How do you take England's £120bn healthcare system that was designed for one set of challenges: infectious diseases, their diagnosis, treatment and orderly cure–and redesign it for an era in which you face, not only huge fiscal challenges, but more importantly, a change in the kind of health problems you face?
Indeed, the biggest challenges now are no longer about infectious diseases but rather ageing, long-term conditions and lifestyle. This means that having highly capital-intensive, large institutions in fixed places with very expensive doctors pushing more and more technology at people is probably just going to drive up costs rather than create better solutions at lower cost. If that isn’t the solution to this new set of problems, what is? And where do we find it?
"We make it fun."
They change the place where health takes place. — Health does not take place primarily in hospitals, doctors clinics, GP surgeries, medical centres, but in homes, communities and workplaces.
They change the kind of technologies that are used. — There is an entirely new wave of frugal, low-cost, simple, robust, portable and possibly reusable technologies which are being developed often in collaboration between the developed and developing worlds to help people on location treat conditions or symptoms. A very simple one, Monash University in Australia is developing a nasal inhaler for oxytocin, which is crucial for mothers who are bleeding just after giving birth. Traditionally it’s an injection, but for that you need a needle, a syringe and you need a fridge, none of which a mother will have in rural Kenya. But an inhaler would work.
They change who does the work. — They’re doing as little with high-cost doctors as they can and doing as much as possible with peers, nurses, community nurses and through self-help.
They change the nature of health. — What they’re doing in these types of schemes is creating health together, not delivering it. They’re enabling people to create it and make it, rather than thinking that it’s something that comes from professionals.
Finally, they change how health is paid for. — Financial innovation is a crucial part of it. Either through cooperative models or through vouchers or through per capita spending, these innovators are changing how and by who health is paid for. They’re delivering help to the home, through those in the home. They are creating the best mix of truly modern systems, which are networked and distributed, and very old systems, which focus on families.
Motivation and mutual support are the most powerful kinds of medicine. That is the DNA of these schemes. If we want to meet the challenges we face we will need to import these models. In Britain we have long been used to exporting ideas and culture. That is why we have the British Council and the BBC World Service. But one thing I would love to be able to do would be to create a centre of reverse-innovation to bring to the developed world more ideas from the developing world. We will need a new wave of frugal innovation and the best source of these ideas will be the developing world.
Charles Leadbeater is a leading authority on innovation and creativity. He has advised corporations, governments and cities around the world and is the author of several books including We-Think: The Power of Mass Creativity. This chapter was reproduced with his permission, as well as the permission of The Alpine Review.