Save Britons, run health service from India
AMIT ROY
London, Jan. 3: India could gain in theory if patients in the UK are willing to accept a difficult choice — that more work of the British National Health Service (NHS) needs to be outsourced abroad.
Responsibility for making some of the £20-billion savings Prime Minster David Cameron’s coalition government has ordered lies with an official body, NHS Shared Business Service (SBS), whose managing director John Neilson commended workers in India for their competence.
One suggestion, hugely unpopular though this would prove with the overwhelming majority of patients is that they should make appointments with their general practitioners in the UK via call centres in India. Millions of pounds could also be saved if more NHS administration is shifted to India.
At present, patients telephone surgeries where harassed staff often have to deal with impatient or rude callers who insist their cases demand urgent attention.
But how Indian call centre staff would react to being sworn at by patients in Britain can only be surmised. To deal with train timetables is one thing; matters of life and death quite another, especially if there is incomprehension on the question of accents.
Neilson told The Times newspaper today that Indian workers were so good that it was only the potential for controversy that stopped medical records or bookings being similarly outsourced: “There isn’t a capability issue, there’s more a local UK sensitivity issue.”
But as pressure on NHS budgets intensifies, Neilson suggested the alternative was cuts to services.
The paper pointed out that “call centres and offices in Delhi and Pune already handle invoices and other administration for a significant number of NHS trusts for a fraction of what UK-based labour would cost”.
Asked by The Telegraph whether more NHS administration could be transferred to India, a department of health spokesperson gave a reply which could be interpreted either way.
“NHS Shared Business Services is working with the department of health on a number of initiatives to get the best value-for-money for the NHS,” she said. “To date, it has delivered savings of over £50m to the NHS, freeing up funds for frontline patient care.”
She added: “As elsewhere cross government, We are working to use purchasing power to get the best possible deal for the taxpayer. NHS Trusts and Foundation Trusts are seeking substantial procurement savings in their planned efficiency savings of up to £20 billion over the next four years. All of these savings will be reinvested in patient care.”
Neilson said his company was not pushing trusts to send more activity overseas, since he recognised public touchiness about foreign call centres meant that most trusts were not exploiting this as much as they could. But he believed “significant” savings could be made.
The SBS now has almost 700 employees in India, mostly engaged in data entry and financial administration — there were barely any five years ago.
“That’s been a reflection of people’s increasing comfort in what we’re doing. And clearly what we’ve tried to do is focus on those activities which are not contentious,” Neilson said.
He went on: “There is no clinical data, medical record data or anything with that level of sensitivity or anything that involves direct customer contact.
None of that sort of activity happens in India. We’re sensitive to the market need that people feel more comfortable with that sort of data being managed in the UK.”
Not everyone agrees with Neilson.
Katherine Murphy, Patients Association chief executive, told the Times that outsourcing was often a false economy.
“Efficiencies have to be made,” she agreed, “but not if the result is that patients are often getting a worse service.”
Britain is justly proud of its NHS which was allocated a budget of £437million (roughly £9billion at today’s value) when it was launched in 1948. Funding will rise by £10billion to £114 billion over the next four years.
Unions say that the NHS is being put under great strain by demands to find £20 billion of savings while spending £3 billion on a reorganisation that the government is also planning.
If India is to bid for more work, it has to carefully analyse the operation of the NHS. Some 60 per cent of the NHS budget is used to pay staff.
A further 20 per cent pays for drugs and other supplies, with the remaining 20 per cent split between buildings, equipment and training costs on the one hand and medical equipment, catering and cleaning on the other.
Nearly 80 per cent of the total budget is distributed by local trusts in line with the particular health priorities in their areas.
The money to pay for the NHS comes directly from taxation. The 2008-09 budget roughly equates to a contribution of £1,980 for every man, woman and child in the UK.
The NHS employs more than 1.7 million people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff. Each GP in the nation’s 10,000-plus practices sees an average of 140 patients a week.
Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people.
India is pushing not only for more administration and clerical work but also medical treatment of NHS patients. This is impossible at present because NHS patients can only be treated in hospitals no further away than three hours flying time — India is 10 hours away.Also India’s top hospitals, whose main objective is to make more money, are acquiring the reputation of being thoroughly corrupt — especially with domestic patients with corporate insurance who are treated more as cash cows.
Further, Indian government officials have not completely dispelled allegations that foreign patients treated in hospitals in India are at risk of picking up a possibly incurable infection “highly resistant to almost all antibiotics”.
Last August, Timothy R. Walsh, professor of medical microbiology and antimicrobial resistance, school of medicine, department of medical microbiology at Cardiff University, was sceptical about the wisdom of medical tourism.
“People should think long and hard before making that decision,” he said.
However, financial pressures may force some more non-medical work to be outsourced to India in the next four years.
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