Posted on Aug 31, 2012 by Sergio Ulloa
Following a tribute in the London 2012 Olympics that was broadcast to the world, the NHS is encouraging its member trusts to do the same and expand globally in a bid aimed at funding health services in the United Kingdom. The idea originated in the Labour Party and is now gaining speed to expand the National Health Service beyond the UK's borders. However, will this idea affect the costs and quality of care for current residents of the UK?
The government is supporting a recommendation for large private hospitals, such as the Great Ormond Street, Royal Marsden, and Guy's and St. Thomas'. Following the model set by Moorfields Eye Hospital in London which has set up shop in Dubai, the UK hopes to emulate the success which Moorfields' Dubai branch has seen since its establishment overseas in 2007.
Governmental officials say that these large hospitals and entities should utilize their profits derived from their private practices and use them to develop healthcare assets overseas. After the overseas operations are established, profits from the entity should be rerouted back to the NHS to fund ongoing improvements to the UK healthcare system.
The NHS aims to make itself a global leader in providing healthcare by marketing itself as a recognizable name worldwide. By setting up hospitals overseas, it can market its services and create a demand for it.
"The NHS will be bringing together the Department of Health, the UK Trade, the National Commission Board, and form an organization that will help healthcare providers in [the UK] and develop those skills and sell them abroad for the benefit of the patients in [the UK]," says Health Minister Anne Milton, a Member of Parliament of Britain. Any kind of profits will have to be redirected back to the benefit of NHS patients, in a scheme which Ms. Milton says is a, "Win-win."
The government is currently eyeing hospitals and institutions with great international reputations, allowing for an easier uptake of the program. Once the program becomes more successful, the government should open it up to smaller private healthcare providers.
What's unclear at the moment is exactly where the doctors and medical practitioners will be sourced from. There are two possibilities: The NHS could source the staff from their own current employees - after all, they are the world's fifth largest employer. Alternatively, the NHS could source the staff internationally, which could also be feasible because of the vast number of readily available professionals around the world. However, there are possible negative effects of both methods of sourcing which need to be taken into consideration.
First, if the NHS proceeds with sourcing from existing NHS staff, skilled workers in the UK may be less readily available. With workers being asked to work abroad, there could be a premium added to their salary, as well as other fringe benefits which compensate workers for their move. In addition, as these workers will be a direct foreign representation of the organization itself, there is a high chance that highly skilled workers will be recruited to move overseas first. More skilled workers may also be more adept at adapting to challenging situations, further making them a target for recruitment overseas. However, this will draw the UK's more skilled healthcare workers away from the UK system, potentially lowering the standard of care in the country. This also represents a costlier decision because of the need to incentivize doctors to go abroad by adding benefits to their compensation packages.
What if the NHS decides to hire internationally? The goal of the NHS is to export the "brand names" of the NHS that have international and esteemed reputations. As such, it could be contradictory to start a new branch with staff who do not previous history with the NHS in essential, and especially management, roles. It would make most sense for the NHS to at least fill higher level roles with skilled medical practitioners from the NHS in order to preserve the level of service. Moreover, an international hire may not inspire as much confidence in local patients who are seeking high quality international care based on the NHS brand name. Why would they need to go to the potentially more expensive NHS which features a local hire if they can receive the same type of treatment at a potentially lower cost? Furthermore, hiring the best doctors available locally in the oversea hospital's area might cause issues for the local healthcare system, especially if there is already an ongoing shortage of doctors in the region. If the NHS doesn't hire in the target area but still recruits internationally, it may still represent a higher cost because of relocation packages and expatriate salaries that they may need to attract international hires.
Will the costs of healthcare increase because of the expansion? As mentioned earlier, highly skilled workers may be incentivized to take up positions in the new hospital developments overseas. As such the ability to properly provision healthcare for the nation may be reduced if the NHS does not replenish or properly account for the departure of some of its staff. Moreover, the NHS has been widely reported to be experiencing a significant shortage of workers, despite being the world's 5th
largest employer. Shortages of nurses and doctors are, in some cases, extreme, as data from the Department of Health indicates that some family doctors may be responsible for as many as 9000 patients. A new development requiring skilled practice may hinder the system, preventing patients in the UK from having adequate access to much needed healthcare services.
The demand for medical practitioners is high in the UK. There is a general shortage for the medical field, vastly due to the amount of doctors leaving the UK for better packages worldwide. In a recent report by the Policy Research Programme in the Department of Health, UK doctors are being offered attractive benefits packages, better living standards, higher control of their work, and in places with better living conditions than the UK. This incentivizes many highly trained doctors to move abroad, resulting in a shortage of doctors able to provide important healthcare services. Some of the doctors surveyed also indicated that they were disillusioned by the NHS, stating that it was bureaucratic and limiting.
This expansion overseas will not affect the highly specialized private hospitals which have a well-recognized name brand - in fact it may be quite easy bring in profits as foreigners may be attracted to these brand names. However, whether smaller hospitals will be capable of following suit or willing to remains to be seen. Many hospitals in the UK are currently designed to be providing an essential service to the community and gearing them towards acting as for-profit multinational companies may cause them to lose focus on providing quality care within the UK. If managed poorly, the implementation of this program could cause shortages and cuts to existing services as hospitals direct their attentions and funds overseas. This could affect prices negatively for the patients they service locally in the UK. With the significant burden that many general practitioners already face - upwards of 3,000 patients per doctor, some even 9,000 - and in the middle of a large scale reorganization of the NHS, the main focus should be improving these services and ensuring that the new system provides the benefits its supposed to.
This leads to a discussion about the focus of the NHS - should this really be what they are redirecting resources towards? The NHS is asking for their hospitals and entities to redirect profits from private health practice to fund their international developments. While the NHS does provide quality services to UK citizens, waiting times for both scheduled treatment and A&E care are a serious problem due to a lack of beds and medical professionals.
Could this expansion affect healthcare costs and insurance premiums? There is a possibility this could happen if the private hospitals which are establishing hospitals overseas increase charges on private care in order to raise funds to start the overseas ventures. Similarly, if the overseas private hospital programs lead to increased brain-drain on UK doctors, it could drive up the costs of private care further. Both of these possibilities could have knock on effects on the private health insurance system in the UK, which is already trying to avoid large premium rises to avoid off putting customers.
Given the NHS budget freezes and cost savings put in place as part of QIPP (Quality, Innovation, Productivity and Prevention) policies in the UK, it is understandable that new sources of income are being investigated and considered. However, it is of the utmost importance that these efforts do not come at the expense of local capabilities, especially during the largest reorganization of the NHS system in years.