Dilemmas of leadership at the NHS

Leaders in the UK’s National Health Service are facing a new (but curiously old) set of challenges, as another Government initiative is introduced to set up international profit-making hospital services

Tudor Rickards & Susan Moger

Officials from the Department of Health and UK Trade and Industry will launch the joint scheme this autumn, [2012] which will aim to build links between hospitals wishing to expand, and foreign governments which want access to British health services.

Hospitals including Great Ormond Street, the Royal Marsden and Guy’s and St Thomas’ could create new branches. The proposal draws on initiatives occurring in America, including Baltimore’s John Hopkins, Hospital.

Health Minister Anne Milton is quoted as saying:

“This is good news for NHS patients who will get better services at their local hospital as a result of the work the NHS is doing abroad and the extra investment that will generate. This is also good news for the economy, which will benefit from the extra jobs and revenue created by our highly successful life sciences industries as they trade more across the globe.

The NHS has a world-class reputation, and this exciting development will make the most of that to deliver real benefits for both patients and taxpayers”.

Unsurprisingly, the announcement [21st August, 2012] attracted criticisms

Katherine Murphy, chief executive of the Patients Association, said:

“The guiding principle of the NHS must be to ensure that outcomes and care for patients come before profits. At a time of huge upheaval in the health service, when waiting times are rising and trusts are being asked to make £20 billion of efficiency savings, this is another concerning distraction. The priority of the Government, hospital trusts and clinicians should be NHS patients.”

New and curiously old dilemmas

The dilemmas for NHS leaders are in some ways new, for example in the sense that the implementation of such a scheme will involve addressing problems of untested technologies impacting on clinical, informational, and managerial actions.

In other ways the dilemmas are curiously old. There have been a series of ‘revolutions’ announced by successive Governments to reform, update, transform, the NHS. The shocks and repeated initiatives led one distinguished commentator, Professor Andrew Pettigrew, to refer to the process as one of “churning not changing”.

It would hardly be surprising if some hospital leaders will see the plan as a further temporary burden to be shouldered, or one further storm to be weathered, rather than an opportunity to be seized.

Investment from private patient profits

A deeper analysis can be found in The Independent. The proposed initiative attempts to anticipate some of the dilemmas. Investment will be allowed only if drawn from income received from private patients; and any profits made abroad would be channelled back to the UK.

Areas of the world identified as key to the success of the project include the Gulf, where British medical brands already have high recognition, and China, Brazil, Libya and India.

The marketing of the NHS ‘brand’

Media comment is describing and evaluating the intiative as an attempt to market the MBS brand. It has echoes of marketing UK plc. The enthusiasm for business school language is not without dangers. Effective implementation of innovation may require a strtegic evaluation of what the ‘brand’ will look like in th future.

An example from a related service sector is that of the universities who are discovering the challenges of establishing outposts in various international locations. The learning curve is steep and competition ferocious. The most successful UK example is the Open University, and that has one unique advantage. Its knowhow (brand?) is precisely of a kind which makes such international ventures attractive to its undergraduate students.

Earlier LWD posts of interest

Health policy

Creative leadership

Distributed leadership

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