We need to avoid NHS knee-jerks

23rd August, 2012 4:13 pm

The NHS provides a range of invaluable services. Foremost among these has to be the testing of knee reactions. For decades, local GPs up and down the country have been hitting the knees of the nation and watching the resultant kick. For years now, there has been another test offered by Danny Boyle’s favourite public service. The greatest test of the national knee-jerk reaction comes with the simplest of suggestions of NHS reform. As Dan Hodges has already noted, this is not helpful or constructive. If the NHS is to be preserved, it cannot be locked in an era of Marilyn, Macmillan and the Marshall Plan. We must, from time to time, restrain our (mostly justified) complete and utter distrust of any attempt by the Tories to meddle with this particular national treasure.

It is, in fact, precisely because the NHS is a jewel in the metaphorical crown of the United Kingdom that we should (as the only party that can truly claim responsibility for the NHS) take seriously the proposals for the NHS global brand. What The Independent called “a radical plan to be launched this autumn” was outlined by the Department of Health and UK Trade and Investment yesterday. The chief executive of the Patients’ Association quickly reassured us that the national knee was still in good jerking order.

Let’s get clear about one thing before going any further. All arguments which rely on back doors and thin ends of wedges belie an ideological dogmatism that impairs careful consideration and rational debate. There is no reason to think that this is the illicit love-child of Milton Friedman and Niccolo Machiavelli. This is not a crafty trick to sneak privatisation into the NHS – that’s happening elsewhere. It is not difficult to separate what happens in the UK and what happens outside it. We only have to look as far as the BBC for a workable model. Those within the UK get to enjoy the BBC without commercial interruption. Those outside our little island receive the same quality of programming but not on the same terms. There is no reason to think this distinction could not be maintained for the NHS.

There are two genuinely interesting questions to be discussed. The first is about talent; the second about ethics. The issue of talent and, more specifically, the fear of “brain drain” is very real. We should all be able to agree that the best NHS cancer specialists should be in the UK. A badly designed NHS global brand could result in doctors being trained at the taxpayers’ expense before taking more lucrative “NHS” opportunities overseas. However, a well designed system could create a “brain draw”. The high international reputation of the NHS means that doctors all over the world want to work in the UK and – more importantly – for the NHS. Global NHS hospitals could act as training grounds and talent recruitment centres to drive up the quality of professional medical care within the UK. One place where something similar has been tried is at the Moorfields Eye Hospital in Dubai where it is local doctors who are trained in the hospital and gain the skills that could, ultimately, land them a specialist job in a British hospital.

The ethical dilemma boils down to whether we let the best be the enemy of the good. Those of us who consider ourselves internationalists about global justice, might be tempted to object to encouraging private healthcare systems in other countries in the same way we object in the UK. If it is good enough for us, it’s good enough for them. However, this is to ignore the fact that national boundaries do still exist and social contracts work between people and their governments. There is also the obvious point that oil barons in Dubai will find a way to pay for their eye surgery whether through the Moorfields Eye Hospital in Dubai or the Moorfields Eye Hospital in London. This approach also ignores the fact that increasing the number of well trained eye specialists in Dubai, means that more people in Dubai are likely to receive eye treatment. At the risk of defending Dan Hodges, Niccolo Machiavelli and Milton Friedman in the same post, there will be (to some extent) a trickle down effect of talent. DfID and the WHO should be doing more to raise the quality of global health outcomes but that’s not a reason to prevent good NHS hospitals doing their little bit towards these common goals.

All of this can be done whilst generating revenue for the NHS in the UK. It can lessen the burden on the public purse. This is an approach taken by many social enterprises. Establishing a commercial arm to support one’s charitable work is quickly becoming best practice among large swathes of the third sector. Given how well it works, why shouldn’t public services do the same?

None of this is to suggest that there aren’t details that need to be worked out. The politics of the situation and the national mood, for one. Ensuring the NHS staff aren’t distracted by new projects at a time of great internal upheaval is another. But the question should not be “Do we support this?” but rather “Is now the right time?” At a time of limited resources, many will argue that this should not be a priority but ensuring that all initial investment comes only from existing private patients is not a bad attempt to assuage that particular concern. Limited resources drive innovation and creativity. As the party of progress, we should be looking for positive outcomes from such processes. The NHS should not make us the (small ‘c’) conservative party.

We have a wealth of talent and expertise in the field of healthcare. This is something that can be exported. This is something which, in a globalised world, must be exported. It is an economic reality as much as George Osborne’s failed deficit reduction strategy. It is also a potential source of that much less tangible “soft power”. An ability to attract talent and goodwill from overseas should never cease to be a governmental priority. Projects such as the creation of an NHS global brand can serve precisely that function.

Win-win situations are hard to come by in politics. When there is a chance that we might have found one, we should tie our legs to the chair if that’s the only way to prevent that oh-so-tempting knee-jerk reaction.

Value our free and unique service?

LabourList has more readers than ever before - but we need your support. Our dedicated coverage of Labour's policies and personalities, internal debates, selections and elections relies on donations from our readers.

If you can support LabourList’s unique and free service then please click here.

To report anything from the comment section, please e-mail [email protected]
  • Pingback: What’s the prescription for knee-jerk reactions? | Adam Tyndall()

  • AlanGiles

    It would be difficult for the current  Labour party  to argue too strongly against the announcement from yesterday.

    Why?;  (apart from not wishing to upset the delicate   sensibilities of Dan Hodges)  2007 – NHS Global – the brainchild of…….Andy Burnham.

    This is yet another example of Identikit policies which are now such a pronounced feature of the three main parties.

  • MonkeyBot5000

    The reason people automatically recoil from the idea of NHS reform is that politicians have spent years using the word reform as a synonym for cut or privatise.

  • “This is not a crafty trick to sneak privatisation into the NHS”
    No, of course it isn’t. There’s nothing crafty about it, nor is it a trick and sneakiness is starkly absent. It’s an upfront proposal to offer private health care to a wealthy elite in boutique hospitals, for profit.

    Perhaps the well-meaning Mr Tyndall should concern himself with devising a means to provide improved conditions and acceptable health care to the estimated one million guest workers in Dubai who often earn no more than £120 a month for a six-day week, often working up to 12-hour shifts.

    But hey, there’s no money in that. And if conditions for those doing the hard graft are improved then, unhelpfully, profitability will diminish. So, instead, just mention the trickle-down myth and hope that people are daft enough believe in it.

    • jaime taurosangastre candelas

      Well, there is about £11 billion a year in the DFID budget. Perhaps DFID should transfer a proportion of that to the NHS for just that purpose?

      • What I’m attempting to emphasise is the need for a people-centred politics. There is significant support for a profit motivated politics even within the Labour Party (not that profit is a dirty word but humanity counts for something also) and this connects to the now discredited marketised approach to every area of human activity.

        Unsurprisingly, the political application of the profit motive as an organising principle, finds firm advocacy from the feverishly ambitious, in particular those with little life experience beyond university and Westminster.

        It’s all dreaming spires-a-go-go, in the worst possible Sir Keith Joseph sense.

      • MonkeyBot5000

        It would do a damn sight more for international development than building another shopping centre or investing in mining companies.

  • Brumanuensis

    I do not have a strong ideological objection to the proposals, although I do share some of the ‘ethical’ concerns Tyndall highlights. If, like BBC Worldwide, the project can cross-subsidise the ‘home’ NHS, then it might be a useful initiative.


    I do think Tyndall has been too glib in his dismissal of the potential issues with staffing. It will be quite difficult, particularly if NHS centres are set up within the EU, to prevent staff from going abroad for more lucrative work. It will also be tricky to avoid Trusts prioritising potentially lucrative overseas work, unless there is a completely separate structure for the ‘foreign’ NHS, which might create unwanted complexities.

    What I don’t understand are the continual references to the NHS’ ‘brand’. Surely its ‘brand’ is healthcare free at the point of use, funded out of general taxation (and prescription charges)? If the NHS abroad is simply a normal, fee-charging health-care provider, what aspect of its ‘brand’ are we taking advantage of? If anything, it risks looking like institutional hypocrisy.

  • timsharp1

    I don’t think that using NHS expertise internationally is a bad idea. There are plenty of examples of excellent practice in the UK especially in mental health that are transferable around the world. One aspect of the NHS which probably shouldn’t be exported is it’s confusing management structures and multiple levels of hierarchy which is where the real cost inefficiencies in UK healthcare lie. Labour did a lot of good for the NHS during its time in government – sadly the next Labour government will need to spend a lot of time and money putting right the havoc being unleashed by this one.

  • tomkeeley

    “This is not a crafty trick to sneak privatisation into the NHS”….I would have to say I disagree with that.  This is a very clear example of the government giving another opportunity to trusts to raise capital from private investment.  I think in this case there may be a logical benefit to NHS patients, with relatively little risk (unlike in the 49% cap situation). 

    However having said that, the limited experience that trusts have with expanding into the international market is that the profits are limited.  This appears to be because the expansions are largely into regions where patients are sicker and more complicated, and this does not sit well with profit making (most trusts make money from the less complicated patients, which cover loses on the others.  So….”This is something that can be exported. This is something which, in a globalised world, must be exported.”….nice writing, but the facts may not support you on that one, especially if the primary objective is a profit motive.  If ithe objective was to raise health standards in other countries, which is clearly is not, then the case may be different.

    A better comparison than the BBC may be UK universities that have developed campuses in other countries, many in China.  It is not clear at the moment how UK students are gaining from this.  Certainly universites are not making huge profits.   

  • AlanGiles

     I am rather surprised to see you say ” There are plenty of examples of excellent practice in the UK especially
    in mental health that are transferable around the world.”.

    This at a time when many MH services are being curtailed, out-patient clinics being reduced or abandoned altogether, because of a lack of funding, and for the same reason, occupational therapy groups disbanded.

    • timsharp1

      Sorry Alan I should probably add that the NHS is despite what the condemns say is very much in a state of chaos but I do believe that the quality of some of our services are world standard …. Early Intervention in Psychosis Services (developed under the Labour govt) and community personality disorder services …. I think it is a very real concern about whether these services will exist in two years time.

    • timsharp1

      Sorry Alan I did reply to this but the comment system broke down. I totally agree that the government is doing enormous damage to mental health services. However, services such as Early Intervention in Psychosis and Community Personality Disorder Services are world class in the UK and have a lot going for them …. Admittedly if they survive the current chaos in viable forms.


LabourList Daily Email

Everything Labour. Every weekday morning

Share with your friends