The Lord Bishop of Leicester

I am very grateful to the noble Lord, Lord Crisp, for securing this debate, and it is an honour to follow him. I thank him sincerely for his sustained work over a number of decades to show how medical partnerships with low-income and middle-income countries bring benefits both to those countries and to our own NHS. This is something very dear to my own heart. My wife is a paediatrician and, together, we worked for a number of years in west Africa. My son has just graduated and started his first job as a doctor in Derby. Earlier this year, he did his medical elective in east Africa and, because he studied at the University of Newcastle, he was able to do the whole of his second year at Newcastle’s campus in Malaysia, an advantage he did not know about when he applied to that university. In a number of ways, cross-cultural medical work has been a big part of my family’s experience. More than this, the principles that in giving we also receive and that we have much to learn from those with whom we differ—culturally, socially, economically, religiously, or whatever it may be—have shaped my experience of Church ministry in various parts of the world and in the multicultural context of Leicester, where I now serve. Indeed, I have written about my learning on gift exchange in different contexts. So there is a lot that I could say on the benefits to our own NHS of UK-based healthcare workers spending time working in low-income and middle-income countries. A quick list could include: increased awareness and knowledge about cultural differences and similarities; increased cultural sensitivity, which is so important for the NHS today; the ability to work with limited resources, which, again, is critical for the NHS today; the ability to deal with the unexpected and work towards solutions; improved flexibility and adaptability; and the ability to innovate in overcoming challenges. The list goes on. Importantly, these skills and attitudes are hard to pass on in classroom settings or familiar clinical contexts. Working overseas is a particular learning experience that really does have a lifelong impact. However, I also want to speak of something that is, I believe, a major barrier to healthcare partnerships, particularly where lower-income countries are concerned: the attitude that we know best and have nothing to learn from these countries. As one chief executive is recalled to have said in a report by NHS England, “What on earth are we going to learn from these poor countries?” This air of superiority—assuming that, because of our technological advances in this country, we are also culturally superior—was, of course, core to colonialism and, sadly, is still present today. We have it in the Church, and we see it in academic studies and so many other areas. There is, therefore, a need to develop what I call “cultural humility”—that is, an approach to interacting with people of other cultures that says, “We always have something to learn”. This is linked to the concept of “reverse innovation”, as mentioned by the noble Lord, Lord Crisp, whereby higher-income countries learn from and adopt practices developed in their lower-income counterparts. Kangaroo care in neonatal units is one example; oral rehydration sachets are another. The lack of cultural humility is also, I suggest, a factor that explains why UK healthcare professionals working in other countries do not always have the local impact that they would wish for. People can sense whether we have a genuine desire to serve them or are simply in it for our own gain. Good partnership working requires cultural humility—both the willingness of the individual to learn from the other and the willingness of the other to receive the gift that is being offered them. In other words, it is a form of gift exchange; as I say, there is a whole body of literature on that. I ask the Minister: what are the FCDO and the Department of Health and Social Care doing to encourage genuine partnerships with overseas healthcare bodies and to equip staff to work well within these partnerships? It is not simply a case of having formal partnership agreements, important though they are; there is also a need for the training and development of staff to work well within these partnerships. For instance, I am struck that my wife, who works in the NHS, has protected time for teaching and learning, quality improvement and clinical governance—all of which are recognised as statutory requirements—but it is much rarer for any NHS employee to have protected time to support global health. This means that it has to done in evenings and weekends, or during annual leave, thereby restricting it as an option for many—particularly those with caring responsibilities. Perhaps most surprising of all is the fact that there is little recognition of those who have spent time working in other countries. Indeed, research with some of those who volunteered abroad found that., because it means deviating from the typical training pathway, it is sometimes considered career suicide. Some returning healthcare professionals report difficulties with professional revalidation or securing permanent employment on return because, more generally, they lack experience in this country. This could be addressed, as participants in the NHS England report mentioned, by having national bodies, such as the DHSC or NHS England, recognise the benefits of global health partnerships and encourage executive buy-in. If this were more common across the NHS—indeed, if every trust had an enduring partnership with a hospital overseas—the two-way positive impact would be greatly magnified, and the obstacles that some individual volunteers face would be done away with. Finally, just before the matter of costs is raised as a possible barrier, let us remember that by recruiting healthcare workers from overseas, it is estimated that the NHS has saved £14 billion in training costs. That saving should surely come with a responsibility to offset the loss to these countries’ own healthcare systems.