Monday, 14 January 2013

NHS in India - be aware of what it means

This blog post was originally published as a guest editorial at Soumyadeep Bhaumik's Caffeinated Works & Random Musings which is one of the largest healthcare blogs in India
Reposted here.

I follow Indian healthcare with some interest.

I have wondered about 'why do doctors who work in India and want to continue to work in India take up exams such as FRCS, MRCS, etc?' Many of these exams are conducted in India. I suppose I should give those doctors the benefit of the doubt and think that they do it as a part of knowledge improvement and knowledge validation with an international perspective. Many though may have commercial marketing motives. I ask myself if the content and the style of these exams are suitable for non-western practice? I think not, but that is purely my view.

Now the news of NHS wanting to go to India. The NHS in UK is a government funded public service healthcare system. Is that the model the NHS will follow in India? The NHS in UK is increasingly outsourcing its activity to the private sector and inviting private sector in to the NHS. However, the NHS in its new wisdom may be choosing to go to India to provide services as a private provider. Which is the exact opposite of what the NHS does here in UK. The policy and strategy confusion seems to be immense and contradictory. The NHS currently does not have any great operational experience of purely private provision.

Why would the Indians allow the NHS to do the exact opposite of what they do in UK in terms of business model, inside India? It is a question that should be asked in the Indian parliament; I am sure it will be asked if and when trouble arose.

More relevantly, why would the NHS itself want to do this? The reasons are not that difficult to fathom. India is a growing market in general, healthcare is a really high growth market, there is a clear need for more high quality providers. The non-commercial UK NHS wants to take commercial advantage of these factors to make money for UK. It is nothing else apart from money making. Money making in itself is not such a bad thing, only to couch it in the language of healthcare improvement, helping populations, transferring expertise, spreading knowledge and other obviously superficial euphemisms reflects poor intentions. I am a believer in the primacy of intentions.

I wonder if the NHS would still go to India if it was required to provide 72% of its Indian services in rural India (that is the percentage of population that lives in rural India) to the same standard and more or less the same price that they provide in urban India? I ask because that is exactly what the NHS prides itself in UK; providing more or less the same standard of service at more or less equivalent costs all over UK. Well, if you want to be an international business thats how you begin to think; Coke and Pepsi do that, produce soft drinks, distribute it to all corners of India at almost the same price; which is exactly what they do anywhere in the world. Will the NHS do in India what their business model does in UK? Would the NHS in India treat the rich and the poor equally as they are required to do in UK?

I suspect that is not what the NHS in India will be about. I sincerely hope the NHS in India will make me eat my words as that will be a win-win for everyone.

The principles of care, content of education, models of care delivery that are needed in India are different. India is perhaps already suffering from a techno-centric, finance driven, western oriented, urban focussed, doctor obsessed healthcare system. As long as we are clear in our minds that whether it is examinations such as MRCP/FRCS/MRCOG/MRCGP which are conducted in India or a possible NHS as a provider in India are simply commercial businesses operating in India for profit making; as long as we recognise and be constantly aware of this its fine. Once we start assigning higher value, philosophical or operational, we will be doing a disservice to the Indian public by deliberately misleading them. Those of you who are highly sensitive amongst the Indians should also reflect on whether this is a form of cultural and knowledge colonialism.

I am British and work in the NHS. I am an admirer of the NHS system and I believe the NHS in UK does a great job in terms of many clinical, operational and cost parameters. It is my vested personal interest that NHS in India is successful commercially. I am of Indian origin and have family in India, hence creating awareness of potential sub-optimisations is probably my broader duty.

Follow me on twitter @HemadriTweets


Ross Taylor said...

Great post. The NHS in UK is a govt financed public service medical care system. The NHS in UK is progressively outsourcing its task to the personal industry and pleasing personal market in to the NHS. So definitely they doing great work in India. If the NHS in India, then they required to provide lot of its India services in their local Indian peoples to the same common and more or less the same prices. So, that's beneficial for Indian individuals. Comparative Market Analysis

Anonymous said...

It is a commercial enterprise so the NHS can fund themselves here in the UK. It cannot be good at all. Moreover, there are plenty of other Healthcare enterprises in India ,so NHS in india is going to be no different.Moreover why would indians want to send money to the UK?

vivek chhabra said...

Dear Hemadri

Your views are essential and important for bridging the gaps as this plan moves forward, which I hope it should.

All your inputs are coming as expected out of a technocrat which have a certain and important value.

However the resistance against the whole thought due to certain ideas, right or wrong, against the whole concept is mere ignorance about the big picture - explaining which is not always easy to a technocratic brain - and that too on an email.

My suggestion to you will be engaging with the system by being there on 11th Feb on conference and then make views which for me at this stage are nothing but strong prejudices, which you have made on basis of your knowledge and experience.

Your thoughts remind me of stopping eating mangoes for 10 full years as a child because the fibres of one variety got stuck in my teeth and cleaning them out I felt a hard task as a kid and I hated mangoes after that to everybody surprise - of course others were not aware of the reason I had - but after eating a nice sweet mango 10 years later and of not the variety which had fibres to get stuck in my teeth - I realised what I missed for a decade and felt really foolish - but than it was my choice.

So, it is your choice at this stage what you want to make of it without having experiences of policy making at governance level of India which I had a chance with my NDMA tenure and also sone understanding of how various types of minds think via Hermann Brain Dominance model.

Your expressions are expected to be agreed by 75% of doctors as per basis of evidence and I am glad to say that the final say is not of this majority though some important valid points are always utilised by the policy makers in the final shaping of the issue.

The recent BSc in community health course is an example of the way how governance is done and policies are made, if you would like to see how while thing evolved over last 2-3 years in India.

I hope that helps you explore the new windows in the brain, else bin this mail as I will be able to convince only later by my actions, and that too I will realise if I am getting platform for after going to the conference, about which I am not pessimistic to begin with, unlike the majority.



M HEMADRI said...

Dear Vivek

Thanks for you comments; there is a lot to reflect and learn from them.

You also make some assumptions; some are valid.

My main thrust was on the core integrity and consistency of purpose of business models irrespective of geographical location.