HEALTH IN UK Fighting Fit

The coalition government in the UK is introducing major reforms to the state-owned health services in the country, but will it work?<br>BHAGIRATH YOGI in London

Feb. 28, 2011, 5:45 p.m. Published in Magazine Issue: Vol. : 04 No .-17 Feb.25-2011 (Falgun 13,2067)

In October 2007, Balram Pyasi, a freelance Nepali journalist, was staying with his friends in North London, when he suddenly felt burning and pain in his chest. As his pain intensified, his friends dialled the emergency number 999. Within five minutes, an ambulance arrived with three health personnel and emergency health equipment.

The ambulance reached the Royal Brompton and Harefield hospital, some 40 kilometres away from his residence, in about 15 minutes. He was rushed to the Operation Theatre where senior doctors were waiting for an emergency cardiac operation on him.

After the operation, a senior doctor at the hospital told him, “The capillary through which blood circulates in your heart was blocked; now it has opened up after the surgery.’

Two days after he was discharged from the hospital, Pyasi received a bill from the hospital amounting to £6,593 (around Rs 850,000). “As you are not a permanent resident of United Kingdom but a tourist, the National Insurance regulation does not apply to you, therefore you will have to pay for your treatment, according to your capacity on instalment basis,” the letter said.

“The NHS saved my life. If I had had stroke in Kathmandu, I am not sure if I could ever make it to the hospital,” said Pyasi, who returned to Kathmandu later that year. After a few days, he visited the Gangalal Heart Care hospital at Bansbari with his medical records. A doctor on duty gave a cursory look at his prescriptions, asked him to continue his medicines and called another patient in barely two minutes. “I felt very bad. There was no way I could compare the quality of care and services which I received in the UK (with that in my own country),” he added.

‘Jewel in the Crown’
Not only foreigners like Pyasi, an overwhelming number of British people see their state-run health provider not only as a service but also as a symbol. Obviously, reforming NHS was a major plank in the parliamentary elections in UK last year. While proposing to cut millions of pounds from different departments, Prime Minister David Cameron said that he would ring-fence the budget of the NHS. “When Tony Blair was elected in 1997, he said his top three  priorities would be Education, Education and Education. My top priority can be described in three letters, N-H-S,” declared Cameron.

Introduced more than six decades ago, NHS is the publicly-funded health care system in England, which provides healthcare to anyone normally resident in England or any other part of the United Kingdom with most services free at the point of use for the patient. However, patients have to pay separately to procure services like eye tests, dental care, prescriptions, and many aspects of personal care.

During the 13 years of Labour government (1997-2010), deaths from cancer, strokes and heart attacks fell substantially. Mental health, access to drugs, infant mortality, life expectancy and  access to General Practitioners (GPs) also improved. The NHS budget tripled to 105 billion pounds during the period.

The NHS has, however, seen its ups and downs. “In 1997, the National Health Service was in a state of disrepair. Hospitals were falling apart, more than a million patients were on waiting lists, there were too few staff and care varied widely in quality,” said The King’s Fund—a London-based think tank—in its report published last year.

Managing the NHS—the third largest employer in the world with 1.7 million employees ( first being the People’s Liberation Army of China and second the Indian Railways), has never been an easy task.  “While the NHS budget has ballooned, productivity has somehow fallen and too little has been done to force through changes to how and where healthcare is delivered,” The King’s Fund said.

The new Conservative-Liberal Democrats coalition – that was voted to office last May-- has made sweeping proposals to restructure the NHS. They include dissolving both the Primary Care Trusts and Strategic Health Authorities—agencies responsible for delivering health services through local surgeries and hospitals. Instead, General Practitioners or GPs (also known as Family Doctors) will now have a major say in spending the massive NHS budget.

So, will the new proposals drastically improve the quality of service being delivered by the NHS?

Dr Raghav Dhital, who has been working as a GP since 1984, has witnessed big changes in 1990 and again in 2004 in the way NHS was run in the UK. “The current change proposed by the coalition government is by far the biggest in the NHS since its creation,” said Dr Dhital, adding, “The speed and scale of change has not been universally accepted by the profession. It is a challenge and opportunity for the GPs and will require sincerity and hard work from all concerned to make it a success.”

When the war-trodden Britain launched the NHS in the early 1940s, British economy was in the doldrums and the provision of social welfare in the tatters. More than six decades down the line, NHS is considered one of the best health service systems in the world-- ‘jewel in the British crown.’

“Nepal could learn many things and emulate from Britain to improve her health services in order to make our country a much better place to live. All we need is a political commitment and a strong will,” said Dr Dhital.

Journalist Pyasi, who told us he was enjoying his ‘second life’ in Nepal-- thanks to the NHS, agreed fully.

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