Zohra Mohamed Teke speaks to Lord Nigel Crisp, former head of the UK’s National Health Service.
Durban - Just one night before the British elections in 1997, former British prime minister Tony Blair famously told voters they had “24 hours to save the NHS” by voting his Labour party into government.
By 2000, the National Health Service (NHS) was on the decline with deteriorating standards of care and falling public confidence in the system.
But in November of that year Nigel (later Lord) Crisp, with a background in service and community work was appointed NHS chief executive and permanent secretary at the department of health.
Thanks to reforms made during Crisp’s tenure, the British NHS tops the list of countries with the best health- care systems in the world, according to the latest survey by the New York-based Commonwealth Fund.
But can South Africa really achieve such levels of care given the skewed public spend?
“The circumstances and nature of the UK NHS and South Africa’s National Health Insurance (NHI) are very different, but they share the same ideals of ensuring everyone in the country has access to high quality health care,” said Crisp, who was speaking on the sidelines of the Board of Healthcare Funders’ 15th Southern African Conference in Durban recently.
“The NHS was initially opposed by doctors and some private interests – mainly because it interfered with their private practice.
“The NHS went through a very bad time in the 1980s and 1990s with poor standards and long waiting lists.”
These were much improved from 2000 and waiting lists are no longer a big public issue, said Crisp.
“A major lesson for South Africa would be to give more emphasis to prevention rather than treatment, which the South African health minister is trying to do.
“The other is to reduce the level of political interference in the day-to-day running of the NHI.
“We have suffered from new ministers wanting to change everything during their tenure.
“The government has to set the framework, create the direction and secure the funding and then enable the NHI to run itself,” he said.
With the SA government now piloting 11 districts as part of phasing in the NHI over the next 12 years, there is growing momentum in the private sector, which initially resisted the NHI plan, partially through ignorance of how it would work while also feeling threatened at having to share their spoils.
Many felt that with a subsidised health system, private health would be diminished if not curtailed altogether.
However, extensive consultations and forums with the health ministry are gradually putting those fears to rest.
The private sector would play a major role in the success of the NHI, with doctors being allowed to contract within the NHI system – potentially earning more than they do now, but with targets and health outcomes to meet.
But many unresolved concerns, mainly over the funding mechanism, remain.
How will the NHI be funded, where will the taxes come from and will it lead to further pressure on a health system already bursting at the seams with the workload?
But there is concern within the health sector that there has not been a shift in the public’s mindset from having a curative health system to a preventative one, necessary for NHI to succeed.
Without the individual responsibility for health, the NHI is doomed to fail as hospitals will continue to treat ailments that can be addressed at community level by primary health-care clinics.
Crisp believes the following is needed for the NHI to succeed:
* Create strong GP and community health-care services.
* Develop strong public health services.
* Have appropriate regulation systems and a system of assessing quality (South Africa has both, including the recently launched Office of Standards Compliance).
* Leadership and management development for clinicians and administrative staff.
* A process for assessing the benefits of new technologies and drugs.
* A practical way of engaging the private sector so its talents and capabilities are put to the service of the people.
Crisp stresses the need for private sector involvement, saying it is key.
“We did this in the UK and it is particularly important to do so in South Africa where you have such a big and strong private sector.
“They could do an enormous amount if they set their mind to doing so. The worst thing to happen would be if they walk away from this challenge,” he adds.
Despite the challenges, resource constraints and skills shortages in South Africa, there is a groundswell of effort and determination to ensure the NHI becomes a reality – not simply a political ideology fulfilled, but a catalyst of change to provide a health system to all South Africans with dignity, equity and quality of care.
As a final word of wisdom to South Africa, Crisp cautions the NHI will not be ideal.
Seventy years after implementation, the UK’s own NHS is still rocked by controversy now and then over quality issues, most recently over the care of the elderly in a hospital.
An investigation last year found thousands of patients had died because of poor care. It also found poor staffing levels and lack of oversight, with staff failing to address the needs of patients.
“A system like the NHS, which treats a million patients every 36 hours will make some mistakes.
“All have room for improvement. Providing health care is very difficult and people have to be constantly striving for improvement.
“No one in England or South Africa should imagine there is – or could be – a perfect health system anywhere.”
Crisp stressed there are no no simple or easy solutions; making the NHI work will “require hard work and determination from many people working together”.
“There will be opposition and problems. But big improvements can be made and many millions of people in South Africa will lead better, long and more fulfilled lives as a result,” said Crisp.
Daily News