A lot more for a lot less


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The UK needs a rescue mission not only because of the state of the public finances but also because of the structural causes of inefficiency in the public sector. If these aren’t addressed, a temporary freeze in public spending will be followed by another overreach of public spending and an even greater collapse – a completely unnecessary groundhog day of public sector boom and bust. Most importantly, the areas of poor and mediocre performance in public services will remain unchallenged. In no area of public spending is this more apparent or urgent than in the NHS. In this period of fiscal consolidation, to pinch the words of the Kiwi physicist Ernest Rutherford, “we haven’t got the money, so we have to think”.

Medicine has been revolutionised by modern technology. Medical imaging and minimal interventions have emerged as alternatives to major surgery. New treatments have allowed greater management of disease. Genetics are allowing greater understanding of risk and also more targeted medical interventions. Coronary artery disease, which once could only be treated by open heart surgery, can often now be managed through the use of statins, which allows clinicians to deliver safer, more effective and cheaper care. These advances in medicine now mean that how healthcare is organised must change. It will have to change in ways few can envisage.

Making healthcare affordable, accessible and sustainable will require a transformation of how health services operate. Modern technology and medicine means that services can move closer to the patient, but more efficient and innovative medical services continue to be frozen in old, high cost hospitals. “Disruptive innovation” will break up traditional healthcare organisations such as the hospital and the GP practice and change business models to capture the potential of more innovative services. As Nicolaus Henke and Tom Kibasi argue in their article, there are concrete ways in which the NHS can embrace innovation and rethink its approach to delivery.

This transformation of healthcare services can only be achieved by allowing providers to enter the market, putting pressure on existing providers, and reforming healthcare so it is more responsive to patient choice. Right now, in the UK, the debate on public service reform has reached a pivotal moment. A new Government has made pledges to open up public services, but the critics of change have put the Government on the defensive and, on the NHS, Ministers have become as critical of competition as their opponents. Our job is to raise the level of debate above the politics and look at the evidence. Inevitably people will have different views about the future of public services but there are facts and experience on which all should agree, and which the examples showcased today bear out. Foremost, for-profit companies and not-for-profit organisations are delivering healthcare successfully around the world and doing so at greater value and with equal, if not better, quality.