Is the NHS on its last legs?

With the NHS in the UK nearing its 60th birthday, there’s been considerable talk about whether the system should be put into retirement. At the recent European-based World Healthcare Congress in Berlin the Chief Executive Officer David Nicholson explained why he felt that there was plenty of life in the old girl yet.

Nicholson pointed out that the last 18 months have seen significant change in the NHS. One year ago, the NHS was in its third year of producing a deficit – averaging about £0.5 billion annually. In 2007 the organisation managed to turn this around so successfully that they created a surplus of £0.5 billion, and this year the surplus is projected to be 3 times that. Now, why, you may ask, is a surplus a good thing in a non-profit organisation? Simply because when you have money you have an element of control over what you do. Being constantly in debt leaves you on the back foot and leaves little room for manoeuvre. So it is with the NHS, Nicholson claims.

Thinking of the NHS as purely a system helps with the implementation of change, according to Nicholson. He described the changes that have happened in the NHS as a series of phases.

The first phase began in the post 1997 era with a focus on building capacity based on national targets. In this phase the NHS grew by almost a third, in staff buildings and all levels of healthcare provision.

Phase Two of the change was in providing reforms in healthcare delivery – setting up tariff systems and organisational models.

Phase Three, underway at the moment is the individualisation and personalisation of care – making patients partners in their own healthcare provision.

From the 1st of April (a somewhat unfortunate choice of date) patients will have free choice of their secondary healthcare. The NHS is hoping to introduce an element of choice and contestability into healthcare, and also to integrate primary and secondary care a little better with advanced IT systems. To that end, they are working closely with BT Health to develop electronic patient records.

A start of this phase is the ability for patients to interact with their own healthcare records via HealthSpace on the web. So it seems, with an exciting future ahead, the NHS is heading a second youth/swinging sixties/second wind.

‘Big box’ companies and public health

Whether it’s because of a shortage of primary care physicians, impatience at the length of time it takes to see one, or simply increasing costs, the so-called big-box companies are getting more involved in health issues. Steven Burd, CEO of Safeway, told attendees at the World Health Care Congress (WHCC) in March that 70% of healthcare costs are driven by behaviour and he called for introducing market forces into preventive medicine and drug compliance.

Safeway has attracted a coalition of more than 50 other companies in promoting healthful behaviours. At Jefferson Medical College ‘s Department of Health Policy’s 17th annual Dr. Raymond C. Grandon Lecture, Dr. John O. Agwunobi, a senior vice president at Wal-Mart, spoke about bridging the worlds of business and public health. And also at WHCC, Stanley B. Blaylock, president of Walgreens Health Services, described his company’s healthcare initiatives.

In an interview with HOC, Blaylock noted that Walgreens has more than 6200 retail pharmacies, and that 146 of these have “Take Care” in-store clinics that the company is adding to at the rate of one a day. In March, Walgreens became the exclusive specialty pharmacy provider for Prime Therapeutics, a pharmacy benefit manager collectively owned by 10 Blue Cross and Blue Shield plans, which together serve more than 20 million health plan members.

Medmark, a Walgreens specialtiy pharmacy of which Mr. Blaylock, a former investment banker, was a cofounder, will provide Prime Therapeutics with medication fulfilment and complement Prime’s existing patient education and clinical support services. Its pharmacists and nurses will counsel patients on the importance of medication adherence and on managing side effects.

Blaylock describes the company’s new employer on-site clinics as “Take Care on steroids.” He notes that in the US more than 7000 employers have over 1000 employees, and 200 of these, including Sprint, BMW, and Disney, are Walgreens clients. Taking healthcare to the workplace, he says, increases productivity and accessibility while decreasing absenteeism. It’s also more user-friendly, he believes. The next step for Walgreens, says, Blaylock, is to integrate the company’s health services more fully in an attempt to provide something closer to the so-called ‘medical homes’ – comprehensive, community based primary care.

While Safeway, Wal-Mart, and Walgreens may all serve different client bases and adopt differing strategies to serve them, there is clearly a growing trend towards store-and work based healthcare delivery as we try to come to grips with the increasing challenges of cost, access, quality, and efficiency.