Lord Oates (LD)

My Lords, I join other noble Lords in thanking the noble Lord, Lord Crisp, for securing this debate and for his long-standing leadership on global health. I also pay tribute to the work of the global health partners with which I have had the opportunity to work in the past. This is the first time I have taken part in a debate with the noble Lord, Lord Wood, since he has become a Minister, so I welcome him to his ministerial position and congratulate the Prime Minister on making such an excellent appointment. I have spoken in previous debates about my experiences earlier in my career: teaching in a rural school in Zimbabwe and, later, working in South Africa for a few years. Although I hope that the contribution I made in those roles was valuable to the communities in which I worked, I know that it was absolutely priceless to me. I learned about living in a resource-constrained environment, about the ingenuity and commitment of the community and about the perspectives of people with very different life experiences and cultural backgrounds from mine. Those experiences shaped my life. They taught me how much we have to gain when we are prepared to listen and learn. That is why, this afternoon, I want to speak in particular about the contribution of NHS England’s Global Health Volunteer Fellowships programme, which puts that principle into practice. I want to make what seems to me to be the overwhelming case for continuing the modest financial support that enables the scheme to operate, allowing doctors from the UK to contribute overseas and bring valuable skills home. The programme deploys doctors for four to six months in health facilities in a number of low and middle-income countries, including Kenya, Malawi, Namibia, Sierra Leone, South Africa, Uganda and Zimbabwe. These doctors are paid a small stipend to cover travel and living expenses. More than 450 have been deployed to date, making a significant contribution to the communities they have served but also gaining new skills and experiences, to the benefit of our National Health Service. An independent evaluation of the programme by Hughes Hall, Cambridge, found that 94% of fellows responding reported improved clinical skills, while 92% reported better problem solving and decision-making. One doctor described returning to British general practice calmer, more confident and more aware of how poverty shapes patients’ health; working with limited diagnostics had sharpened his skills of observation, examination and clinical judgment. Another explained how they managed presentations of which they had little or no prior experience, including trauma, burns and snake bites, building confidence and a practical skill set that they would not have developed in the UK. Another described learning from highly skilled South African doctors and incorporating those skills directly into NHS practice. These are benefits that they can provide to the NHS and their patients throughout their careers. Secondly, the programme encourages a more thoughtful use of resources. Doctors described learning to weigh decisions carefully, adapt to constraints and avoid waste. An Oxford radiology registrar who worked at George Hospital in South Africa’s Western Cape explained how the experience better equipped him to allocate limited resources, avoid waste and appreciate the resources that are available in the National Health Service. Thirdly, there is the benefit to morale and retention. One participant described rediscovering the joy of practicing medicine. The evaluation records testimony that the programme can help retain GP trainees and renew their commitment. We invest heavily in training doctors; helping them remain motivated and committed to NHS practice should be part of protecting that investment. The benefits to the partner hospitals were also clear. In Mitchells Plain, a highly deprived community outside Cape Town, fellows are described as integral members of the emergency team. Both fellows and local medical staff reported learning from each other. At George Hospital, the partnership has helped sustain patient care while developing future healthcare leaders, and the Tshemba Foundation, which supports volunteers at Tintswalo Hospital and surrounding rural clinics in north-eastern South Africa, describes the Global Health Volunteer Fellowships programme as invaluable and explains why continuity matters so much—a regular flow of fellows allows it to plan. Finally, there is the benefit of the personal relationships that are built, which contribute to the kind of personal diplomacy that is important for the UK’s relationships abroad. I know that myself from the time I spent working in South Africa and Zimbabwe; I built enduring relationships which remain to this day. Lots of those personal relationships contribute to how the UK is seen. Despite all these benefits, there is deep concern that the programme may be discontinued. I very much hope that this will be reconsidered. Ministers should consider what will be lost: training opportunities, clinical contributions and relationships built through years of co-operation. Can the Minister tell us what the Government’s position is in this regard and explain how the benefits to NHS training and partner hospitals are being assessed? I understand the pressures on resources, but we are talking here about very modest funding. A small stipend can make possible months of service and learning, with benefits that last well beyond a placement. We should have the judgment to recognise that value and the commitment to sustain it.