What can the NHS learn from the fashion industry? Quite a lot it turns out. Just as the NHS is going through a period of unparalleled austerity today, the clothing industry experienced its own era of austerity during the second world war in the 1940s.
Rationing was necessary to save resources, but the government feared shortages would lead to escalating prices. To protect the public it introduced the Civilian Clothing utility scheme to ensure clothes were available at reasonable cost.
It might have been expected that this would be the death of fashion. The idea was to bolster a frugal mentality focused on high efficiency and quality but that kept prices affordable – exactly what today’s NHS needs.
The Clothing Utility scheme regulations specified that dresses should have no more than two pockets, five buttons, six seams in a skirt, two box pleats or four knife pleats and no more than four metres of stitching. There were also a series of films to encourage the “make do and mend” culture, urging women to improvise by turning curtains into clothes, and replacing leather shoe soles with cork.
The restrictions were at first received with dismay. But designers soon rose to the challenge, inventing new styles, removing anything extraneous but still finding ways to add detail. Instead of sacrificing style, they re-defined it.
Today in the NHS we face the same test which has stimulated interest in a new concept: frugal innovation. All health services are experiencing escalating costs, and all face the same task of redesigning the products and processes needed to deliver high quality, safe care with greater value.
Frugal innovation is often discussed in the context of the developing world. One of the earliest examples was a simplified ECG machine developed by General Electric with a price tag of US$800 (£560) compared with a normal price of US$10,000 (£7,050). It was battery powered, had few buttons and a simple printer, could be operated by unskilled workers and was targeted at rural clinics in India.
Other manufacturers have followed with simplified ultrasound machines and similar pieces of kit. These have found their way to distant parts of China and India where they can be operated by health workers in rural outposts with basic skills – and are transforming care.
Now, frugal innovations are starting to flow the other way – from low and middle income countries to the west, fuelled by the growing recognition that we cannot go on using ever more financial and natural resources to produce ever more costly and sophisticated products and services which, ultimately, we will not be able to afford.
One of the best known is a scheme for delivering world class heart surgery at high volume and low cost pioneered by cardiologist Devi Shetty who established Narayana Health in India in 2001. By streamlining the delivery of the surgery, eradicating bottlenecks and ensuring staff do what they are best at, the company has cut the cost of a heart operation to US$2,000 (£1,400), less than a tenth of its cost in the US.
First attempts to translate the innovation to the west are being made in the Cayman Islands in the Caribbean, where Narayana has partnered with Ascension Health, the largest not-for-profit health system in the US, to offer heart operations to US patients regardless of their economic circumstances.
The scheme is operating well but there has been low take up – patients are reluctant to travel to an unfamiliar location and seek treatment from an unfamiliar provider. Narayana has also found it difficult to recruit and train local staff – its outpost in the Caymans remains reliant on Indian staff.
At the Institute of Global Health Innovation we have established a design studio, Helix, in association with the Royal College of Art where we have 15 designers working on frugal innovations for the NHS. Among the items we have developed are Floot, a simplified peak flow meter designed for children to enable them to spot early signs of an asthma attack, and innovations to help patients navigate cancer care and to improve the uptake of bowel screening.
The biggest barrier to adopting innovations such as these more widely is that they have mostly been created by individual doctors or small entrepreneurial companies who lack the clout to compete with the larger companies that dominate the market and whose businesses may be threatened by simpler, cheaper, more effective alternative products. The progenitors of frugal innovation often lack the funds to do the clinical trials required to prove their worth. Policymakers must wake up and recognise frugal innovation needs government support. It could help cut the escalating costs of healthcare worldwide.
Lord Darzi is a surgeon and director of the Institute of Global Health Innovation at Imperial College London. He was a Labour health minister from 2007-9.
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