Comparison of the English and Danish Health Care System

Kylie Baker

Ruth Clark

Katherine Dantanus

Rachel Stone

English Health Care System

NHS established in 1948 Modernisation of the NHS since 1997 Greater patient centred care Shift to primary care and the community by devolving

responsibility to be managed locally Shift from health care policy to policy for health Empowered patients to become partners in their

health care Drivers for change

Denmark

Capital city; Currency DKK Around 5.5 million population;

10% immigrants Constitutional Monarchy Temperate climate Denmark's main exports are:

industrial production/ manufactured goods 73.3%; agricultural products; meat and meat products; fish and fish products ).

Danish Language: Say what you see…

jordbær og fløde

Danish Language

sygeplejerske

Danish Culture

Democratic Socialist Welfare system…Move to Civil Society. C 19th: ‘Grundvigianist’ – Grundvig (priest, social reformer,

educator)…Social reforms came from the people and were widely adopted ‘peasant movement’. “Denmark is a country where few have to much and fewer have too little”.

Heavy involvement of the state from birth. State child care and education: Egalitarian. Day-care for all.

Criticized: Favouring the middle layer; anti-elitarian ‘Jantelov’ (Danes exercise internal control by suppressing any initiative to rise above others. Success deemed unworthy and inappropriate).

Role of the state in the lives of the people as a provider for the worker but also those in greatest need – Aim to return them to normality.

Citizenship-based universalism: Sense of duty in the citizen as their rights come with responsibilities.

High level of equality, and a relatively high level of material well-being.

Greater pressure on assuming the collective identity, less cultural diversity.

Law of Jante, ‘Jantelov’ There are ten different rules in the law as defined by Sandemose, all expressive of variations on

a single theme and are usually referred to as a homogeneous unit: Don't think you're anyone special or that you're better than us.

The ten rules state:

Don't think you're anything special. Don't think you're as good as us. Don't think you're smarter than us. Don't convince yourself that you're better than us. Don't think you know more than us. Don't think you are more important than us. Don't think you are good at anything. Don't laugh at us. Don't think anyone cares about you. Don't think you can teach us anything. An eleventh rule recognized in the novel is: 11. Don't think that there aren't a few things we know about you. In the book, the Janters who transgress this unwritten 'law' are regarded with suspicion and

some hostility, as it goes against the town's communal desire to preserve harmony, social stability and uniformity.

“A Fugitive Crosses his Tracks”, Aksel Sandemose (Danish-Norwegian writer), 1933.

Danish Health Care System

Similar model to the NHS – primary and secondary care

Free and equal access to health services Funded through taxation and social insurance Reputation for high quality public services Danes have a high regard for the health and social

care system Significantly smaller private sector provision What can learn from the Danish health care system?

Danish Health Care System

Three political and administrative levels:

The State – national The regions – regional (now 5 – before 15) The municipalities – local ( 98 – before 271)

Responsibility for running public health service is decentralised.

Danish Health Care System

Organisation of the Danish health care Two sectors:

Primary health care 1. Treatment and care2. Preventative

Hospital sector - Specialised treatment

Health Expenditure

Public and private health expenditure as share of GDP

2005Finland 7,5Great Britain 8.3Sweden 9,1Denmark 9,1Belgium 10,3Germany 10,7 France 11,1

General Observations in Practice

Higher staff to patient ratio Equality rather than hierarchy Staff all in the same uniform Multi professional working - meetings Working in partnership with patients, patient centred

focus Shorter waiting times – 4 week guarantee Social emphasis –patient – dining area, staff - coffee

breaks

General Observations in Practice

Ward based Doctors Charge nurse- no patient allocation on dialysis Nurses – more responsibility – cannulation, ordering

bloods, prescribing fluids Nurses using clinical judgment, teaching students to be

critical analytical thinkers HCA’s – more responsibility - flush IV’s, write patient

notes, administer medication from patient Nomads More emphasis on teaching time – students 4 day week

placement + 1 study day High staff retention Culture of learning rather than culture of blame

Health & Safety & Infection Control

Low prevalence of MRSA – do not swab patients on admission Uniform – scrubs – not worn outside of work Open shoes (sandals) Alcohol gel preferred over washing hands (gel not as sticky and

more hand friendly) Glove usage - cannulate without gloves (personal choice) Apron usage - only for infectious diseases Clean technique used on central catheters – hospital policy Dressing for central catheter not sterile Changing sheets only when needed No clinical bins (open bins) Fabric pillows and duvets – can not be wiped down All have toilets in bay- 4 patients to 1 toilet

Money Saving

Reusable equipment through sterilisation Hand towels not paper towels Changing linen only when needed Saline being drawn up from dialysis machine Patient involvement and independence –

saves nursing time

Privacy and Dignity

Doctor consultation in private rooms Patient centred focus Not every bay has curtains (cultural

differences?)

Communication

Nurse - Patient relationship more open and respectful

Language barrier- interpreting and disclosure of information

‘Expert’ patient

Patients more independent with activities of daily living

Focus on patient education Dialysis – patients involved in dialysis from setting up

machine to self cannulation. Focus on primary care – home dialysis Working in partnership e.g. Copy of drug chart given

to patient with explanation of medication use next to drug name e.g. paracetamol- for pain

Documentation

Electronic documentation- access all patients using CPR number

Single Assessment Process Document using the nursing process

Other

Nutrition - big initiative Resus team- staff have allocated roles

(porters resuscitating and nurses intubating, limited equipment in crash tray on ward)

Short shifts – 8 hours

Conclusion

We can learn from other healthcare systems The UK can learn from the Danish health

system with regard to patient satisfaction, growing waiting lists, funding and effective integration of health and social care.

Denmark can learn from the NHS with our increased focus on infection control, patient privacy and patient dignity.