"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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Lord Empey: Northern Ireland likely to be without government for a year

The former UUP leader says Gerry Adams is now in "complete control" of Sinn Fein and no longer wants to be "trapped" by the Good Friday Agreement

The death of Martin McGuinness has made a devolution settlement in Northern Ireland even more unlikely and has left Gerry Adams in "complete control" of Sinn Fein, the former Ulster Unionist leader Reg Empey has said.

In a wide-ranging interview with the New Statesman on the day of McGuinness’ death, the UUP peer claimed his absence would leave a vacuum that would allow Adams, the Sinn Fein president, to consolidate his hold over the party and dictate the trajectory of the crucial negotiations to come. Sinn Fein have since pulled out of power-sharing talks, leaving Northern Ireland facing the prospect of direct rule from Westminster or a third election in the space of a year. 

Empey, who led the UUP between and 2005 and 2010 and was briefly acting first minister in 2001, went on to suggest that, “as things stand”, Northern Ireland is unlikely to see a return to fully devolved government before the inquiry into the Renewable Heat Incentive scheme is complete -  a process which could take up to a year to complete.

“Adams is now in complete control of Sinn Fein,” he said, adding that it remained unclear whether McGuinness’ successor Michelle O’Neill would be “allowed to plough an independent furrow”. “He has no equal within the organisation. He is in total command of Sinn Fein, and that is the way it is. I think he’s even more powerful today than he was before Martin died – by virtue of there just being nobody there.”

Asked what impact the passing of McGuinness, the former deputy first minister and leader of Sinn Fein in the north, would have on the chances of a devolution settlement, Empey, a member of the UUP’s Good Friday Agreement negotiating delegation, said: “I don’t think it’ll be positive – because, for all his faults, Martin was committed to making the institutions work. I don’t think Gerry Adams is as committed.

Empey added that he believed Adams did not want to work within the constitutional framework of the Good Friday Agreement. In a rebuke to nationalist claims that neither Northern Ireland secretary James Brokenshire nor Theresa May can act as honest or neutral brokers in power-sharing negotiations given their reliance on the DUP’s eight MPs, he said: “They’re not neutral. And they’re not supposed to be neutral.

“I don’t expect a prime minister or a secretary of state to be neutral. Brokenshire isn’t sitting wearing a hat with ostrich feathers – he’s not a governor, he’s a party politician who believes in the union. The language Sinn Fein uses makes it sound like they’re running a UN mandate... Gerry can go and shout at the British government all he likes. He doesn’t want to be trapped in the constitutional framework of the Belfast Agreement. He wants to move the debate outside those parameters, and he sees Brexit as a chance to mobilise opinion in the republic, and to be seen standing up for Irish interests.”

Empey went on to suggest that Adams, who he suggested exerted a “disruptive” influence on power-sharing talks, “might very well say” Sinn Fein were “’[taking a hard line] for Martin’s memory’” and added that he had been “hypocritical” in his approach.

“He’ll use all of that,” he said. “Republicans have always used people’s deaths to move the cause forward. The hunger strikers are the obvious example. They were effectively sacrificed to build up the base and energise people. But he still has to come to terms with the rest of us.”

Empey’s frank assessment of Sinn Fein’s likely approach to negotiations will cast yet more doubt on the prospect that devolved government might be salvaged before Monday’s deadline. Though he admitted Adams had demanded nothing unionists “should die in a ditch for”, he suggested neither party was likely to cede ground. “If Sinn Fein were to back down they would get hammered,” he said. “If Foster backs down the DUP would get hammered. So I think we’ve got ourselves a catch 22: they’ve both painted themselves into their respective corners.”

In addition, Empey accused DUP leader Arlene Foster of squandering the “dream scenario” unionist parties won at last year’s assembly election with a “disastrous” campaign, but added he did not believe she would resign despite repeated Sinn Fein demands for her to do so.

 “It’s very difficult to see how she’s turned that from being at the top of Mount Everest to being under five miles of water – because that’s where she is,” he said. “She no longer controls the institutions. Martin McGuinness effectively wrote her resignation letter for her. And it’s very difficult to see a way forward. The idea that she could stand down as first minister candidate and stay on as party leader is one option. But she could’ve done that for a few weeks before Christmas and we wouldn’t be here! She’s basically taken unionism from the top to the bottom – in less than a year”.

Though Foster has expressed regret over the tone of the DUP’s much-criticised election campaign and has been widely praised for her decision to attend Martin McGuinness’ funeral yesterday, she remains unlikely to step down, despite coded invitations for her to do so from several members of her own party.

The historically poor result for unionism she oversaw has led to calls from leading loyalists for the DUP and UUP – who lost 10 and eight seats respectively – to pursue a merger or electoral alliance, which Empey dismissed outright.

“The idea that you can weld all unionists together into a solid mass under a single leadership – I would struggle to see how that would actually work in practice. Can you cooperate at a certain level? I don’t doubt that that’s possible, especially with seats here. Trying to amalgamate everybody? I remain to be convinced that that should be the case.”

Accusing the DUP of having “led unionism into a valley”, and of “lashing out”, he added: “They’ll never absorb all of our votes. They can try as hard as they like, but they’d end up with fewer than they have now.”

Patrick Maguire writes about politics and is the 2016 winner of the Anthony Howard Award.