"Innovation" is an NHS buzzword. It shouldn't be.

Martha Gill's Irrational Animals column.

“Innovation” has been an NHS buzzword for quite some time. It’s how they think they are going to make money. The word peppers Andrew Lansley’s sentences and appears on every NHS website. It turns conference speeches into tongue twisters and makes job titles too long to fit on to name badges. But let’s cliché this down. Being innovative is like being a lady. If you have to tell people you are . . . you  aren’t. The NHS isn't.

Not that promoting innovation is a bad aim. One bright idea, one new drug and you can potentially generate billions. This is the thought in the minds of the policymakers who have directed several taxpayer billions to this end.

But here’s the problem. A great deal of the money has gone towards creating “facilitatory groups”, such as the National Institute for Health Research – boards that manage the interaction between NHS employees with the new ideas, and the companies that might want to invest in them. Yet the interaction is an unhappy one. The inventive employees must now fill out a vast amount of paperwork and jump over many more hurdles than they used to. The boards are large and unwieldy, absorb a huge amount of capital and are made up largely of ex-nurses, inexperienced in business and, by training, highly risk averse.

Being unwilling to take risks is all very well in patient care but it can lead to utter stupidity when it comes to investment decisions. This was perhaps best demonstrated in 2006 by the US economists Uri Gneezy and George Wu, in one simple, cruel experiment.

Participants were asked to state how much they would pay for a $50 book token, a $100 book token, and to take part in a lottery in which they would win one or the other. It turned out that on average they were willing to pay $45 for the $100 token, and $26 for the $50 token.

So far so predictable. But then, in the lottery, things became a little uncertain and the participants started acting ridiculously. Given a 50 per cent chance of winning the more expensive token and a 50 per cent chance of winning the cheaper one, subjects were only willing to pay an average of $16. This was a situation where the worst possible outcome was getting the less expensive book token, but they valued it less than one in which they were guaranteed to get that token. Madness. Unless people are experienced in business, the smallest whiff of uncertainty can completely unsettle them.

Selling out

But even when these inexperienced NHS boards do take a risk on an idea, they simply don’t have the capital to protect it properly. The new drug or surgical device is therefore sold off at a very early stage of development, relatively cheaply, to private companies. If it turns out to cure cancer, it is the that company profits, not the NHS.

Far from being a profit-generating “centre for innovation”, then, the NHS has become a feeding ground for lean, mean American companies who cherry-pick the best ideas and capitalise on the revenue. It’s time for the NHS to take a lead from the private sector where it counts. They need to stop investing in “facilitators” and start investing properly in ideas. That’s where the money is.

Photograph: Getty Images

Martha Gill writes the weekly Irrational Animals column. You can follow her on Twitter here: @Martha_Gill.

This article first appeared in the 23 July 2012 issue of the New Statesman, Israel: the future

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Leader: Trump's dangerous nation

From North Korea to Virginia, the US increasingly resembles a rogue state.

When Donald Trump was elected as US president, some optimistically suggested that the White House would have a civilising effect on the erratic tycoon. Under the influence of his more experienced colleagues, they argued, he would gradually absorb the norms of international diplomacy.

After seven months, these hopes have been exposed as delusional. On 8 August, he responded to North Korea’s increasing nuclear capabilities by threatening “fire and fury like the world has never seen”. Three days later, he casually floated possible military action against Venezuela. Finally, on 12 August, he responded to a white supremacist rally in Virginia by condemning violence on “many sides” (only criticising the far right specifically after two days of outrage).

Even by Mr Trump’s low standards, it was an embarrassing week. Rather than normalising the president, elected office has merely inflated his self-regard. The consequences for the US and the world could be momentous.

North Korea’s reported acquisition of a nuclear warhead small enough to fit on an intercontinental missile (and potentially reach the US) demanded a serious response. Mr Trump’s apocalyptic rhetoric was not it. His off-the-cuff remarks implied that the US could launch a pre-emptive strike against North Korea, leading various officials to “clarify” the US position. Kim Jong-un’s regime is rational enough to avoid a pre-emptive strike that would invite a devastating retaliation. However, there remains a risk that it misreads Mr Trump’s intentions and rushes to action.

Although the US should uphold the principle of nuclear deterrence, it must also, in good faith, pursue a diplomatic solution. The week before Mr Trump’s remarks, the US secretary of state, Rex Tillerson, rightly ruled out “regime change” and held out the possibility of “a dialogue”.

The North Korean regime is typically depicted as crazed, but its pursuit of nuclear weapons rests on rational foundations. The project is designed to guarantee its survival and to strengthen its bargaining hand. As such, it must be given incentives to pursue a different path.

Mr Trump’s bellicose language overshadowed the successful agreement of new UN sanctions against North Korea (targeting a third of its $3bn exports). Should these prove insufficient, the US should resume the six-party talks of the mid-2000s and even consider direct negotiations.

A failure of diplomacy could be fatal. In his recent book Destined for War, the Harvard historian Graham Allison warns that the US and China could fall prey to “Thucydides’s trap”. According to this rule, dating from the clash between Athens and Sparta, war typically results when a dominant power is challenged by an ascendent rival. North Korea, Mr Bew writes, could provide the spark for a new “great power conflict” between the US and China.

Nuclear standoffs require immense patience, resourcefulness and tact – all qualities in which Mr Trump is lacking. Though the thought likely never passed his mind, his threats to North Korea and Venezuela provide those countries with a new justification for internal repression.

Under Mr Trump’s leadership, the US is becoming an ever more fraught, polarised nation. It was no accident that the violent events in Charlottesville, Virginia, culminating in the death of the 32-year-old Heather Heyer, took place under his presidency. Mr Trump’s victory empowered every racist, misogynist and bigot in the land. It was doubtless this intimate connection that prevented him from immediately condemning the white supremacists. To denounce them is, in effect, to denounce himself.

The US hardly has an unblemished history. It has been guilty of reckless, immoral interventions in Vietnam, Latin America and Iraq. But never has it been led by a man so heedless of international and domestic norms. Those Republicans who enabled Mr Trump’s rise and preserve him in office must do so no longer. There is a heightened responsibility, too, on the US’s allies to challenge, rather than to indulge, the president. The Brexiteers have allowed dreams of a future US-UK trade deal to impair their morality.

Under Mr Trump, the US increasingly resembles a breed it once denounced: a rogue state. His former rival Hillary Clinton’s past warning that “a man you can bait with a tweet is not a man we can trust with nuclear weapons” now appears alarmingly prescient.

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear