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The NHS should embrace the world stage – Ben Marshall

The NHS should embrace the world stage

The first of a two part series by Ben Marshall

Every three years, US-based think tank The Commonwealth Fund publishes a report comparing the health systems of 11 developed countries. In the last two reports (2017 and 2014) the UK has come out top, with the NHS being found to deliver the safest and most affordable care with superior ‘care processes’.

We can be rightly proud of that achievement. In the seven decades since Health Secretary Aneurin Bevan implemented the recommendations of the Beveridge Report and set up the NHS, it has become the largest single-payer healthcare system in the world[1], employing around 1.2m people and seeing over a million patients each day.

But to truly be considered world class, the NHS has to engage on the world stage. This article is the first of two which explore the concept of international engagement by the NHS. It will outline the way in which NHS organisations are beginning to work internationally and how that benefits them and their communities. Part Two will then identify the challenges of scaling up that effort and offer some practical solutions to be considered.

The idea of increasing international engagement is not new. Many Trusts (disproportionately albeit unsurprisingly based in London) have been “exporting” their expertise for years via internal strategy teams, private patient units (PPUs), and charitable foundations. There is clear international interest in learning from Trusts and Arm’s-length Bodies (ALBs), with both governments and private organisations seeing the NHS blue lozenge as a kitemark of quality and innovation.

Now though, more than ever, there is an o

pportunity for the wider system to take advantage of this interest. In 2018, on the 40th anniversary of the Alma-Ata Declaration, the WHO convened a summit in Kazakhstan which re-affirmed its commitment to the ideal of “Health For All”. A couple of years earlier, the UN published the Sustainable Development Goals, with good health and wellbeing not only a priority in their own right, but also a core component of reducing inequality and stimulating economic growth. Every member of the UN has been challenged to achieve universal health coverage by 2030 and the NHS has much to offer: for developing countries that have historically underinvested in health systems, and for middle income and developed countries struggling with the rising prevalence of non-communicable diseases and aging populations.

So what does it mean to take advantage of these opportunities? The approach is varied. Some Trusts admit international private patients. Others host fellowships or observerships for foreign clinicians to shadow senior staff. In some cases, Trusts and ALBs have been able to be more proactive, providing goods (digital solutions) or services (such as remote diagnostics and clinical/policy advice). The most ambitious have even set up sites overseas.

The clear trend is that every year more NHS organisations are benefitting from international opportunities. These are manifested in five main ways:

  1. Improved global health. The health and care sector is built on a shared sense of vocation, driven by a genuine desire to help. International engagement is an extension of that mission, allowing healthcare professionals to improve outcomes in some of the world’s poorest communities, not just through individual philanthropy, but also system-level interventions and schemes like the Better Health Programme (a series of overseas aid initiatives financed by the Prosperity Fund).

  1. Staff recruitment and engagement. There is a general shortage of healthcare professionals. The ongoing pensions crisis is driving experienced doctors away from NHS work and only a third of junior doctors are going immediately into specialty programmes after finishing their foundation training (many citing the risk of burnout or the desire to gain broader experience). Overseas initiatives offer the opportunity to ethically recruit foreign healthcare professionals and to support the retention of existing NHS staff by providing them with more varied work, travel, and purpose.

  1. Reputation for innovation. By working with governments and organisations in a broad range of countries, the NHS further cements its visibility and popularity. A strong international reputation and overseas partnerships drive academic staff and grant funding towards the NHS, help make the case for clinical trials, and promote an environment amenable to research, innovation, and the establishment of world-leading centres of excellence in e.g. genomics and AI.

  1. Ongoing learning. There are plenty of examples, from community care in Brazil to digital infrastructure in Nigeria, where the NHS can learn from innovations in countries without the legacy structures that sometimes slow down change. NHS staff need to be in a position to interact with these systems, extract lessons that can be valuably implemented within the UK, and effectively share those lessons across the dozens of organisations that may benefit from them.

  1. Financial support. It is impossible to separate patient care from financial provision, especially in light of evidence that austerity has contributed to tens of thousands of excess deaths. Given existing financial constraints, the response of many NHS organisations has been to focus on “efficiency” – cutting costs rather than growing revenue. International commercial income can offset the widespread financial deficits and convoluted funding structures that plague the NHS. Project wins have accounted for more than £100m of revenue the last two years, although research by Healthcare UK estimates that the total value to the NHS could be £800m each year, all of which could be reinvested in the care of UK patients and service users.

As will be discussed in the second half of this feature, in a complex landscape, looking beyond national – or even regional – boundaries can be daunting. But organisations within the NHS family, and indeed central government, have a duty of care to live up to the opportunities available. The NHS as a whole is poised to benefit from (and contribute positively to) an increasingly connected world, and there’s no time like the present.

[1] In terms of budget. Indonesia’s Jaminan Kesehatan Nasional (JKN) covers more people but is funded via insurance premiums rather than general taxation.


Ben Marshall is a healthcare for the government, and part of a joint team leading a new strategic initiative outlined in the NHS Long Term Plan. Previously he was a management consultant at Concentra Analytics, where he worked with a variety of public and private organisations in the healthcare and financial services sectors. His Twitter is @bmcmarshall.



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