Intended for healthcare professionals


In brief

BMJ 2013; 346 doi: (Published 30 January 2013) Cite this as: BMJ 2013;346:f606

Re: In brief

A few years ago I was talking to the Chief Executive Officer of the Mayo Clinic (I had worked there for a short time in the early 1990s and used to visit periodically) and he told me of the various UK delegations who were making regular visits to the Clinic to learn the reasons for their success with a view to emulating it in the NHS. He commented that he wished he knew the formula as he could then ‘bottle’ it and make millions from its sale! The Clinic ‘happened’ when the original founder William Worrall Mayo happened to be in Rochester at the time of the tornado in 1883 and then due to the long and hard work of his sons, William and Charles, with a small number of close associates, over the next few decades. The usual ingredients of right time, right person, team work, and sustained effort over prolonged period were the reasons behind the success of the Clinic. The CEO described his role as first being about preserving the legacy and secondly when and where possible to add to it.

I was again reminded of this exchange at the recent meeting in London on how to take the NHS to India. There is a clamour for this - many meetings both here and in the UK have taken place and others are planned. However, people forget the long gestation period for the NHS, and that it came after two world wars, and as part of a package of social reforms. It was not easy, and like the Mayo Clinic certain conditions came together to form the NHS. Creating and sustaining great institutions is sheer hard work and requires societal commitment; whilst the fact that the NHS is so political is its downside, it is also its biggest strength. The NHS is in the genes of the British society. Overall, the NHS is not an institution or a set of management and business processes only but at its core it is about certain values, and it is this whole package that goes to make the NHS. And like the Mayo Clinic, it is not possible to ‘bottle’ this and implant it elsewhere.

Notwithstanding the challenges, and notwithstanding the current problems including the ‘Francis’ Report on Mid-Staffs Hospital, take the NHS to India we must. There is a lot of intellectual capital in the NHS which has serious value for the developing health sector in India and equally there is much that we in the NHS could learn from India – it was interesting to note that two award winners in last year’s BMJ Awards were from India. Most importantly, however, with almost 1 in 6 person in the world being an Indian, and given the health status of its population, its record on innovation ( and the economic developments, India is both, the cause of global health inequalities and the potential solution. In this interconnected world with access to health care becoming a security issue, it is in everyone’s interest to promote such collaborations.

However, we must resist the temptation of quick fixes and fast returns – no doubt there are some early wins in areas of clinical services, research and teaching, but if these are not coupled with investments in leadership development to promote professionalism and ensure good governance and accountability, the whole strategy may backfire. The organ trades and surrogacy and blood farms ( not to mention the distorted child sex ratio due to female foeticides, the poor medical education and growing corruption in training and the rising costs of health care with almost 40 million Indians getting into poverty every year for example, are the price of unregulated and unethical expansion of the health sector. It would be tragic if our efforts and the rush to secure fast returns reinforces, or indeed exacerbates, these practices.

Being an Indian doctor in the NHS in the 21st century is a privilege and a responsibility – to be able to build on the best of both worlds and make a real difference is a wonderful opportunity. Like many of my colleagues, I look forward to strengthening the many existing links between UK and India and to forging new links.

We hope that the forthcoming trip of the Secretary of State to India to sign a Memorandum of Understanding between the two countries will take note of the considerable enthusiasm of the Indian community in the UK and equally note the need to ensure that we build ethical and sustainable collaborations. Indo-UK collaborations on health is a win-win strategy but only if we neither patronise (we ignore at our peril the tremendous expertise that already exists in India) nor neglect the need to challenge serious governance and professionalism deficit in the Indian health sector.

Competing interests: I am the Chairman of the British Association of Physicians of Indian Origin, although the views here are personal. I have been encouraging Indo: UK exchanges for the last two decades. Despite the discriminatory treatment of Indian doctors in the NHS, with institutional racism, I am committed to the NHS values and keen to promote them in India. More details of my future plans will be available on the website.

15 February 2013
Rajan Madhok
Medical Director
Kleyn Healthcare
93 Bewsey Street, Warrington, WA2 7JQ