29 January 2018
Piece originally published on 25th January 2018 on HSJ.
The slew of recent headlines on NHS performance could leave you with the impression that the service is on the verge of collapse. And it’s no secret that it faces huge challenges, from a prolonged funding squeeze to staffing problems brought about by low morale, changes to pay structures and training bursaries and the drying up of new recruits from the EU.
But 70 years since its foundation, the NHS remains not just a cherished institution at home, but a global exemplar. We were one of the first nations to adopt universal healthcare coverage (UHC) in 1948 and, as pointed out last year by the Commonwealth Fund, the NHS continues to be recognised as the ‘fairest’ health system in the world, with all citizens regardless of income having access to high-quality care.
When the NHS was founded the UK was not an especially rich country by modern standards. Our economy had been shattered by the Second World War and many people were living in what we would now call ‘absolute poverty’. GDP-per-capita was at a level comparable with China’s today. Even so, Nye Bevan and the Attlee government went ahead with their bold plan for a nationalised health service, convinced that this was the right thing to do to ensure fairness for citizens, regardless of wealth.
In many countries around the world, people cannot take this for granted. In India, for example, over 80% of the population has no healthcare cover and many expenses are paid out-of-pocket. To middle income countries (MICs) like India – which often show enormous disparities in wealth despite fast economic growth – the NHS and its founding principles serve as a highly-valued model for ensuring the poor do not get left behind in rapidly-growing economies.
With the UN’s Sustainable Development Goals encouraging nations to invest in UHC, and an estimated 18 million shortfall in healthcare workers globally by 2030, the NHS is already making a huge contribution to alleviating the problem. Through programmes like the Health Partnership Scheme, the UK has trained over 84,000 nurses, doctors, midwives, community health workers and other health workers in low and MICs. This is a record we can be very proud of. But this altruistic impulse can be the start of long-term, mutually beneficial relationships if properly nurtured.
In our latest discussion paper, The Transition from Aid, we make the case that the need for UK engagement in MICs remains pressing, with commercial opportunities growing as economies do, but with aid still vital in some contexts.
Firstly, we argue that the UK’s healthcare sector – and the NHS in particular – is underutilised as a driver of development and commercial exchange with MICs. This is particularly true when it comes to workforce development. With an exceptionally diverse and international workforce itself, the NHS is well placed to export its expertise in education and training by, for example, establishing new centres of excellence in each of the four UK nations to promote, coordinate and develop the role of the NHS as a leader on global workforce development.
Health Education England, for instance, are working in partnership with one of India’s largest healthcare providers to offer postgraduate training in the NHS to nurses from India for a limited period on an ‘earn, learn, return’ basis. This is a promising example and one model of many that new centres of excellence could explore allowing us to work at scale to solve the global health worker crisis.
Secondly, we must hardwire the idea of bi-directional learning into our thinking. Most people working in the NHS would admit that we don’t have all the answers. There’s a huge amount we could learn from the experience of low and middle-income countries, especially when it comes to adopting innovative technologies and practices. ‘The Brain Gain’ programme in Uganda, for example, takes former mental health patients and trains them to offer support to others affected by similar issues. It is a programme that is proving to be particularly effective in Uganda and one that our stretched mental health services could benefit from employing.
This is our challenge for the NHS in its 70th year. As we move towards Brexit, the UK needs to substantiate the political rhetoric that we remain an outward-looking country, open to partnerships and new ideas. The NHS is a beacon for healthcare worldwide and this is something to be both proud of, and use to strengthen our own health services whilst working to achieve UHC.
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