NHS takes Indian lessons; please don’t gloat

Britain’s health system – largely funded, organised and delivered by the state through a system of compulsory taxation – is often held up as the world’s best. And not, it must be said, by Britons alone: the National Health Service (NHS) has countless admirers all over the world.

But it is an article of faith for Britons – a curious anomaly in a country that upholds the free market in all other spheres of life. I have long been fascinated by the fervour with which Britons regard the NHS – it is like a religion to them.

As this blog has recorded before, the NHS at its best is astonishingly good. It is an unbeatable service, particularly in emergencies. The scenario can run somewhat like this: you suffer a heart attack, a panicky family-member calls up the emergency number 999, the telephone attendant calms you down while taking you through a series of questions. An ambulance with two trained paramedics is at your doorstep within 15 minutes, before you get off the telephone.

As far as medicines go, now matter how expensive they are, you pay a standard charge of £7.40 (Rs 550). If, however, you are jobless, disabled, too young or too old, you don’t pay a penny. If you need repeat prescriptions, they actually get cheaper (£104 for 15 items). Cancer patients don’t pay for any drugs.

The problem, as is well known, is that the system is running out of money and is burdened with bureaucracy. It has found itself unable to keep up with the health needs of a growing and rapidly ageing population that either does not pay or pays next to nothing (relative to income) for its health needs.

The NHS recognises the need to improve this system – aiming to cutting down waiting lists and improve efficiency – and its bosses and others have been examining other health delivery systems. It turns out they have been very impressed by what they’ve seen in India, particularly at hospitals in the southern states.

What did they see? They saw Devi Shetty’s Narayana Hrudayalaya Hospital in Bangalore, which has reduced the cost of heart surgery to $2,000 (60% cheaper than most Indian hospitals). Its 42 surgeons perform an impressive 3,000 operations a year, becoming what The Economist described as “virtuosos in their sub-specialisms.”

They saw Life Spring Hospitals in Hyderabad, which has borrowed the element of uniformity from the manufacturing industry to reduce the cost of delivering a baby to $40, a fifth of the cost at comparable local hospitals.

And they came across the most astonishing of figures at the Aravind Eye Hospital in Tamil Nadu. Surgeons here perform 70% of the number of eye operations performed by the entire NHS at just 1% of the cost.

The lessons, drawn by Nick Seddon of the independent thinktank Reform, are as follows:

1. A focus on performance: “no secrets” is the rule at Narayana Hrudayalaya. All errors and complications are logged and some shared by text messages. Waiting times are posted on screens.

2. Doctors must be accountable on how they spend money. At Narayana, every consultant gets a text message at midday with a loss-profit analysis from the previous day. “If you get the profit and loss at the end of the month, it’s a post-mortem – the patient is dead,” says Devi Shetty. If you get the information daily, “it’s a diagnosis and you can treat.”

3. Healthcare must be willing to learn from other industries: this is the point about Life Spring’s emphasis on uniformity. Many NHS hospitals have unexplained variations in treatment, says Seddon. At Life Spring, doctors must do exactly what the checklists and information systems dictate, which results in more being delivered for less.

4. “The NHS must be opened up to competition so that patients can choose the best care.” Seddon spoke to a woman who described Life Springs as better than government hospitals and cheaper than private ones. “Someone with no running water was able to choose where to give birth – and knew more about the available options than most British people.”

It remains to be seen if competition in health services will also be extended to countries such as India – with a level playing field so insurance can cover the treatment for Britons. In the meantime, if you are feeling all puffed up by this account of how the much-vaunted British NHS is learning from India, please do take some time out to read up on the experiences of the two countries.

Here are some basic figures from the UNDP report of 2010 that could be instructive:

  • How much does the government spend on health, as a percentage of GDP? Britain spends 7%; India 1.1%.
  • How many children will die before the age of five? In Britain, six children per 1,000 live births; in India 69 children. In fact, India is the world leader in the number of newborn babies who die before the age of 28 days.
  • How long will you live? In Britain, nearly 80 years; in India, 64 years.
  • Prevalence of undernourishment: zero in Britain; 22% of population in India.
  • How many mothers will die in the act of giving birth? 450 women per every 100,000 live births in India; eight in Britain.
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