The shock of the new

In 1948, when the National Health Service was born, its structures were designed to provide reliable and comprehensive medical treatment for everyone, dealing with health emergencies and one-off illness. Its remit was to deliver sound, adequate health care.

Sixty years on, in 2008, the report of Lord Darzi's NHS review, High-Quality Care for All, spoke of driving the NHS towards completely reinventing itself. In this vision, decisions are made to improve quality, rather than minimise cost. It foresees models of patient-centred care that engage individuals in the long-term management of their own health, with clinicians on hand to advise, guide and support their choices.

The impact of these changes is expected to be profound, with patients and families diagnosing, monitoring and treating their own conditions, resulting in changes to the usual relationship between health professional and patient, and to the organisational structures of the NHS. It will be hugely different from the NHS of six decades ago, and it will be possible only if we develop new ways of working, new attitudes, new treatments - if we embrace innovation.

However, with the challenge of an ageing population, with our system encumbered by the growing numbers of people with long-term conditions, rising health expenditure has led to a debate about how we can continue to pay for the fruits of progress. When we spend more on education or on technology, we do not think: "Oh, what a burden." But when we spend more on health, we fear: "We cannot afford this." Why is that true of health, and health only? Education is an investment in people's futures - but so is health. Perhaps it is because we still tend to see the NHS as an "illness" service, rather than a "wellness" service.

We are one of the richest economies in the world. Bioscience is one of our most promising sectors. Because of the beliefs that we have about the NHS, however, we are usually the least innovative user of technology. The NHS provides a large resource for clinical trials, but it has not lived up to its potential as a driver of biotechnology. Although we have an integrated service that gives us the opportunity to serve patients and the health-care industry better than any other country in the world, we are one of the slowest adopters of innovation. Having budgeted huge sums for this nonetheless, we do not actually spend the money on patients. Consequently, we cannot really see the benefit. No wonder we think we cannot afford it.

In what ways are other industries and services successfully adapting to changing circumstances and requirements? The information technology industry is one that constantly innovates. Companies in this sector have been unleashing the creative potential of their customers. And they realise that, if you are going to listen to your customers, you have to do it properly, involving them fully in the design phase. By integrating their views, such firms create a kind of innovation that has the customer at the centre. Market leaders such as Apple and Microsoft seem to have developed meaningful relationships with their customers which now provide them with a base from which to produce ever-more creative solutions to those same customers' requirements.

On page 4, Paul Rodgers offers an introduction to the themes and questions around medical innovation in technology and systems. In the round-table debate that starts on page 6, participants discuss how we can nurture the innovation that the NHS needs to deliver the high-quality care the Darzi review promises.

This is part of a series of debates sponsored jointly by the New Statesman and Pfizer.

All the debates and supplements in this series are available on the New Statesman's website and from



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