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.

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