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Prof Sir Malcolm Grant: Globally exporting the NHS

Source: NHE Nov/Dec 2018

The NHS must export its services and expertise to protect its lead as the global healthcare market explodes, argues Professor Sir Malcolm Grant CBE, outgoing chair of NHS England.

We’re at a turning point in history as global healthcare cost and demand rise – due not only to the increase in ageing populations with complex conditions, but also to a huge expansion of the middle classes in countries such as India and China.

For instance, using a fitting medium for 2018, India’s finance minister Arun Jaitley tweeted that his country is witnessing “an expansion of the neo-middle class” following  the announcement of its highest GDP growth figures in two years. 

It’s not just India. Washington research group The Brookings Institution says 140 million people across the globe are reaching the middle-class category annually, a rate which could rise to 170 million by 2022.

The potential threat – and opportunity – for the NHS is clear. As the global middle classes grow, they create demand for healthcare and the capacity to pay for it. Worldwide spending on healthcare is increasing by 7% annually. We should expect that the people and skills the NHS relies upon to maintain its excellent care will be drawn towards growing markets around the world.

But changing global demographics also present huge opportunities for our health service.

Many countries are at the early stages in developing large-scale healthcare. They face the same challenges the NHS has grappled with over many decades. In particular, that better living conditions, better medical procedures and drug efficacy mean a steady increase in longevity, leading to growing demand and expectation for high-quality healthcare – with commensurate growth in costs.

But developing nations don’t have decades to understand and overcome these challenges. They need help now to leapfrog their existing limitation to create services fit for the 21st century.

The NHS model fosters innovation, and many trusts have developed unique services which have global applicability. Many – especially tertiary trusts – already have a strong global presence. They also compete for the highest-quality staff and research on the world stage and train practitioners from around the world. But the approach can extend well beyond those trusts.

I believe that all NHS trusts not only have the capability, but also the responsibility to develop strategies to export their expertise and services, even – and arguably especially – when they are under severe pressures in maintaining vital services at home.

The NHS is an extraordinary brand and is internationally renowned. There is great demand for healthcare expertise across the world. American hospitals, consultancies and healthcare systems have already focused on these opportunities. As many trusts have already demonstrated, the NHS can be an exemplary competitor. To have a product or service that is NHS kitemarked is a powerful route to market. Extending NHS expertise to the world through export is not only entirely practicable, but also potentially of great financial benefit. We have huge assets of expertise and experience that can be deployed well beyond our shores, helping to bring about a much-needed revolution in healthcare internationally while earning revenue to support our performance nationally.

And the NHS has reach. Other countries still evolving their systems have the opportunity to leapfrog many of the processes, discoveries and advances in healthcare the NHS has overseen. They can adopt swiftly and cheaply the new technologies that will in due course underpin healthcare everywhere, including advanced mobile communications, data analytics, and AI-assisted diagnostics. The development of mobile day surgery in India, building on ubiquitous mobile data networks, is a good example.

Talent and research

We can be sure that recruitment and retention of staff will also benefit. Extending the reach of the NHS through exporting provides new opportunities for talented people.

The same is true for research. Research that brings benefits to patients only thrives on a global level. International collaboration already underpins most research breakthroughs, and a trust whose leadership has international vision can be an active participant, and leader, in this world. And export collaboration with the many innovative UK small and medium businesses active in the healthcare arena – as we have demonstrated annually at NHS Expo – holds out great promise for all partners in terms of impact and returns.

But none of this is suited to amateur adventure. Expert support and advice is available that is specifically tailored to NHS bodies. Healthcare UK, which is a public body, has developed a service, Export Catalyst, to help NHS trusts access global healthcare opportunities. It helps assess risks in incomes, expenditure and investment for more trusts to follow the lead of well-known trusts into the global market.

Healthcare UK is funded by the Department of Health and Social Care and NHS England, but it sits with the Department for International Trade.

With access to the UK’s network of embassies and consulates around the world, it can target markets which have a need for our health and life science expertise. It can find and validate opportunities for export and match them to UK service providers. It will also be proactive in supporting the commercial process through creating proposal, assisting in negotiations and helping to close deals.

And it’s already doing well: Healthcare UK achieved over £700m of export wins last year, supporting more than 100 exports projects for private and public UK suppliers in 17 countries. With the help of Export Catalyst, the NHS will be ready to target up to £7bn of opportunities a year over the next decade.

The time is right – globally – for a sharp upturn in this activity.


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