House of Commons - Strengthening Health Systems in Developing Countries

Strengthening Health Systems in Developing Countries - International Development Committee Contents

5 Making better use of NHS expertise

76. The NHS was judged by the Commonwealth Fund in June 2014 to be the best of eleven major wealthy health systems and has an excellent international reputation.[198] DFID makes use of NHS expertise through programmes such as the Health Partnership Scheme and its funding of NICE International. In this chapter we consider whether DFID might work more closely with the NHS.

Health Partnership Scheme and volunteering overseas

77. The Health Partnership Scheme (HPS), operated by the Tropical Health and Education Trust (THET), facilitates over 80 institutional health partnerships between UK-based health organisations and their counterparts in low and middle-income countries.[199] This enables skills transfer, the exchange of ideas and the building of support for broader UK development priorities.[200] To date, over 20,000 health workers have received training, education and peer-to-peer support. The HPS has two main components: a grants mechanism for projects proposed by partnerships, and activities to support and develop partnerships so that they are better equipped to deliver effective projects.[201] Grant recipients include NICE International and several of the Royal Colleges.[202] DFID has extended support for the scheme, which originally covered 2010-2015, to 2017, committing an additional £10 million in funding.[203]

78. In 2013, the All-Party Parliamentary Group on Global Health praised the HPS as "the most effective government action to support NHS overseas work in recent years", noting its "transformative effect".[204] More than 1,000 volunteers from the NHS have been supported by the scheme.[205]

79. The Academy of Medical Royal Colleges has been highly supportive of the HPS and other initiatives to promote greater volunteering overseas by NHS professionals, arguing that they are of mutual benefit. In particular, individuals who volunteer often acquire personal and professional skills that are transferable to the NHS;[206] international health partnerships can help stimulate innovation in both settings; and the UK benefits from goodwill and extended influence.[207] This view was echoed by Lord Crisp, former Chief Executive of the NHS, who described volunteering overseas as "a great potential win-win".[208]

80. We heard that DFID had recently become more interested in assisting with volunteering programmes.[209] However, volunteering schemes are said to be small-scale, fragmented, unsystematic and arguably underfunded.[210] These concerns were familiar to us: in our recent Report on Democracy and Development in Burma we recommended the creation of a small fund to support an impressive proposal by University College London Medical School, the Royal College of Physicians and others to establish a partnership programme with colleagues in Rangoon.[211]

81. Volunteering can meet internal resistance in the NHS, from employees who fear for their careers or hospitals who fear losing staff.[212] There is also a lack of formal recognition of the value of volunteering for professional development.[213] Lord Crisp called for greater inventiveness in making volunteering more viable for health professionals, drawing attention to a proposal before USAID for volunteer doctors to be excused a proportion of their student loan as an incentive.[214] He argued that a relatively small financial outlay would enable the development of a more systematic programme, suggesting that it could form part of training for some student doctors.[215] The Minister told us that the NHS, in conjunction with DFID, the Department of Health and others, would publish a new framework for volunteering in the NHS in the coming months.[216]

82. Volunteering overseas by UK medical staff can be highly advantageous for developing health systems. Through the personal and professional development of individuals, the sharing of best practice and the building of global contacts, it can also be of great benefit to the NHS. Existing volunteering schemes, though often successful, are small-scale and fragmented. The Health Partnership Scheme is highly effective, but its funding is a drop in the ocean. Volunteering schemes need coordination, structure and scaling up.

83. NHS staff should be supported in seeking to apply their skills where need is greatest. We recommend that the new NHS framework for volunteering establishes a formal structure to facilitate the participation of many more medical professionals, including through extended sabbaticals, and makes clear that volunteering overseas is valued and consistent with career progression. DFID should provide the necessary funds to support these more ambitious schemes. We further recommend that DFID investigates means of supporting those who volunteer, including continuing NHS pension contributions and paying down student loans.

Management and finance skills

84. We were told that economic development and increasing complexity in health systems mean that greater expertise in managing and financing health services than can be offered by established international aid organisations is now required.[217] Management skills were identified as a key gap in developing systems, including by the Minister.[218] We also heard that the problems faced by developing systems were often the same as those in rich countries.[219] The NHS is home to a wealth of health systems management and finance expertise,and that knowledge is held in high international regard.[220]

85. One example of NHS management and finance expertise being used in development is NICE International. The National Institute for Health and Care Excellence (NICE) is the part of the NHS responsible for advising on cost-effectiveness and the allocation of resources. Its small international arm, which was founded in 2008, has offered advice to more than 60 overseas governments on making informed prioritisation decisions. It does not use NHS resources and is funded jointly by DFID, the Gates and Rockefeller Foundations and the World Bank.[221] DFID repeatedly referred to NICE International's work as examples of effective HSS in evidence to us.[222] We asked NICE International's Dr Kalipso Chalkidou what would help the organisation extend its work. Rather than additional money, she called for improved coordination between DFID and other government departments and for the Government to be more confident in promoting NHS governance principles overseas.[223]

86. Demand for NHS staff does not end with doctors and nurses. Though often criticised at home, the NHS is held in high international regard and many countries would greatly benefit from the assistance of those expert in managing and financing such a successful health system. In turn, NHS managers would benefit from tackling familiar problems in unfamiliar settings. This is a challenge to traditional development models and DFID must be sufficiently agile to adapt to changing and increasingly complex needs. NICE International is a successful example of how NHS expertise can benefit overseas systems, and leverage funds from other donors in the process. We recommend that DFID establish a clear strategy for how UK government should work in partnership with the NHS to support overseas health systems.

198 Q78 [Dr Kalipso Chalkidou] and the Commonwealth Fund, Mirror, Mirror on the Wall, 2014 Update, June 2014. The Commonwealth Fund study evaluated the health systems of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. Back

199 THET is a "THET is a specialist global health organisation that educates, trains and supports health workers through partnerships, strengthening health systems and enabling people in low and middle income countries to access essential healthcare". See http://www.thet.org/. Back

200 THET, Support for Health Partnership Scheme extended beyond 2015, 23 May 2014 Back

201 HSS47 [THET] Back

202 THET, Homepage, accessed 1 September 2014 Back

203 HSS6 [Dr Fiona Samuels and Dr Dina Balabanova] Back

204 All-Party Parliamentary Group on Global Health, Improving Health at Home and Abroad: How overseas volunteering from the NHS benefits the UK and the world, 2013, p34 Back

205 HSS47 [THET] Back

206 Q53 [Lord Crisp] Back

207 Academy of Medical Royal Colleges, Statement on Volunteering: Health Professional Volunteers and Global Health Development, 25 March 2013 Back

208 Q53 [Lord Crisp] Back

209 Q58 [Dr John Howard] Back