‘Healthcare UK’ – the NHS goes international
Elliot Bidgood, 12 February 2013
The idea of expanding the health service’s reach globally in the hope of raising the profile of the UK health sector and generating additional income to fund NHS services at home has been around for a few years now – the ‘NHS Global’ branch of the Department of Health was launched in March 2010 in the waning days of the previous government. Recently, the culmination of years of efforts in this direction came with the launch of Healthcare UK in Dubai on January 31st by Under-Secretary of State for Health Lord Howe, Lord Darzi (UK business ambassador and former Under-Secretary for Health, 2007-2009) and Healthcare UK’s new managing director Howard Lyons, who has 30 years of experience in healthcare management both in the UK and abroad. This new government-backed organisation will be run jointly by the Department of Health, the new NHS Commissioning Board and by UK Trade & Investment (UKTI), an office which reports to BIS and the Foreign Office.
The Gulf is a fitting place to start marketing UK healthcare internationally. The Saudi German Hospitals (SGH) group has operated in Saudi Arabia, the UAE and the wider Arab world since 1988, built on firm links with German universities, which shows the appetite for Western healthcare in the wealthy region. Similarly, the French, the Canadians and the Americans have facilities in the region – US ‘brand names’ with branches in Dubai include Harvard Medical School and the Mayo Clinic. It is hoped that it could provide a lucrative funding stream for our financially-pressed domestic health service if Britain expands its operations there as well. Indeed, Great Ormond Street Hospital already has an office in Dubai, established in 2005, and Moorfields Eye Hospital has since 2007, so there would appear to be a base to build from. Despite controversy around it at the time, Danny Boyle’s celebration of the NHS and Great Ormond Street in last year’s fantastic Olympic opening ceremony seems to have paid dividends in this sense, as a spike in international interest in British healthcare has been reported as a result (though recent international coverage of the Stafford hospital scandal could counteract this somewhat). Broader expansion to the emerging markets of the world, including Brazil, India and China, also appears to be on the cards. Given the huge competitive healthcare market in America and some of the attacks British healthcare has often been subject to there, I would also tentatively suggest that expansion into the US market should perhaps also be explored, as if Healthcare UK caught on there it could allow us to safeguard our reputation and strengthen the Anglo-American bond. And insofar as all of this will put Healthcare UK facilities in direct competition with German, American and other foreign health sectors, columnist Dan Hodges has noted that the plans could perhaps also “help settle the age old argument between Left and Right about where the NHS stands in terms of international health care comparisons”, a subject I touched upon recently.
The idea has not been without controversy, however. Objections have essentially been threefold. First, there are concerns that it represents further privatisation of UK healthcare. Second, there are concerns that it will be another distraction for the NHS at a time when it faces great challenges. Third, it has been argued to be at odds with the core ethos of the NHS and potentially detrimental to the foreign countries we are exporting to. Let’s address each in kind.
First, privatisation. As has been noted, NHS Global/Healthcare UK is undeniably an expansion on the general trend of encouraging the NHS to deliver more for its patients by thinking more entrepreneurially as an institution, following on from the establishment of Foundation Trusts, commissioning, internal competition and so on. However, we must acknowledge that alongside a huge and timely boost in health spending and a few other measures, it was precisely these sorts of innovations that helped modernise the health service and push public satisfaction with the NHS up to 70% by 2010, compared to the deathly lows of the 1990s. Thus, entrepreneurialism in the NHS has already played a critical role in strengthening the health service’s reputation in eyes of Brits and getting us to the point where we can now talk about exporting UK healthcare abroad. The failings at Mid Staffordshire and elsewhere, which occurred in part due to a fundamental lack of provider pluralism and competition in the NHS, further reinforce this need for a more pluralistic and entrepreneurial mindset within the service. Moreover, as the dire fiscal situation at home cuts off previously plentiful funding, any new revenue provided by a successful Healthcare UK programme abroad will ease the pain at home. Though he has now turned against the scheme, when NHS Global was first announced, then Health Secretary Andy Burnham noted that funds raised would be “going straight back into NHS organisations, which will benefit patients across the country” and that harnessing innovation in this way would be key to responding to the NHS’s fiscal challenges. Favourable comparisons were also drawn between the NHS Global concept and the already-successful BBC Worldwide service. However, in a piece in The Telegraph last year, Max Pemberton did point out that the status of NHS facilities as financially independent trusts could mean that while certain well-known teaching hospitals such as Great Ormond Street could gain huge revenues by establishing branches abroad, most NHS organisations would struggle to do so, thus concentrating the benefits in a small number of wealthy trusts. Designing the programme so as to ensure that a share of revenues are redistributed throughout the NHS would therefore be advisable.
The second concern, the possibility that it will distract the NHS, is one that should be given more weight. The current pressures faced by the NHS are huge and it is right that organisations such as the Unite and the Patients Association be vigilant about ensuring that nothing is done that will make it more difficult for NHS staff to deal with these challenges and uphold high standards of patient care. For this reason, it would appear wise that the government take care to ensure that British staff are not excessively incentivised to go abroad and work in Healthcare UK facilities, as a large ‘brain drain’ away from the core UK NHS would not be good. However, if a reasonable balance is maintained, the revenue and profile could be good for the NHS and for the image of Britain in the world. Moreover, the involvement of UKTI ensures that the burden of running the scheme will not fall solely on the Commissioning Board and Department of Health.
The third set of objections, also made by Max Pemberton in his piece, are more complex. Pemberton points out that the UK has already in effect benefited from brain drain in foreign countries by attracting foreign personnel here, without which we couldn’t have founded and run the NHS with nearly as much success, and therefore argues that it is insulting to then sell care back to some of these countries. I would argue however that providing local jobs and investment in these countries is a service, as is allowing local health professionals to get the benefit of British medical training and experience, which some will no doubt later take back to their own healthcare institutions. Pemberton also argued that to export the true spirit of the NHS would be to encourage the establishment of universal, free at the point of use systems in other countries. However, while the expansion of universal healthcare is hugely desirable, as the British public can and should speak to, it is ultimately a matter each nation decides for itself. Moreover it is worth noting that other developed nations with strong health systems, such as France and Germany, combine universal coverage with varying degrees of independent sector provision. Therefore, I don’t see why Healthcare UK couldn’t happily operate under the auspices of universal systems if the countries in question have chosen not to opt for an entirely public system.
However, I was at first quizzical about whether the core concept of the NHS itself can be ‘exported’ when I first read of these proposals. How can a fee-paying service be marketed under the NHS ‘brand name’ when in the NHS, tax-funded care delivered free at the point of use is currently a part of its basic ‘USP’, as it were? In this sense, keeping the government link (and thus the revenue stream to the domestic NHS) while rebranding it as ‘Healthcare UK’ for the international market seems like a preferable compromise to having it operate under the name ‘NHS Global’. As I understand it, Healthcare UK will also seek to promote Britain’s private health sector abroad as well, which should be good for British business. Overall, it appears that international expansion will be beneficial to the NHS, provided tweaks are made to ensure that a share of any revenues are redistributed across the service and that excessive brain-drain away from the UK does not occur at this crucial time, so as to allow us to fully reap the benefits of the newfound revenue and international recognition it will bring to our shores.
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