THET believes that overseas volunteering from the NHS is already a valuable asset and could play a unique role in addressing some of the challenges faced by the NHS - its strongest contribution being the area of leadership development and service innovation.

Monitor, the sector regulator of NHS-funded health care services released a report on 10th Oct, 2013 entitled ‘Closing the NHS funding gap: how to get better value health care for patients’. The report sets in motion the debate called for by NHS England to address current challenges and outlines opportunities to deliver better care and close the NHS’s financial gap. These include improving productivity within existing services - "everyone working differently and smarter" - and also looks to healthcare abroad to develop new, innovative ways of delivering care.

THET has been working with UK health professionals and institutional partnerships or ‘links’ between the NHS and low or middle income country counterparts for twenty five years. These partnerships are designed to support Human Resources for Health development through training, and education of healthcare workers overseas by UK volunteers. While the primary focus of these coordinated projects is to bring lasting improvements to healthcare in developing countries, at the heart of health partnerships is the acknowledgement of the mutual benefits of working in this way.

Overseas volunteering brings NHS staff into first-hand contact with novel approaches to healthcare delivery.

NHS organisations are increasingly recognising the value of overseas programmes to their workforce and there is a growing interest in the role NHS staff can have in advancing health globally and bringing new knowledge, skills and ideas back to the UK.

While many of the solutions, often born of necessity, applied in low-resource settings are not appropriate for the UK context, there are many examples of those that are. Low-to-high income country healthcare innovation as a result of international partnerships has been compiled by Syed et al. in the review Developed-developing country partnerships: benefits to developed countries? (2012) and neatly classified across six key domains - service delivery, workforce development, health information, technology, financing, leadership and governance.

Volunteering in low-resource settings can lead to "working differently and smarter"

Leadership development is frequently cited as one of the most important benefits accrued from sending staff overseas. Time and time again, returning volunteers report increased confidence, a renewed vocation for the NHS and a more adaptable and open-minded approach to service delivery.

"Whether abroad for two weeks or two years, returning volunteers are seen as having greater understanding of how to enact change, communicate across professional cultures and work as part of a team. Clinical staff in particular, we heard, returned with new interests in redesigning pathways of care, service integration, commissioning and team work".

All Party Parliamentary Group on Global Health report, 'Improving health at home and abroad'

One example of an area that is using overseas volunteering with the explicit intention of developing their workforce’s leadership skills is the Improving Global Health Fellows Scheme, run by the Thames Valley and Wessex Leadership Academy. This programme places doctors-in-training and more experienced nurses, midwives, managers and allied health professionals into partner organisations in Cambodia and South Africa for periods of 4–6 months. The Fellows work on locally-identified projects to provide "an unparalleled personal and leadership development experience to staff" and "create a cadre of skilled clinical leaders with quality improvement skills who can make a real difference to the NHS on their return”. Three years in, an independent evaluation of the scheme found that "without exception Fellows reported outstanding personal development, often described in terms such as 'life changing'. The majority emerged with a greater appreciation of the value of audit, teaching, management and their significance for clinicians, and with an enthusiasm for leading service improvement in the NHS."

Effective government action to support NHS overseas work such as the Health Partnership Scheme and the focus of the All Party Parliamentary Group on Global Health on ‘Improving health at home and abroad’ contribute to creating an enabling environment for staff wishing to volunteer abroad. However, more remains to be done and barriers remain. THET's vision for volunteering through partnerships is for an environment where it is regarded as the norm, not the exception, for all UK health professionals.

The full benefit of the engagement of UK health professionals overseas through volunteering will only be realised when mutual benefit is matched with mutual responsibility and better support is received from employers, the NHS and government.

As such, THET welcomes the opportunity to highlight to Monitor, and the wider NHS, the relevance of overseas volunteering and the part it can play in exploring the proposed opportunities to improve productivity within existing services and in looking outside of the UK to develop new, innovative ways of delivering care.