Narayana Hrudayalaya: a lesson for the NHS
Civitas, 11 August 2010
Long has this blog argued the benefits of increased specialism in the way health care is delivered; that is, for example, for focused centres for operating on particular conditions and disease-specific networks that treat and help people manage chronic diseases. Evidence, contained particularly in Clayton Christensen’s brilliant book The Innovator’s Prescription, has long suggested such centres offer better and cheaper health care than the 19th century district general hospital model of every hospital trying to do everything. Senior clinicians also appear to agree.
And now the Coalition Government are getting on the bandwagon, marvelling at ‘production line’ heart surgery seen at the 1,000 bed Narayana Hrudayalaya hospital that David Cameron and Vince Cable visited in a recent trip to India. The centre only does heart surgery and (probably) does it better than anyone in the world, with better or equivalent outcomes than UK and US hospitals at much less cost (adjusting for purchasing power parity). Vince Cable described the visit: ‘I just found it overwhelming. It combines what we always see in a good health system, which is humane humanitarian behaviour, with sound economics.’ The centre’s lead surgeon, Dr Devi Shetty (note also the driving force behind the hospital), was educated in the NHS and is interested in building something similar here too.
The problem is you can bet your bottom dollar there will be a chorus of opposition to such a commercial venture: from existing hospitals saying it is dangerous (not being ‘integrated’ with other services, being run by foreign doctors, being concerned with profit etc.), from the BMA and trade unions who want little more than the status quo (and will insist NHS organisations can do it alone), and (if the form of the Tories and Lib Dems in opposition is carried forward to office) the government itself who refuse to countenance hospital closures. There’s precedent for this: ISTCs. The NHS’s opposition to ‘disruptive innovations’ such as Narayana Hrudayalaya has been a historic weakness and – in current financial times – needs to change fast.