A global NHS: from competition to collaboration

William Townsend, Business Development Officer for THET  @Willmo1

Turning 70 this year, the NHS continues to be Britain’s most cherished institution. And rightly so, in all this time it remains one of the world’s greatest social achievements. It also happens to be the 70th anniversary of the docking of the Empire Windrush, an important reminder that the history of the NHS is also a proud history of immigration to the United Kingdom.

From its inception in 1948 to today the NHS has benefited tremendously from immigration: almost a quarter of the NHS workforce is made up of people with a black and minority ethnic background with 202 nationalities represented across a workforce of approximately 1.4 million.

With vacancies of 35,000 nurses and 10,000 doctors in England reported this year, our reliance on overseas health workers persists. It’s even an issue organisations as diverse as the Guardian and the Daily Mail can agree on: non-UK health workers should be able to come to the UK and work for the NHS. As such, the cap on Tier 2 visas for doctors and nurses from outside of the European Economic Area has recently been scrapped by the Government.

But is this debate as clear-cut as it seems?

Health worker shortages are not unique to the UK. The issue is global and the current deficit of 7 million health workers is set to grow to 18 million by 2030. Unsurprisingly, this shortage is felt most acutely in low- and middle-income countries (LMICs), where thousands die daily due to a lack of access to qualified health workers.  

While NHS Employers Code of Practice states that “developing countries should not be targeted when actively recruiting healthcare professionals”, my charity, the Tropical Health and Education Trust (THET), believes the NHS must do more to collaborate, and stop competing, with other countries to ensure we plug the worldwide gap between the demand and supply of health workers.

In some ways the NHS is already pivotal in this regard. For instance, through the DFID funded and THET managed Health Partnership Scheme, NHS volunteers from 130 Trusts have trained over 84,000 health workers across 31 LMICs between 2011 and 2017. Kate Osamor MP, Shadow Secretary of State for International Development, recently witnessed some of this work first-hand as she visited Somaliland and saw how Kings College London and THET are collaborating to strengthen medical education there.

In addition, in April the Department of Health and Social Care also announced a global nursing partnership with Jamaica, seeing Jamaican nurses work in the NHS for 3 years to provide care and gain specialist skills which they will then take back to the benefit of the Jamaican health system.

It is imperative therefore to strike a balance that ensures the NHS’ gain is not another country’s loss; particularly important in the context of Labour’s recent policy commitments to support a global movement for public services. We must continue to respect the rights of health workers to migrate to the UK and work in the NHS, whilst ensuring we don’t have a detrimental impact on patients overseas, for instance by attracting some health workers to the UK for training and education purposes with a view to them returning home to up-skill their peers.

The Human Resources for Health crisis is, of course, a complex issue with multiple changes required across all facets of a country’s health system (for instance in health system financing) but if the NHS is to be a genuine beacon for Universal Health Coverage, it cannot passively benefit from other countries’ – particularly LMICs – investments in health care.

We should be immensely proud of our global NHS workforce, and of an increasingly global outlook from the NHS. This is why THET is calling on the governments of the United Kingdom to enshrine the global nature of the NHS in their respective constitutions. We call on them to initiate a clause committing the NHS globally in ways which will benefit patients at home whilst also enhancing other countries’ abilities to build robust health systems.

There are many innovative and interesting models to be explored in order to do this. We look forward to continuing the debate, and others, at THET’s conference on the 27th and 28th September 2018 at Imperial College London.  

 

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