Global Healthcare In A Local Framework

Back from her trip to participate in UK’s Group Study Exchange Programme, Sheenu Jhawar shares her experience.

Rotary Group Study Exchange is a wonderful platform for observing one’s vocation as it is practiced in other countries. It also gives an opportunity to observe culture of a country reflected through the finer nuances of ‘vocation’.

It is oft repeated, western culture does not care for its elderly. Excuse me one time, does it not? And we do? We have a large percentage of senior citizens, not all of them dependent but progressing towards that stage, when strong hands might become feeble, and ‘CARE’, if not help, will be required. What are we doing about them? Do we have any national / state plan? Is making an old age home a cultured answer to this question? It is oft repeated that western culture does not really care for its infants. Pardon me, yet again.

Indian Scenario

Unacceptable practices exist in India- whether among the rural areas, or even unfortunately in some urban areas, where working is not just an option, but a necessity for mothers, and in the wake of nuclear families- whether out of choice or compulsion, care of the young, is seriously neglected. Are we planning anything on that front?

Indian healthcare functions to a great balance between: public- private partnership. It is an opportunity for both to wake up to some ground realities. Yes, we do have state of art tertiary care centres— a very large percentage of which comes from the private sector as we have a new mission is in the form of National Rural Health Mission (NRHM). But is healthcare in our country really equitable?

At the launch of state-of-the- art pathology lab Acute Penine NHS Trust Hospital, UK, seen from left to right: Steven Price, Chief Executive, Sheenu Jhawar, Lesley Holland, Communications Manager- Lesley Holland and Dr Reeta Burman, consultant-pahologist

GSE Experience

‘Care of the elderly’, ‘care of the young’ and ‘equitable healthcare provision’ were three parameters that I got a good insight into, during my Group Study Exchange (GSE) visit to the UK. I was fortunate to be included as a team member of the GSE Programme, and sent to GSE dist 1280- Manchester, UK. This constituted a four-week-long stay during which I was to study my vocation, and participate in culture exchange between the two districts (ours and theirs).

My vocation being healthcare management, I was able to see and appreciate various aspects of this and felt compelled to compare the healthcare structures of the two countries as reflected by the district under study. Healthcare, termed as the ‘National Health Service’ (NHS) is provided by the government of the UK.

The Difference

Unlike India, where around 60 per cent share of healthcare provision comes from the private sector, healthcare in the UK is primarily from the government and is a major political issue. General Taxation (almost akin to social insurance) provides the resources for the provision of healthcare.

In India, not only can social insurance not work because only 10 per cent of the labour is in the organised sector, but sadly private insurance advertises and caters only to those people, who might not need it. Rural India has never heard of this concept and as research has proved, more often than not, after dowry- healthcare is the next major burden and can lead to further poverty.

In the UK, the ‘Department of Health’ regulates the spending and provision. There are some other agencies too, like ‘National Institute of Clinical Excellence’- which sets clinical standards for providing treatment, and the ‘Healthcare Commission’, which inspects the NHS trust hospitals against the various standards.

The service provision is set in various tiers. About 28 ‘Strategic Health Authorities’ all over the country have some ‘Primary Health Care Trusts’, and some, ‘Trust Hospitals’ working within their area. The interesting thing is that rather than these being accountable to the Government, the Government is accountable to the public through service provision by these units.

Of the hospitals, some are district hospitals, some are large teaching hospitals, some are specialty hospitals and some are dedicated to ‘mental health’ among other specialties.

The Primary Health Care Trusts have a two-fold activity. They commission services from the hospital for their individual catch-ment area (the community) to provide community healthcare. The second key role is to improve the health of the general population through each Trust’s own customised public health initiative. (Some areas might be rural, with worrisome healthcare statistics/ prone to patterns of particular diseases etc.)

The prices of all kinds of hospital activity are set on a national weighted average scheme. Then as per the different range of activities done by a particular organisation, funding is provided by the Government. Various charitable trusts help support their local NHS Trusts too.

Healthcare is free at the point of delivery, and therefore is equitable. This is a brilliant concept since it does not differentiate upon the paying capacity of people to render care.

However, the dynamics have changed over time. Litigation and risk management issues have caused immense paper work, owing to pending waiting lists. Although service provision needs to be reviewed over time, but here is a classic case of constant review, constant changes and growing personnel requirements, amounting to a very management heavy NHS- another resource crunch on the patient money, (although it is reported that overall management costs are lower than in most private companies).

The staff, whether they are doctors, nurses, or other allied professionals like the physiotherapists, occupational therapists, ambulance, paramedical staff members, have the privilege of working on their own initiatives- given that the targets come from the top management. It is rare to find the drudgery of routine. Creativity exists in most areas, and most people work as team-players.

Little wonder that decentralisation is successful, and every little department of a hospital as big as 2000 beds is able to work on its own initiative. The targets of-course come from top-down, but brainstorming to achieve them and implement the job profile, lies to great extent with the staff.

The actual technique of treatment between doctors of the two countries is very similar. Indian doctors are working with pathbreaking technologies, and providing state-of-the-art treatment and this can be comparable to any of the high-tech hospitals of dist 1280.

However, a major difference in the two scenarios is the professional status of the nursing community. In UK, they hold a very important role in healthcare, and work tremendously for achieving better patient care. Freedom of work is a mega booster. The doctors and nurses work in tandem to achieve patient goals. The patient is never just a medical record number. He is treated in entirety. The piecemeal approach of Indian healthcare towards its patients can learn something from the holistic and personal approach of NHS.

Elderly care is on the priority list of NHS. The latest approach is to treat the elderly in their own home- environment. The reasons are two fold- entry to the hospital entails various problems- higher chances of cross infection since this is a susceptible population, the burden of transport for the elderly, lack / shortage of care takers.

The second reason is more administrative in nature. There is a dearth of hospital beds and if a patient can be treated at his own home, not only are the chances of patient attitude towards his healthcare better, but it can also save the hospital bed for an emergency admission.

There is a range of professionally competent elderly healthcare staff supervised by the district nurses, and chaired by elderly care consultants to cater to the needs of this population. The patient care activities involve taking care of the preventive and curative aspects, and include, among other things, home environment assessment, state grants / provisions for relevant helpful equipment for home care and even social care needs.

Lessons for India

The UK government has a national mandate on ‘elderly care’ and takes it as its personal responsibility. It is a lesson which India can learn. The question is not whether it is right or wrong for the family members to leave their responsibility on external factors, but the fact that this situation exists and something needs to be done about it.

Another thing, we need to learn is bettering our child care support system. Government provides partial funding support for childcare organisations. Various perks exist for working mothers, like flexible working system, wherein the working hours maybe adopted at the convenience of the employee. Funded ‘after school care’ exists for bigger children.

Unfortunately in our country, a big chunk of possible GDP is being allowed to go waste because willing workforce cannot function. Private agencies in urban settings, and/or the government in rural India need to come forward and step into the ‘care taker’ shoes.

It is a mere window to another system. However, every glimpse has something to teach, provided we are willing to learn and practice.

The author is Director, Ace Vision Health P Ltd, Jaipur. Email:sheenujhawar@yahoo.com