Page last updated at 01:05 GMT, Tuesday, 18 May 2010 02:05 UK

Could US health firm hold key to NHS reform?

By Adam Brimelow
Health correspondent, BBC News

Surgery
The NHS needs to be more productive - could Kaiser have the answers?

The health systems in the UK and US are about as different as you can get.

The universal and free NHS is a far cry from the insurance-based model currently operating across the Atlantic.

But one of the leading health firms in the US could well hold the key to making the NHS more productive.

A team of executives from Kaiser Permanente is in the UK to advise health managers on new approaches to healthcare. They are holding a three-day conference to exchange ideas.

The company specialises in looking after people with long-term conditions such as diabetes, asthma and heart disease.

It has attracted worldwide interest for its success in preventing unnecessary - and expensive - hospital admissions.

That is something politicians here are keen to emulate - but critics say the US health system has little to teach the NHS.

Interest

Kaiser Permanente is a not-for-profit company based in California with almost nine million members across the United States.

They have attracted a lot of interest, with health service managers heading off to the US to see their system in action, and regular return-visits here.

The focus with Kaiser is on care of chronic conditions, working from the principle that unplanned hospital admissions are a sign of system failure.

So that means concentrating on keeping people healthy, and ensuring effective links between hospitals and the community, so when patients do go in for treatment the right help is available as soon as they are ready to come out.

When these comparisons have been done, they're as like-for-like as you can make them and they do show that Kaiser has achieved very impressive results
Professor Chris Ham, of the King's Fund

Dr Yan Chow, director of Kaiser's innovation and advance technology group, says it is crucial to engage with patients in good times as well as bad.

"Healthcare should not be a crisis management care model but should much better be a preventive care model, with the implication that the relationship between the patient and the healthcare provider is a lifelong relationship.

"And so you can see your healthcare provider as a health adviser, a health partner in life, not just for times when you're sick, but for times when you're well."

Like the NHS, Kaiser Permanente has decided to invest heavily in IT, though of course it is on a smaller scale.

Dr Chow says medicine, essentially, is an information industry, requiring regular updates for the teams of people involved in looking after patients.

Remote monitoring

So the company has spent several years developing detailed patient records and remote monitoring technology so staff can respond quickly, for example to changes in blood pressure or cholesterol.

And patients are more actively engaged in managing their day-to-day health. Dr Chow says good use of IT helps everyone work together towards the same goal.

"In our system the doctors are salaried. We don't get paid per se for doing things. The pharmacists and the care delivery teams are all incentivised basically to keep the patient as healthy as possible.

"So it's great that the incentives are aligned. That's one of the advantages of an integrated care delivery system."

There are critics who say you cannot really compare the different health systems with different types of patients and that success in the US does not necessarily mean success here.

John Lister, from the union-backed campaign group Health Emergency, is sceptical.

"I'm not sure how appropriate it is to bring companies in to tell people that integrated care is a good thing, whereas forward-looking people specialising in older people's care have been arguing that for a very long time. And that could be developed on the basis of local knowledge and expertise we already have."

But Kaiser's ideas are beginning to take hold, with schemes in Devon, Birmingham, Northumberland and Lothian, drawing on their experience.

The Department of Health says it expects to be in close contact with Kaiser to learn from its success.

And Professor Chris Ham, from the health think tank, the King's Fund, says the evidence is impressive.

"When these comparisons have been done, they're as like-for-like as you can make them and they do show that Kaiser has achieved very impressive results in keeping the population healthy, reducing the use of hospitals which is the most expensive part of the healthcare system, and integrating care between hospitals and the community."



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