commissioners and those planning services to allocate their health resources most efficiently to benefit patients in their community.

Meeting so many people from across Asia, Africa and South America, it is quickly apparent that professional traditions in the NHS are the envy of the world – both the historical contributions to the science and practice as well as the first-class training opportunities we offer. Compared to most of the world we have a highly trained, multi-professional and abundant workforce.

However, once again, this asset can create inertia to change. Professional demarcations can create inflexibility, public expectations ‘to see a doctor’ mean that our expensive resources are not always used optimally. Professional autonomy is often seen as a defining feature of professional practice. Innovations such as the LV Prasad Eye Institute and Click Medix rethink the use of the workforce so that everyone is working to the ‘top of their license’. Standardisation of care processes runs throughout these models and improves efficiency as well as reliability of care.

Finally, the cradle-to-grave mentality which conditions us to believe the NHS is there to care for us – always – undoubtedly provides a sense of security we come to take for granted but, at worst, creates a sense of dependency and disempowers us in taking an active role in our own health and health care, and utilising the assets outside the formal health care system.

Where health services are being developed in a context where there is currently little or limited existing service provision, the potential to utilise assets within the community and to engage people in their own care makes economic sense but also can result in greater satisfaction. There is much the NHS could learn from schemes such as Grandes Aides and Le Nest which harness community assets and volunteers to provide local services that improve health and develop social capital.

The need for the NHS to embrace change to meet the challenges of the next decade is not questioned. However, many of the features that have embedded the NHS in our national psyche could themselves create barriers to the change required – we must be careful not to let that happen.

Jo is Director of Strategy at the Health Foundation, www.twitter.com/JoBibbyTHF