Supporting global health: The NHS’s secret equity weapon

The NHS’s participation in global health projects is long established and growing. In low- and middle-income countries (LMICs), for example, brief overseas visits by committed, self-funding NHS professionals (often using their annual leave) have made a positive contribution. And decades’-long institutional health partnerships [ ¹ ] between hospitals in the UK and LMICs have helped contribute to the expansion of health systems.

Participation enables NHS staff to develop a broad range of skills in areas including clinical practice, leadership and communication

The main focus is to support the development of health systems in LMICs, through the sharing of clinical and managerial expertise. But there are important secondary objectives for the NHS too.

Participation enables NHS staff to develop a broad range of skills in areas including clinical practice, leadership and communication, at a rate and in an environment that would be almost impossible to replicate domestically with the same level of resource. Professionals bring these enhanced skills back to the NHS to improve clinical care, staff and patient satisfaction and the progression of their careers.

At a time when professionals are physically and mentally depleted and continuing to face sustained long-term pressures, these secondary benefits are more important than ever. However, despite the many benefits, most NHS staff are not aware of the opportunities, nor clear about how to access them. More troublingly, opportunities are not currently shared equally among staff.

Experts in our midst

A new inquiry, Experts in Our Midst: Recognising the Role Diaspora Make to Global Health, carried out by THET (the Tropical Health and Education Trust) with the support of Health Education England, has found that NHS professionals who identify as being a member of a diaspora [ 2 ] are under-represented as participants and leaders in global health partnerships.

Furthermore, the expertise that many bring from their experience of other health systems and cultures is not properly recognised or used. Diaspora professionals currently have fewer opportunities than their peers to undertake, contribute to and benefit from global health placements, despite in some circumstances being better placed to deliver and benefit from them.

This leads to a troubling conundrum. We know that minority ethnic professionals in the NHS face a host of inequalities and that working in global health alongside their NHS postings, and seeing their existing expertise valued, could help to address this. Yet members of a diaspora remain disproportionately excluded from such opportunities. This exclusion risks perpetuating inequalities. 

Turning the tide

A concern among many diaspora professionals and organisations is that they are limited by unconscious bias and racism at organisational and structural levels

How can the NHS change this? NHS trust and systems leaders have the potential to be valuable allies.

As health partnerships often exist within, or affiliated to a single NHS trust, NHS leaders can support global health projects to develop the professional capacity and expertise needed to deliver at a greater scale. This could include direct support from appropriate professionals within their organisation, or long-term capacity development through education and training.

A concern among many diaspora professionals and organisations is that they are limited by unconscious bias and racism at organisational and structural levels.

Within their organisations, diaspora professionals report concerns that they may be held back in their careers by their superiors if they attempt to take time away from their NHS role. At the institutional level, the rigid criteria and convoluted processes associated with some grant applications exclude smaller organisations and more informal activities (both common in diaspora-led work without wider support) from funding  opportunities. Ultimately, this puts diaspora-led organisations at a disadvantage and reduces their impact, compared to larger organisations with the capacity to meet these demands. 

In these cases, trust leaders can have an impact on two fronts. Within their own organisations, they can champion the implementation of practices and a culture that ensures that all staff are entitled and encouraged to pursue opportunities in global health. This could include promoting the importance of diaspora involvement in these activities or documenting and supporting existing global connections.  

At the structural level, they can use their influence to advocate for and promote the importance of diaspora-led global health partnerships having equal access to funding opportunities. This can also be facilitated by using expertise within the wider organisation to support funding applications.

No leader would be alone in their efforts, as there are examples of positive efforts at national level too. HEE, NHS England and the NHS Leadership Academy have all established programmes to improve diaspora and ethnic minority participation in global health. Charities such as AFFORD, for example, are also committing resources to the capacity development of diaspora-led global health programmes.

Improving equality

Amid the continuing system pressures brought on by COVID-19, global health may feel like a ‘nice to have’ for systems facing down capacity challenges and growing waiting lists, but NHS leaders can score a very efficient triple win here. By supporting the greater provision of diaspora inclusive global health opportunities for their staff, they can make positive strides in improving equality, while simultaneously promoting their organisations as exciting places of employment and supporting the long-term health and wellbeing of their professionals too.

Lisa Kelly is chief operating officer of Nottingham University Hospitals NHS Trust and honorary adviser at THET. Follow the organisation on Twitter @THETlinks