Standing trial for privatising the NHS

In his latest blog post, Lars Sundstrom, Director of Enterprise at the West of England AHSN goes on trial…

As a director of enterprise I am often accused of helping to privatise the NHS through the back door.

In fact my employment in the West of England AHSN could have been very short-lived indeed. At my first board meeting I was challenged by one board member who expressed the view that if I succeeded in my plans companies would actually make a profit out of working with the NHS! I answered, “Yes of course; I thought that’s what you hired me for.”

So I was heading off to a meeting in Bath this week and while on the train I sort of drifted off into a state of mixed slumber and reflection. I guess this particular daydream was triggered by yet another episode of someone accusing me of helping to privatise the NHS.

I imagined myself in a courtroom with a jury on my left and before me sits a judge, you know the really stern kind with a white curly wig and long robe.

The judge says to me, shaking his gavel, “You stand accused sir, of aiding and abetting the private sector in making a profit by stealing the public’s money; money earned by decent law-abiding individuals and intended for the care of individuals in need. You are accused sir, of deceitfully enriching greedy businesses and bleeding the NHS dry of its scarce resources in the aid of corporate profits. You have deliberately flaunted the law, which clearly states that the NHS is free at the point of use and should be free from the scourge of enterprise and evil profit. How do you plead sir, guilty or not guilty?”

Hmmm, well that’s a point of view I suppose.

I stand up to address the judge and jury. “Not guilty, your honour,” I reply, and propose this first exhibit in my defence.

“I accept that companies need to make a profit in order to be able to innovate, but actually this profit is simply a dividend on the risk they take with their own money (and not the tax payer’s money incidentally) to develop new products that actually make people better. If the products don’t make people better I put to you that no one would buy them.

“And your honour, should any company get too greedy and want to make excessive profits from the NHS, this would simply have the effect of stimulating a rival company to make better, cheaper products. Unless of course there is a monopoly situation and the market is unable to function properly.

“In fact your honour, I would go further and state that the NHS could be accused in places of tacitly accepting monopolies by dealing with too few large companies, therefore depriving the tax payer of a market that drives down prices, stimulates innovation and provides value to the taxpayer.

“I now refer to exhibit two, your honour. I accept that the NHS is about 80% funded by money from the said tax payer. However, first of all the majority of tax payers now work in the private sector, so companies are indirectly paying for the NHS via income tax and national insurance on their employees’ salaries and, in addition your honour, I put to you that a further 8% of the NHS’s funding comes directly from tax on corporate profits.

“Therefore your honour in summing up my defence, I plead not guilty of privatising the NHS, but I do plead guilty to the accusation of helping companies make a profit from the NHS.

“I also put to you that a virtuous circle exists where increasing the number of people paying tax via enterprises helps fund the NHS, so that the NHS can return more people to the labour markets and thus pay more taxes.

“Therefore I put to you that best way to keep the NHS free is to help enterprises make a profit and grow, including making money out of working with the NHS.

“So I suggest to you we keep the NHS free by backing enterprise your honour!”

At this point my train pulled in to the station and I woke out of my daydream not knowing whether the jury might find me guilty or not.

I’ll leave that up to you to decide!

How to make a Healthlblick

He’s a nice guy that Lars Sundstrom (Director of Enterprise at West of England AHSN) but does he really get it?

Last week I was talking to Jo, one of my colleagues who’s a surgeon and who works on the front line. She was explaining a problem they have where she needs to manipulate things around patients, but without actually touching them. This really stops her from being able to do operations that she needs to, and it struck me that in this amazing age of technology this might actually be doable.

A few days later I was with Steve, a colleague who works for a local technology company and I explained the problem that Jo was having. His company is developing this amazing new gizmo for the automotive sector  called a ’Schmilblick’, which really does incredible things. For example you can turn on lights and flip switches to turn on the air conditioning and you don’t even have to touch anything.  It’s like a car dashboard that floats in mid air. So Steve says to me, “Well, I think our Schmilblick could to do that, no problem.”

Excitedly I rush back to see Jo and I tell her, “I think I’ve found someone who thinks they have the answer. They’ve got this Schmilblick and they could adapt it to solve your problem!”

“That’s wonderful!”  she says,  “Where can I get one?”

“Ah well,” I say. “They haven’t actually got one like that yet, but they’re pretty sure they can do it.”

Jo’s mood darkens. “So it hasn’t been evaluated or anything?”

“Well, no,” I say. “It hasn’t even been developed. But you’ve got to see it. It’s unbelievable and it could really transform things.”

She turns to me and says, “Look, you’re a nice guy but you really don’t get it, do you? I am busy delivering healthcare every day and I just don’t have time for things that don’t even exist. Do let me know when they have made one though, sounds pretty amazing.”

So I go back to Steve. “Hey Steve, my colleague Jo thinks this could be really great for her problem but she needs you to make a ‘Healthlblick’ first so she can try it out on some patients.”

“Look, you’re a nice guy but you really don’t get it, do you?” he says. “I am busy delivering my business plan for my investors and I don’t have time for a business opportunity in healthcare that may or may not exist, and will take forever to develop. Do let me know when they are ready to sign a development contract though, sounds like it could be amazing.”

At this point I am sensing what I need is some good advice, so I go to see Kevin who works in my local procurement office and I explain that we need some money to make a Healthlblick so it can solve Jo’s problem and some day save the NHS lots of money.

“Look, you’re a nice guy but you just don’t get it, do you?” says Kevin.  “I am busy delivering efficiency savings, and I really don’t have time or resources to look at a business case that doesn’t exist for a product that doesn’t exist either. But I agree it sounds like could be amazing. Anyway, I thought getting innovation adopted was your job?” he adds.

This conversation seems to repeat itself over and over, where businesses from other sectors who have the potential to develop innovative solutions meet a healthcare system where efficiency saving and costs pressures mean that incentives to drive innovation from new sectors into healthcare are few and far between.

So I have come to the conclusion that where innovation is most needed in healthcare is actually in the innovation process itself.

It seems to me that two things would really help us move the Healthlblick forward.

Firstly, some form of longer term partnership that allows Jo and Steve the latitude to co-develop the Healthlblick together, and some way of resourcing this over the time it will take to develop it. With current pressures on the NHS and the reforms that Lord Carter is proposing to the procurement system, this could become more and more difficult.

And secondly, along with efficiency savings, which we obviously need, we also need to develop in parallel a new mechanism to ‘procure innovation’.

This is an area we will be exploring as an AHSN and if you want to find out more and participate in this I’d like to invite you to our next meet-up on 10 December at Ashton Gate in Bristol. We’re calling it a jam session with financial instruments where I will talk more about this and my thoughts on how it could be achieved.

Those of you who speak French will of course realise what a schmilblick is – the rest of you can find out by coming to our event!