Editorials/Opinions Analyses for UPSC – 13 May 2021

Contents

1. A National Health Service in India

A National Health Service in India

Context:

The current surge in COVID-19 infections has exposed problems amounting to near-chaos throughout Indian healthcare, even if the pandemic has also brought to light Herculean attempts by medical staff, patients’ families, and governments to try and cope with what has been called a tsunami, one which is rapidly getting worse.

In effect, COVID-19 may bring about serious consideration of an Indian national health service.

Relevance:

GS-II: Social Justice (Health related issues, Government Interventions and Policies, Issues arising out of the design and implementation of Government Policies), GS-II: Polity and Governance

Mains Questions:

To what extent will the setting up of a National Health Service (NHS) will help to address medical emergencies such as those witnessed during the Covid-19 pandemic? Discuss the formation of NHS and the challenges involved. (15 marks)

Dimensions of the Article:

1. Current situation: A System under strain
2. The earliest proposal for a National Health Service in India
3. Formation of the British National Health Service
4. Success story of the British NHS (Lesson/Example for India)
5. Article 312 for the creation of All India National Health Service

Current situation: A System under strain

• While those involved in the clinical response are clearly doing their often-desperate best — care staff are at high risk of contracting COVID-19 — the Central and State governments are now coordinating measures within and across their respective jurisdictions. For example, the railways are running special trains carrying oxygen supplies, and the military is also involved in supply chains.
• The Supreme Court has, suo motu, called for a national plan to deliver oxygen and vaccines.
• The responses to the worsening COVID-19 crisis are, nevertheless, not free of tensions.
• India’s fragmented clinics, hospitals, and variably functional primary health centres are plagued with various issues like corruption and underfunding along with being urban-centred and elite-focused.
• India’s public spending on health is set to double in the 2021-22 financial year, but that is from a figure that has long been only a little over 1% of GDP.
• In certain rural areas, the doctor-population ratio is over 1:40,000.
• Medical expenses constitute the major reason for personal debt in India, whether the causes are episodic afflictions or, for example, those caused by environmental conditions which none can escape, such as air pollution.

The earliest proposal for a National Health Service in India

• In 1946, a civil servant submitted to the then government a detailed proposal for a national health service broadly modelled on the British National Health Service or NHS, which was on the way towards legislative approval in Britain.
• According to the proposed model, preventive and curative medicine be integrated at all levels based on the British plan that had been drafted in the 1930s, as problems worsened in healthcare services.
• The fact of the Second World War, in the darkest hours of which a plan was prepared to transform Britain into a post-war social democracy with a comprehensive welfare state and a universal free public health service supporting a mixed economy, may therefore have been catalytic rather than decisive in the creation of the NHS.

Formation of the British National Health Service

• The British National Health Service was launched by the post-war government of Britain in 1948 by their leaders who felt that the then existing healthcare system was insufficient and needed to be revolutionized.
• By 1929 the Local Government Act amounted to local authorities running services which provided medical treatment for everyone.
• As early as 1930, the London County Council then took over responsibility for around 140 hospitals, medical schools and other institutions after the abolition of the Metropolitan Asylums Board.
• By the time the Second World War broke out, the London Council was running the largest public service of its kind for healthcare.
• By 1941, the Ministry of Health was in the process of agreeing a post-war health policy with the aim that services would be available to the entire general public.
• In 1942, a special committee put forward a recommendation for “comprehensive health and rehabilitation services” and was supported across the House of Commons by all parties.
• Eventually, the Cabinet endorsed the framework which endorsed that everyone was entitled to treatment including visitors to the country and it would be provided free at the point of delivery.
• The project finally took hold when Clement Attlee came to power in 1945 and Aneurin Bevan became Health Minister. It was Bevan who embarked on the campaign to bring about the NHS in the form we are now familiar with.

Success story of the British NHS (Lesson/Example for India)

• The resulting NHS of Britain was a mighty achievement in public policy, politics, and the provision of top-class universal healthcare, including training, research, and changing engagement with the public as society changes.
• The service is funded entirely from general taxation. The budget includes payment to general practitioners, most of whom remain private providers but are paid by the state for treating NHS patients.
• All hospital treatment and medicines are free, as are outpatient and follow-up appointments.
• The British public share the costs through their taxes, and almost without exception receive treatment solely according to their clinical needs.
• With about 1.1 million staff, the NHS is the largest employer in the U.K.
• Its current budget is about 7.6% of GDP, but despite its size and scale, it provides highly localised access to care.

Core Principle of NHS

The National Health Service for the entire nation would be based on three primary ideas:

1. The services would help Everyone (in the true sense of the word)
2. The healthcare would be free
3. The healthcare would be provided based on need rather than ability to pay.

Article 312 for the creation of All India National Health Service

• The provisions in Article 312 of the Indian Constitution allow for creation of All India Services common to the Union and State.
• Article 312 states that if the Council of States (Rajya Sabha) passes a resolution that it is necessary or expedient in the national interest to create an All-India Service by a special majority of more than two-thirds of the members present and voting- then Parliament may by law provide for the creation of one or more all India services common to the Union and the States.
• According to Article 312, the recruitment, and the conditions of service of persons appointed, to any such service will be regulated by the law passed by the parliament after the resolution is passed by the Rajya Sabha.
• The Indian Administrative Service (IAS) and The Indian Police Service (IPS) are deemed to be constituted by the Parliament in terms of Article 312 of the Constitution.
• After the promulgation of the Constitution, a new All India Service, namely, The Indian Forest Service, was created in 1966.
• A common unique feature of the All-India Services is that the members of these services are recruited by the Centre, but their services are placed under various State cadres, and they have the liability to serve both under the State and under the Centre. This aspect of the All-India Services strengthens the unitary character of the Indian federation.
• Of the three All India Services, namely, the Indian Administrative Service (IAS), the Indian Police Service (IPS), and the Indian Forest Service (IFS), the Ministry of Personnel, Public Grievances and Pensions is the cadre controlling authority for the IAS. The recruitment to all the three services is made by the UPSC.
• There are now 24 State cadres including three Joint cadres, namely: 1- Assam and Meghalaya, 2- Manipur and Tripura, and 3- Arunachal Pradesh, Goa, Mizoram and the Union Territories (AGMUT).

-Source: The Hindu