My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

Markets, business and the creation of innovative value for money health care for NHS patients.

Filed Under (Creating public value, Health Improvement, Innovation, Private Health Care) by Paul on 10-11-2011

A small story last Friday exemplified a much bigger issue. The story concerned the results of research from the University of Birmingham on how the effectiveness of different weight loss schemes.

They compared the efficacy of group diet programmes such as Slimmer’s World, Weight Watchers and Rosemary Conley with plans offered by GPs.

All the schemes achieved weight loss at 12 weeks – from an average of 3 lbs in the GP group to 10 lbs in the Weight Watchers group. At the one year mark all the programmes except the GP group and one other had resulted in significant weight loss.

As well as differential outcomes there were differential costs. The GP’s programme was the most expensive at £112.73 per patient compared with £76.87 for Weight Watchers (the price they charged to the NHS). The Rosemary Conley programme cost £76.87 and Slimming World £71.37.

These costs are interesting. There is a 4% difference between the 3 commercial programme and an over 50% difference when comparing these three to the GP service. This is because the three commercial products compete with each other in the market and inevitably their prices have come together. The GP services have not competed on price and the lack of competition has lead to a bigger price differential.

The GP group outcome was found to be no better than the control group – where people exercised at a local fitness centre. It appeared that gentle peer pressure and mutual support motivated people more strongly than a doctor’s advice.

A key reason why commercial companies scored greater success was that the patients allocated to them kept coming back week after week. People were less likely to attend GP practice sessions.

It would be crass to simply say that this is an example of the private sector demonstrating better value than the NHS. The point I want to make is more complex than this.

Slimmer’s World and Weight Watchers, as organisations, have developed their products to be able to survive without subsidy. They have learned to work in the real world of real economics. They have to develop business models that give their organisations the best chance of sustainability, and that means ensuring that the price is low enough to be affordable. The “personal trainer” approach to weight loss only works if the person losing weight has quite a bit of disposable income. For most people it needs to be cheaper and if the only way this will work is with a low price, so you need a number of people in every class. To make this at all affordable for most people you will need to join a class where a larger number of people are paying.

So group learning was the only way that a business model would work. Get a group together and then work together to lose weight. They help each other and they “co-produce” the loss of weight with the group leader. That’s not only how and why it works, but also why people keep on coming back – because everyone feels a responsibility.

This is the modern way – involving the consumer in the production of their own service – rather than having them rely on the professionals to do it all for them.

So working together to lose weight was an innovation that came from an unsubsidised business model. It could only work if dieters did a lot of the work themselves, and if slimmers do a lot of the work they are more likely to lose weight.

A little competition with the NHS has proved a worthwhile and a more efficient method of providing services.

So what does the DH say about this use of competition?

Let’s look at the lesson that the DH draws from this,

“Weight management programmes can be very cost effective and make losing weight easier for some people, but the way to lose weight will be different for everyone” 

If this is leadership then I am a banana.

In those heady days last year the DH would have jumped upon this research as an example of how a pluralist approach to weight loss had created different models with different motivations resulting in a new way of working with the public to develop a better value for money method of slimming.

But no, we are now living in the days when we mustn’t unsettle the status quo so the current response is that everyone is different and everything works somewhere.

But the real lesson is an interesting one.

Those people who feel that competition cannot create collaboration might have found it interesting that the innovation of collective working on weight loss had not come from the state but from the private sector.

But no in these days – when we mustn’t upset the status quo – the current response is everyone different and everything works somewhere.


One Response to “Markets, business and the creation of innovative value for money health care for NHS patients.”

  1. And how are you going to make this model work to cure people of cancer?

Leave a Reply