Brenda Longstaff explores how health links between the NHS and developing countries deliver benefits to the NHS workforce.

For many years healthcare professionals from across the UK have volunteered their time to support international health projects in developing countries. How does this fit within the current challenging environment facing the NHS and are there any benefits to the NHS from returning health professionals? To explore this, I was commissioned to carry out research by the North East Strategic Health Authority.

The NHS needs to be convinced that health links could benefit both ways. NHS Employers need proof that links work can not only provide development opportunities for staff but also that the NHS will gain from this.

Links enable people to experience healthcare from a totally different perspective. They have to function in an environment where equipment is not always available, drugs are in short supply and the health budget can’t always buy what you need. Lessons learnt from this experience are particularly relevant in the current operating climate and can translate to real benefits for the NHS.

Historically, health linking has been undertaken to provide assistance to countries where health professionals are few, and health resources are limited. The majority of links are self funded and volunteers usually undertake the work during their annual leave. A number of links are supported through grants from the Department for International Development.

Within the NHS, many trusts seem to be unaware that members of staff undertake this work on a voluntary basis. However, some have supported international health links for a number of years and acknowledge the benefits that involvement in link activity can bring, particularly in terms of workforce development and talent management. For instance, the Northumbria link has the full backing of chief executive Jim Mackey and the trust board.

At the same time the UK is looking to skill-up its workforce to serve an increasingly multi-cultural society and needs to be prepared for emerging global health threats. Perhaps knowledge, experience and skills gained overseas could help towards those goals.

Over recent years, the government has raised the profile of international health links through a number of reports and evaluations. In 2007 Lord Nigel Crisp, former NHS chief executive, produced a report which looked at existing health links activity and how this could be used to best effect to support developing countries. The government’s response to the report, published in 2008 brought the Department of Health and DifD together to produce a Framework for the NHS to take forward links activity.

Today there is little doubt that the NHS faces a period of unprecedented change. Policy makers, commissioners and NHS employers are all facing the challenge of motivating the workforce to deliver health services in a smarter way within a challenging environment. Can health links provide an innovative form of advanced leadership training to meet those challenges?

Benefits to the NHS

The benefits to the NHS are more subtle. As Professor Richard Walker said: “throughout the duration of the link I have worked with colleagues from many different departments and disciplines who I would have been unlikely to meet in my normal day to day job. This has given me an invaluable insight into areas such as clinical coding that I would otherwise not have had”. This exposure led to a greater awareness of the importance of medical note taking and how this translated to payments from healthcare commissioners.

Peter Smith, lead nurse for critical care outreach at North Tyneside Hospital found that international experience “gave me a new set of challenges that I had to learn to deal with. I often found myself outside my normal comfort box but the experience gave me a fresh outlook and I came back to the UK fully charged and with a real appreciation about what we have in the NHS. It made it easier for me to work with staff and get the most out of them. I am more adaptable and can cope much easier with change.”

Clinicians in the UK are used to a high technology environment with ease of access to fully resourced clinical support services. When this is not available overseas you have to fall back on core skills and make do with what you have to hand. There is an acute awareness of the costs of healthcare delivery especially when confronted by patients who have to pay for each intervention.

Returning healthcare professionals come back highly motivated to develop innovative approaches to service delivery which would be more cost effective and provide better value for money.

Most people who have been involved in international links will tell you that they get as much, if not more, out of the experience that they put in. The real tangible benefits have been rather harder to explain in terms of professional development and impact on working practices in the UK.

Over a period of six months a number of interviews were held with 28 members of staff from seven NHS trusts in the north of England.  Everyone agreed that there are significant opportunities for professional and personal development through involvement in international health links. At a professional level, the experience enhanced team-working skills, increased leadership ability, encouraged new ways of working and extended cultural sensitivity.

Those working overseas developed higher level skills relevant to the NHS Knowledge and Skills Framework as well as the NHS Leadership Framework. 78 per cent were in agreement that links experience gives you the professional development you don’t get anywhere else.

They all recognised improvements in their ability to problem solve and work towards solutions. Liam Horgan, a consultant surgeon from Hexham General Hospital said “working overseas helps you see more clearly how good the NHS is. It encourages you to look again at what you do, as it is so much easier to make changes in the NHS than over there.”

On a personal level, 90 per cent of those interviewed claimed that the experience had been good for their personal development. They came back with greater job satisfaction and a strong work ethic. 96 per cent of health professionals interviewed for the study thought that the reputation of the NHS could only be enhanced by involvement in international health links.

It seems that health links can deliver benefits to both sides. While the benefits to developing countries may seem more obvious, it is important not to overlook the significant benefits brought back to the NHS by highly motivated staff returning from overseas with renewed passion for their work and the willingness to bring fresh ideas and ways of working.

Top tips

If you would like to find out more about becoming involved in health links you may find the following resources helpful:

  • A Framework for the NHS to take forward links activity was agreed by the Department of Health in March 2010 and set out the benefits of NHS involvement in international development as well as good practice guidelines
  • The Tropical Health and Education Trust has a wealth of experience in supporting health links and also administers grants from DfiD
  • The research report Innovative workforce development: the case for international health links is available attached to this article in ‘Related Files’.