"The primary resource in any healthcare system is its people" – A Scottish approach

‘When a health service worker steps outside their normal environment it frequently leads to better cultural sensitivity and an openness to doing things differently’

Dr Catherine Calderwood, Chief Medical Officer for Scotland

Dr Calderwood’s words open the latest report produced by the Royal College of Physicians and Surgeons of Glasgow – Global Citizenship in the Scottish Health Service – The value of international volunteering. We interviewed Stuart Fergusson, Clinical Leadership Fellow and co-author of the report to hear how Scotland is forging forward with global health initiatives.

Q: How did you first become involved with global health volunteering?

It began when I was a medical student and I took trips to Bolivia and Malawi where I encountered health systems dealing with quite extreme challenges with clearly much fewer means than we have in Scotland. I watched staff having to be really resourceful and creative in the way they used the limited resources available to them.

Having personally encountered the reality of gross healthcare inequality I realised that anyone who has that experience cannot really be the same again: you are left with the sense that you need to do something to be a good neighbour or a good citizen as the report says.

Q: What would you say the support has been like from the Scottish government and the health sector for international health volunteering?

Despite the 2005 and 2016 Scottish international development policy, there hasn’t been a clear articulation of how the Scottish health service might position itself to provide technical assistance

We are in an era of austerity, facing challenging performance targets, with increasing rates of unfilled posts, and an ageing population with an increasing health burden, etc. but in that context engagement in global health has many positive things to offer. The primary resource in any healthcare system is its people and global health work is an effective way of investing in your people and valuing them.

For those who do have interest in international work it is a highly constructive thing to support those aspirations, not just because it makes people feel warm and fuzzy but because it keeps them in their job, it keeps them motivated, and it most definitely brings in new skills.

Q: In this context why is the report so vital?

The report feeds into current concerns over our struggling NHS. Boards are having to make recurring savings (4% a year) – they are having to substantially cut back in a way which you can’t do superficially, it is painful and affecting frontline services so it is a very challenging context to be speaking to. When we started the report we could see that there wasn’t universal enthusiasm for it.

Of course the primary function of a Scottish health system has to be the health of the Scottish population and we are very careful to adopt a pragmatic approach about this. We understand the difficulties in implementing policies which remove resources from an already struggling system and applying it to contexts where we have no direct need to contribute but we also know from our own experiences that time spent volunteering can serve so many purposes.

This is where there is a huge degree of unrealised potential in using Official Development Assistance money (UK aid) within the health service sector to underpin technical assistance elsewhere. By using these funds – in a modest way – we can more effectively leverage development money to provide clear benefits overseas whilst bringing back reciprocal benefits to the UK.

To have the explicit involvement of every single territorial and special health board in Scotland has really illustrated the interest there is throughout the country for global health programmes to take root. For NHS boards it has really proved useful both for those who were already trying to go somewhere with their development work and for those who don’t at organisational level own a strategic mission because it has worked to highlight the real benefits in committing relatively minimal resources.

We also received tremendous support from the Scottish Global Health Collaborative, of which THET is a member, as well as, of course, RCPSG who provided all of the resource and most of the intellectual energy for the report.

Q: What are your hopes for the future?

We have been really gratified with how well the report has been received and with the support the CMO has given for principles of the report. It was also fantastic to have the Minister for International Development Alistair Allan and the Minister for Mental Health at the launch who welcomed the report and said they would work with the College towards the possible pilot of a centre for Global Health.

The success of Lord Crisps report in 2007 is a fantastic example of the success such recommendations can have and my main hope for the future is that our report becomes another example of the impetus for global health action in Scotland and in the UK more widely.