How to sell the NHS

BRITAIN’S National Health Service has been caricatured as “a national religion” inspiring uncritical attachment. Recently though, revelations of high death rates in a number of provincial hospitals have shaken this faith. Yet as arguments rage about whose policies are to blame for failings and errors, the NHS seen from beyond Britain’s shores looks more impressive than its tattered reputation at home. Many emerging economies are showing renewed interest in the system that was founded by Aneurin Bevan, a Labour politician, in 1948.

Nigel Edwards, a former NHS official and health analyst with the King’s Fund, a charitable think-tank, says the main reason is its status as a “national” enterprise, providing a wide range of services to the entire population, regardless of people’s ability to pay. That aspiration unites governments as diverse as China, India, Mexico and South Africa: they are all trying to forge national health provision from piecemeal set-ups—and spending growing chunks of their GDP on the quest.

At a health conference hosted by KPMG, a services company, in South Africa in July, several speakers from the continent referred to establishing national health services as their “holy grail”. Some countries, like South Africa hope to create an accessible public-health insurance system within the next decade as a symbol of divisions overcome. Others with large populations and tight budgets are attracted to the NHS’s reasonably cheap per-person coverage.

Although many emerging economies also want to hang onto private insurance schemes, they relish the NHS’s emphasis on fairness towards poorer folk. Julio Frenk, a former Mexican health minister now at Harvard, praises the British approach for breaking the link between earnings and health entitlements, a problem for insurance-based systems, because premiums are often linked to wages. That solution appeals to places with large populations outside regular paid employment. “If you have to wait until they all get regular jobs,” Mr Frenk says, “you’ll wait too long.”

Another feature of Bevan’s brainchild envied by some developing countries is the idea of the general practitioner (GP) as gatekeeper. This will surprise Britons fed up with busy switchboards for appointments. But GPs prevent patients with trivial, easily treatable illnesses clogging up expensive specialists’ queues. GP-based primary care is becoming popular in India, which has pledged to increased its government health spending from a paltry 1% in 2011-12, to near double that by 2016-17.

Tailoring British-inspired services to low budgets can also spark bright new ideas, with more entrepreneurial focus than is welcome at home. Niti Pall, a doctor from Birmingham, has set up a social-enterprise company with former NHS colleagues to deliver around 150 primary care practices to Indian cities, modelled on British GP services. Given the failures to uncover bad practice at home, it may seem cheeky for Britain to retail itself as a titan of administration. Few countries want to copy say, the Care Quality Commission, which ignored hospital failures. But other British quangos are emulated. Faced with a high cost of drugs, the Chinese are studying the National Institute for Health and Care Excellence, which checks on the cost-efficiency of medicines and treatments.

Even the jargon of the British health system is catching. Your reporter recently visited a private maternity hospital in Sichuan, where the vocabulary owed much to the health reforms of New Labour’s time in office. Proud emphasis was placed on the “purchaser-provider split” and “patient-centred experience”. Waiting lists, irksome to British patients, were viewed as an advance on a system where the well-off push to the front of the queue in return for generous backhanders.

Politically, the vogue for NHS-inspired health care could suit Britain’s governing coalition, because it alleviates the bad news about domestic failures. Some of the best-known London hospitals have set up private branches abroad which plough profits back into their public practice at home. Moorfields, an eye hospital has a branch in Dubai and Great Ormond Street Hospital provides training and consultancy services in the United Arab Emirates. It now promotes itself as a “global centre of excellence”.

Keen to keep pace with technological changes, the Department of Health is conducting an assessment of M-health (diagnosis and monitoring by mobile phone). And despite pitfalls with IT systems gone expensively awry in the past few years, Jeremy Hunt, the health secretary, wants to make Britain the “most interesting country in the world” in terms of patients’ access to data about their own records and the performance of hospitals and surgeons. An advantage of a unified system of records is that the NHS has comparable data across big swathes of the population; that is harder to guarantee if the population is divided between insurers.

Just as the NHS influences other countries, could it learn from them? Templates used far from home can be adapted, without the fuss that accompanies change at home. Dr Pall’s project in Delhi, for example, raises funds privately and patients pay a consultation fee of a few rupees. In England some local doctors think a similar small consultation fee might be a good idea too. The founding guarantee of treatment “free at the point of delivery”, encourages overuse of the service for transient ailments.

Harvard’s Mr Frenk believes the NHS might emulate the Oportunidades, scheme of conditional cash transfers set up in Mexico in 2002 to encourage the country’s poorest people to look after their health. Britain still lacks widespread incentives for healthy living, like South Africa’s Vitality scheme, which offers discounts on wholesome foods in return for attending the gym. And as the demand for better health-care value grows, countries with tight budgets and high aspirations, from Brazil to Ethiopia and Mozambique are breaking down stiff workplace demarcations to enhance hospital productivity, a debate still largely out of bounds in Britain.

The NHS’s success overseas shows that it is not as hopeless a cause as domestic doom mongers believe. But as it exports its best features, it also needs to pay more attention to the improvements of younger, less hidebound systems. The nation’s religion has much to teach—but a lot to learn, too.