Comparison of the English and Danish Health Care System

1. Comparison of the English and Danish Health Care System Kylie Baker Ruth Clark Katherine Dantanus Rachel Stone

2. 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

4. 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 ).

5. Danish Language: Say what you see… jordbær og fløde

6. Danish Language sygeplejerske

7. 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).

8. 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.

9. 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.

10. 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?

11. 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.

13. Danish Health Care System Organisation of the Danish health care Two sectors: • Primary health care • Treatment and care • Preventative • Hospital sector - Specialised treatment

14. Health Expenditure Public and private health expenditure as share of GDP 2005 Finland 7,5 Great Britain 8.3 Sweden 9,1 Denmark 9,1 Belgium 10,3 Germany 10,7 France 11,1

15. 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

16. 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

17. 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

18. 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

19. Privacy and Dignity • Doctor consultation in private rooms • Patient centred focus • Not every bay has curtains (cultural differences?)

20. Communication • Nurse - Patient relationship more open and respectful • Language barrier- interpreting and disclosure of information

21. ‘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

22. Documentation • Electronic documentation- access all patients using CPR number • Single Assessment Process • Document using the nursing process

23. 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

24. 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.