REPORT OF THE COMMITTEE - PowerPoint Presentation

Slide1

REPORT OF THE COMMITTEE

FOR

UPGRADATION OF

PORT TRUST HOSPITALS

Slide2

CONSTITUTION OF THE COMMITTEE

By a Notification dated 6

th

May, 2016 under the signature of Joint Secretary (Ports) in a Ministry of Shipping, Government of India Slide3

MEMBERS OF THE COMMITTEE

Dr.

Vedprakash

Mishra

– Chairman

Shri

Prakash

Page - Member

Dr.

Pradip

Shingore

- Member

Dr.

Prabhakar

Kore

- Member

Dr.

Agrawal

- Member

Shri

Ashutosh

Pandya

- Member

Shri

Sameer

Meghe

- Member

Shri

Ashish

Deshmukh

- Member

Dr. Ashok

Khurana

- Member

Dr.

Subhash

Bhamre

, MP,

Dhule

- Member

Dr. P. D.

Patil

- Member

Shri

Sarang

Kale - Member

Shri

Abhishek

Chandra - Member Secretary. Slide4

TERMS OF REFERENCE

1. To study port hospitals at all the major ports and to suggest model for development and the process to be followed for modernization of the hospital on public private partnership basis at no cost to the ports

2. To explore the possibilities of setting up medical colleges along with these hospitals. Slide5

CARDINAL POINTS FOR CONSIDERATION

The developmental propositions for the port hospitals have to be evoked in terms of without any financial liability on to the said port hospitals.

Augmentation of the existing health care facilities and the services that are being rendered by the existing port hospitals

Academic utilization of the hospital facilities at the Port Hospitals including feasibility of starting of medical college and postgraduate

speciality

courses.

The developmental plan to be proposed under the aegis of Public Private Partnership ModelSlide6

PROCESS OF STARTING OF A MEDICAL COLLEGE

1. Provisions at Section 10(A) of the IMC Act, 1956

2. Establishment of a New Medical College Regulation, 1999 as amended from time to timeSlide7

ELIGIBILITY CRITERIA

A

State Government/Union territory;

A University;

An

autonomous body promoted by Central and State Government by or under a Statute for the purpose of medical education;

A

society registered under the Societies Registration Act, 1860 (21 of 1860) or corresponding Acts in States; or

A

public religious or charitable trust registered under the Trust Act, 1882 (2 of 1882) or the WAKFS Act, 1954 (29 of 1954).

*

Companies registered under Company Act may also be allowed to open medical colleges. Permission shall be withdrawn if the colleges resort to commercialization.Slide8

MODELS IN VOGUE IN MEDICAL EDUCATION

Medical colleges run and managed by the Central Govt.

Medical

Colleges run and managed by the State Govt.

Medical Colleges run by the Govt. of Union Territories

Medical Colleges run and managed by a University within the scope and meaning of section 2(f) of the University Grants Commission Act, 1956

Medical Colleges run and managed by the Deemed Universities (Public Funded/Private Funded) within the scope and meaning of Section 3 of the University Grants Commission Act, 1956.

Medical colleges run and managed by an autonomous body promoted by Central and State Govt.

….

contd

…Slide9

MODELS IN VOGUE IN MEDICAL EDUCATION

Medical colleges run and managed by an autonomous body under a statute for the purposes of medical education.

Medical Colleges run and managed by a Society registered under the Societies Registration Act, 1860 or a corresponding Acts in the state as the case may be.

Medical colleges run by the statutory Municipal Corporations.

Medical colleges run and managed by a Public Religious or Charitable Trust registered under the Trust Act, 1882 or the WAKFS Act, 1954.

Medical colleges run and managed by the companies registered under Companies Act with a rider that the permission for such college would be withdrawn if the company resorts to commercialization. Slide10

PUBLIC PRIVATE PARTNERSHIP MODEL

MANIPAL

SIKKIM MEDICAL COLLEGE, GANGTOK, SIKKIM

MEDICAL COLLEGE AT BHUJ, GUJARAT

EMPLOYEES STATE INSURANCE CORPORATION MEDICAL COLLEGES

AUTONOMOUS COUNCIL FOR GOVT. MEDICAL COLLEGES IN STATE OF MADHYA PRADESH

MEDICAL COLLEGE RUN BY THE MUNICIPAL CORPORATIONS

MEDICAL COLLEGES UNDER STATE SPONSORED SOCIETY

MEDICAL COLLEGE BY GOVT. OF ANDAMAN AND NICOBAR (UNION TERRITORY

)

MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES (SEVAGRAM), WARDHA MODEL

Slide11

ENABLING PROVISIONS FOR PPP MODEL

Amendment

to Establishment of a Medical College Regulation (2012), wherein it came to be provided that –

*“

Provided that any agency or instrumentality of appropriate Government desirous of establishing a medical college may be permitted to utilize the facilities of the hospital owned and managed by appropriate Government entering into a Memorandum of Understanding for this purpose.”

…contd..Slide12

Govt. Gazette Notification dated 29.05.2015 stipulated

(1) That the hospital owned and managed by the appropriate Government should be minimum 300 bedded hospital with necessary infrastructural facilities capable of being developed into a teaching institution situated on a plot of land having an area not less than prescribed under the Regulations. The medical college shall provide free transportation facilities for students and staff. The said hospital would be on one piece of the land and the building of the college including library and hostel for the students/interns, PGs/Residents, nurses may be housed on any of the two pieces of land.

(2) The minimum 300 bedded hospital has to be transferred by the Government to the applicant trust/society/company through an appropriate Memorandum of Understanding for a maximum period of 33 years or by way of lease

upto

99 years. While transferring the Government Hospital facility, the State Government may safeguard the interest of State particularly in respect of admission of students under Government Quota in the medical college and patient care in affiliated Hospital(s) of the Medical College.

(3) The hospital must be suitably altered through appropriate modifications into a teaching hospital specially with reference to the break up of the 300 beds into 120 beds for Surgical

Specialities

, 120 for Medical

Specialities

and 60 for

Obst

. &

Gynae

. and also capable of forming clinical units of 30 beds each with required ward size, teaching and training space and other prescribed requirements as per the governing regulations before the application is made by the applicant for starting the new medical college.

…contd..Slide13

(4) The hospital should have all the feasibility for it being periodically upgraded including the augmentation of the number of beds and commensurate teaching units and teaching compliment as prescribed by the Governing Regulations with respect to the permitted annual intake for the college of 50/100/150/200/250 as the case may be.

(5) The personnel working in the said hospital, technicians,

para

clinical staff including nurses and the menial staff, if transferred to medical college, upon their transfer shall be under the administrative control of the Dean of the Medical College ensuring that there is no “duality” of administrative control of any type.

(6) The administrative control so envisaged would include “Academic”, “Clinical” and “Financial” aspects as well.

(7) The clinical staff working at the said hospital other than those who conform to the prescribed eligibility for being designated as Assistant Professor, Associate Professor, Professor of the concerned subject, as the case may be prescribed by the Teachers’ Eligibility Qualification Regulations will have to be replaced by the full time appointment of the requisite number of duly qualified full time medical teachers, such replacement will not apply to nonteaching position like Casualty Medical Officer, Hospital Administrators, etc. in accordance with the prescribed requirements under the governing Regulations. In order to ensure that the binding operational dictum that “teaching physician has to be the treating physician” meaning thereby that the “treating” personnel would be the one who would be the “teaching” personnel.”

…

contd

…Slide14

The Government of India, Notification dated 14.01.2016, further stipulated that –

The

minimum 300 bedded hospital has to be transferred by the Government to the applicant trust/society/company through an appropriate Memorandum of Understanding of minimum of 33 years or by way of lease of 99 years preferably but in any case not less than 33 years. While transferring the Government Hospital facility, the State Government may safeguard the interest of State particularly in respect of admission of students under Government Quota in the medical college and patient care in affiliated Hospital(s) of the Medical College

.

…contd..Slide15

Notification No. 17.01.2017 by the Government of India, further provided that the word ‘company not for profit’ at Sr. No. 6 would be replaced by ‘company registered under Indian Companies Act, 1956’Slide16

TEACHERS ELIGIBILITY

1. Teachers Eligibility Qualification Regulation

2. Amendment thereto for Postgraduate Courses in the year March, 2005 (RML Hospital)

3. Amendment thereto for undergraduate courses August, 2012 (ESIC)

4. Broadening of the same in the context of Notification on 29

th

December, 2015Slide17

STARTING OF POSTGRADUATE COURSES

Regulation on Postgraduate Medical Education 2000

Provisions included under section 8(1)(a) thereat

Prescribed requirements governing the same at the Annexure appended to the Regulation Slide18

RECOMMENDATIONS

1.

The

present mode of Public Private Partnership in terms of the notification dated 29

th

December, 2015, issued by the Government of India, on the recommendations of Medical Council of India defines a single mode of the Public Private Partnership, where-under an appropriate govt. can transfer its minimum 300 bedded hospital to a private party for opening of a medical college by the concerned private party as an applicant within the scope and meaning of Section 10(A) of the IMC Act, 1956. The interest of the Central Govt. in regard to the extent of permissible admissions and utility of hospital services from the attached hospitals thereat is limited. As such, this mode does not go to fulfill the legitimate requirement of the Central Government to have its own medical colleges under the proposed Public Private Mode.

2. The

proposed Public Private Mode contemplates recognition to the staff working in the non-teaching district/ referral hospital as ‘teachers’ in the cadre of Professor, Associate Professor and Assistant Professor strictly in conformity with the eligibility prescribed under the governing Teacher Eligibility Qualification Regulation, of Medical Council of India, which would be non-conducive as staff at such hospitals conforming to the said eligibility may be either miniscule in number or non-existent. As such, the problem of requisite number of teaching faculty with prescribed qualifications would be hard to procure and tough to find.

..contd..Slide19

3. It

would be appropriate to pursue the amendment to the Notification of 29

th

December, 2015, proposed by the Medical Council of India at its meeting held on 30

th

March, 2016, modifying Clause 2, whereby under the Public Private Partnership Mode the State Govt. instead of transferring its district minimum 300 bedded district hospital under an MOU would be required only to permit the utilization of facilities thereat, which would be far more conducive to the legitimate interest of the State Govt.

4. It

would be equally appropriate to pursue the intent of the Central Govt. as depicted in their communication dated 28

th

January, 2016, addressed to the Secretary, Medical Council of India to extend the provision of scheme of equivalence and recognition of teachers in case of Employee State Insurance Corporation run hospital for opening of new medical colleges to the proposed medical colleges to be opened under the Central Sponsored Scheme (CSS).

..contd..

RECOMMENDATIONSSlide20

5. It

would be in the fitness of things to propose to the Central Govt. that the applicability of the provision of scheme of equivalence and recognition of teachers in case of Employees State Insurance Corporation run hospitals for opening of new medical colleges be made applicable as it is to the Public Private Partnership Mode contemplated vide the Notification of 29

th

December, 2015, by appropriately amending Clause 7 thereat so that the provision of conformity with eligibility prescribed by the Teachers Eligibility Qualification Regulation is done away with, so that the problem of appointment of requisite number of faculty in conformity with the prescribed standard regulatory requirements are dispensed of and are found to be easy to tackle.

6. It

may be pursued by the Central Govt. and the Medical Council of India to broaden the ambit of the Notification of 29

th

December, 2015, so as to include Public-Public Partnership Mode therein, whereby by a suitable collaboration with the Public companies and undertakings which per se in their individual capacity are not covered as eligible to be an applicant for starting of a medical college, within the scope and meaning of the eligibility criterion prescribed under the governing Establishment of New Medical College Regulation may be availed by the Central Govt. to open its own run medical colleges

.

..contd..

RECOMMENDATIONSSlide21

7. The

Public-Public Partnership model will definitely give a desired fillip to the Central Govt. to open new medical colleges commensurate with the need and requirement of the State with least financial burden as compared to any other model as in vogue for the said purpose.

8. In

the fitness of things it would be appropriate to await the outcome of the two core pending issues namely, a) the broadening of the ambit of the notification of 29

th

December, 2015 and b) the broadening of the ambit of Teachers Eligibility Qualification Regulation in terms of the applicability of 06.09.2012 Notification by the Government of India, before embarking on the present available mode of Public Private Partnership

.

..contd..

RECOMMENDATIONSSlide22

9. During

the pendency of the same the Central Govt. may avail the model of starting of a medical college as has been evoked by the Govt. of Union Territory of Andaman and Nicobar where under the concerned State Govt. availing his own District Hospital has started a State run and managed medical college, having full control on the admission of students thereto.

10.Further

, the Ministry of Shipping, Government of India, availing its owned more than 200 bedded Port Hospitals and getting it converted into a teaching hospital may venture in starting of a medical college owned and managed by the Central Govt. itself thereby having complete and total control of the same

.

..contd..

RECOMMENDATIONSSlide23

11. Alternatively

, the Central Govt. following the public private partnership model as contemplated in the notification of the Medical Council of India dated 29.12.2015 and updated by another notification dated 02.02.2016 read with the Government of India, Notification dated 17

th

January, 2017 transfer a more than

200 bedded Port Hospital at Mumbai

to a Society/Trust or Company, as the case may be, for starting of a medical college and protecting its interest by taking recourse to provisions included at clause No.2 of the 29.12.2015 notification in respect of admissions of students under the Govt. quota at the said medical college and patient care in the affiliated hospital of the concerned medical college on mutually agreed terms and conditions ensuring that the services that are being catered to the registered employees continue to be on the same terms and conditions for all times without causing any prejudice to their legitimate claim and entitlement.

12. In

terms of the illustration availed by the Committee by an appropriate extrapolation of financial receipts and expenditures in regard to a medical college in the mode of Public Private Partnership as recommended at seriatim 11, the extent of admissions that can be availed by the Central Govt. under its quota could be 25% of the total admissions annually and 25% of the patient care in the affiliated hospital of the said medical college vide transferring more than 200 bedded Port Hospital to the concerned Society/Trust or the Company

(Annexure-10- bringing out an illustration with reference to transfer of 300 District Hospital by the State Govt.)

, with a rider that 15% of the annual intake should be earmarked s the NRI (Non-Resident Indian) quota towards which the higher chargeable fee would be compensating for the fee charged against with 25% Central Govt. quota as a cross subsidy mode

.

..contd..

RECOMMENDATIONSSlide24

13.The

healthcare facilities at other port hospitals at Mumbai, Cochin, Chennai, Kolkata and

Vishakhapattanam

need to be upgraded with reference to their teaching bed strength, so as to cater to the prescribed eligibility for opening of a medical college under Public Private Partnership Mode as has been contemplated in the recommendations at Sr. No. 11 and 12 respectively

14. Alternatively

The healthcare facilities at other port hospitals at Mumbai, Cochin, Chennai, Kolkata and

Vishakhapattanam

may be upgraded into tertiary care facilities vide invocation of Public Private Partnership Mode under mutually agreeable terms and conditions ensuring that the services that are being catered to the registered employees continue to be on the same terms and conditions for all times without causing any prejudice to their legitimate claim and entitlement

.

..contd..

RECOMMENDATIONSSlide25

15.It

would be appropriate that the

upgradation

to tertiary care facilities could be worked up in a manner that a particular super

speciality

stands assigned to a specific Port Trust Hospital, which then becomes the super

speciality

centre for all referral purposes by the remaining Port Hospitals. As such, Port Trust Hospital Chennai could be availed for development of tertiary care facilities in the domain of Cardiovascular Thoracic surgery, Port Trust Hospital Cochin for Nephrology, Port Trust Hospital Kolkata for Neurology and Neurosurgery and Port Trust Hospital

Vishakhapattanam

for Gastroenterology and Surgical Gastroenterology respectively.

16. The

developmental plans as of now envisioned by the respective Port Trust Hospitals in vogue to the extent necessary be merged with the developmental suggestions made in respect to them by the present committee, so that there is no overlap and the resources do not stand squandered as they are scares and therefore precious hence are required to be availed judiciously.

..contd..

RECOMMENDATIONSSlide26

17.The

developmental plan in regard to Port Trust Hospital

Paradip

, which the committee has looked into critically is well conceived and has incorporated the suggestions proposed by this committee in its ambit to a substantial extent and hence needs to be pursued as such.

18. A

venture is necessary to start postgraduate courses at the Port Hospitals other than Mumbai in the relevant

specialities

, where the teaching beds are allocable to the concerned

speciality

with available qualified teaching manpower in identified

specialities

in terms of provisions included at section 8(1)(A) of the Post Graduate Medical Education Regulation, 2000 notified by the Medical Council of India by making an appropriate

MoU

with the medical college in the geographical vicinity to fulfill the condition which is prescribed on the said count

.

..contd..

RECOMMENDATIONSSlide27

19. The

venture of starting of post graduate courses could be feasible at Port Hospitals Chennai, Cochin,

Vishakhapattanam

and Kolkata.

20. In

case of Port Hospital Mumbai if the feasibility of a medical college does not work up then it should be availed for starting of Post Graduate Courses in relevant

specialities

vide the qualified manpower available there including the requisite number of teaching beds in terms of provisions included at Section 8(1)(A) of the regulations governing Post Graduate Medical Education notified by the Government of India, on the recommendations of the Medical Council of India

.

..contd..

RECOMMENDATIONSSlide28

21. At

Port Hospitals other than Mumbai, Cochin, Chennai,

Vishakhapattanam

, Kolkata and

Paradip

the

upgradation

of the existing healthcare facilities to sumptuous secondary and to some extent tertiary care level need to be augmented for enhancement of the quality of the services to be catered to the relevant stakeholders.

22. All

these initiatives as proposed would be under Public Private Partnership Mode and therefore, could not end up in any financial liability on the Central Govt. and the proposed venture even for the starting of the Postgraduate courses would be in tune with the one which has been worked out for starting of a medical college in tandem with Port Trust Hospital Mumbai, including the financial implications and appropriate balancing of the resultant liabilities in an illustrative manner.

RECOMMENDATIONSSlide29