Tuesday, 23 September 2014

NHS expertise, how to reach its full potential

The International Development Committee (IDC) recently published a report on the findings of an inquiry into DFID’s work on strengthening developing country health systems. Graeme Chisholm, THET’s Volunteer Engagement Manager talks about its recommendations and what it might mean for the future of volunteering from the NHS. 

In my previous blog, Voluntary Engagement in Global Health, I asked, partly rhetorically, whether a leap of faith was required for us to believe that engaging in global health can be good for everyone. I didn’t expect an answer so quickly and certainly not one as resounding as the one I read in the recently published report Strengthening Health Systems in Developing Countries from the House of Commons International Development Committee. In this report the highly influential Committee states in no uncertain terms their firm belief that volunteering overseas can indeed be of great benefit to the NHS as well as to developing country health systems.

The report calls for volunteering schemes to be well coordinated, structured and of sufficient scale to achieve lasting change. Engaging in global health comes in all forms but let’s not forget that there are a number of wonderful examples of volunteering schemes funded by the Health Partnership Scheme (HPS) that display all the qualities called for in the report. Take Global Links, managed by the Royal College of Paediatrics and Child Health, for example. Since it started in the spring of 2012 36 paediatricians, trainees as well as consultants, have volunteered for periods of six months in some of the toughest conditions in East and West Africa. A number of Global Links paediatricians have been working, for example, in Ola During Hospital, the only children’s hospital in Sierra Leone, alongside Sierra Leonean doctors and nurses. What they’re achieving is summed-up by Timur Bekir in Giving Children a Chance: Reducing Child Mortality in Sierra Leone below. One other thing to celebrate about Global Links though is how the RCPCH have worked hard to ensure that paediatricians from west and east Africa get the chance to come to the UK, 17 so far, to learn and share knowledge with us before returning to their countries to help lead their health services. And I know that all this hard work has helped greatly to counter the Ebola threat currently faced by the people of Sierra Leone.

So what else does the report say? At its heart is a call for us all, however we engage in global health, to make better use of NHS expertise. The report recommends that NHS staff should be supported in seeking to apply their skills where need is greatest. It rightly points out that the new guidance, Engaging in Global Health, from the Department of Health, Department for International Development and the NHS, should lead the way. But it’s worth pointing out that Engaging in Global Health is simply that, guidance rather than policy. So how do we take the next steps and create ‘formal structures to facilitate the participation of many more’ to engage in global health as the report goes on to recommend?

There are two things that can make this happen. One is more money and the other is policy change. But where can we find the money in these austere times and what needs to change in terms of policy? Here are some ideas.

When it comes to engaging in global health through partnerships, a patchwork of charitable donations and support from philanthropic and commercial sources all provide vital funding. But the lion share of funding is currently provided by DFID through the Health Partnership Scheme. The report commends HPS but it also says that its level of funding is but ‘a drop in the ocean’. There is clearly an appetite for more partnerships that can demonstrate value so shouldn’t we be lobbying DFID right now for a higher level of funding to allow partnerships to flourish beyond 2017 when HPS is currently due to end?

These are exciting times we live in as Healthcare UK and UK Trade and Industry look to markets overseas to export the UK’s healthcare knowledge and expertise. And as profits from these commercial partnerships begin to flow and we continue to understand more and more the value to the UK’s health sector of voluntarily engaging in global health isn’t the time now right for us to explore the relationship between commercial partnerships and voluntary health partnerships and how they can mutually support one another?

As for policy change where to begin? In terms of direction from the top, there has been some progress. Even though Engaging in GlobalHealth is guidance rather than policy it does provide solid foundations to work from. And earlier this year a new clause supporting voluntary engagement in global health by the UK workforce was included in the refreshed Mandate from the Department of Health to Health Education England. But what is notable is the absence of anything similar in the government’s Mandate to NHS England. This is worrying. Shouldn’t we be calling for support for engaging in global health from NHS England? I think we should for if the de facto system manager of our health service has nothing to say on the matter then doesn’t this legitimise inaction and insularity?

But what about more practical measures? I’m delighted to report that Health Education England and NHS Employers are working on a Continuing Professional Development toolkit that will help all those who volunteer overseas to reflect on and evidence the competencies they gain whilst volunteering. And we at THET are keen to study how this is received at appraisals when NHS employees return to the UK. We know, anecdotally at least, that lots of good comes from volunteering but we also really want hard evidence to put to bed once and for all the concern that the NHS is losing vital skills and gaining nothing in return. This is a big task so wouldn’t it be great if Local Education and Training Boards helped to roll this initiative out to help to really embed it across the health service?

A final thought. Model policy examples aren’t always necessarily eye catching but my gaze keeps drifting back to the one developed by NHS Employers in conjunction with the Ministry of Defence for NHS employees who are also members of the reserve forces. This particular Model Policy Example manages to tackle the many issues as well as offer solutions and it packages it all up neatly in the one document. I wonder whether we should be pushing for something similar for international volunteering?