NHS: Global Health

Baroness Hollins Excerpts

Monday 20th December 2010 Lords Chamber

[Baroness Hollins]

My Lords, I, too, welcome the initiative of my noble friend Lord Crisp in calling for this debate.

As a former VSO volunteer myself in Nigeria many years ago—an experience that I consider to have had a major influence on my career and outlook—I am keen to give more opportunities for healthcare professionals today to gain a better understanding of global health issues. I should like to discuss attempts to develop greater awareness of global mental health issues, particularly in postgraduate psychiatric training by the Royal College of Psychiatrists, and I declare an interest as a former president of the college.

With the help of Professor Rachel Jenkins of King’s College, a scheme called the college volunteer programme was established about five years ago. We had wanted to set up a programme with VSO, as two other colleges had done, but this was difficult because VSO responds to requests for volunteers and it was not receiving requests for psychiatrists. In a way, that indicates the low priority given to, or low recognition of, mental health issues in many of the countries where VSO works. Therefore, we set up our own programme and gained agreement to the principle of out-of-programme placements abroad, fully approved for higher training. We put in place some safeguards, which included an in-country mentor providing supervision of all placements, with supplementary e-mail supervision from a UK-based consultant who had relevant overseas experience and who would have helped to prepare the volunteer in advance.

The intention was threefold, as I shall set out, although not in any particular order. The first was to provide a training experience in global mental health for UK trainees so that they would better understand the health perspectives and needs of migrant communities here in the UK. The second was to do that through meeting an identified need in the host country in a sustainable way. Often such needs were identified through our own college members and fellows who live and work in low and middle-income countries around the world. The third was to ensure that trainees would be equipped and motivated to be able to contribute to health services in low and middle-income countries in the future.

A number of mental health trusts have set up a specific link with a country, and I give as an example the trust where I have an honorary consultant contract—the South West London and St George’s Mental Health NHS Trust. While I was president of the Royal College of Psychiatrists, I talked to the chair of the mental health trust about ways in which he could help us to develop our volunteer programme. We thought that Ghana would be a good country with which to establish a relationship, partly because of its political stability but also because we were aware that the trust employed a number of Ghanaian staff, and the catchment population included many West Africans. The scheme at our trust was helped off the ground by a charity called Challenges Worldwide, which helped to set things up in Ghana. The scheme involved the trainee volunteer forgoing one month’s salary to cover the overheads involved in setting up the placement. The royal college fundraises to provide bursaries to support trainees’ travel costs. I shall quote two recent trainees who have each spent three months in Ghana. One said:

“This was for me the best professional training experience of my life … The support I received was excellent”.

The second said:

“My placement in Ghana was the most fascinating and perspective-changing experience in my career”.

Let us reflect on the fact that the NHS has for many years received the benefit of large numbers of health professionals from low and middle-income countries. Does the Minister agree that the value to the NHS of supporting training placements overseas far outweighs any short-term local costs? Also, can he confirm that all medical postgraduate curricula include core competences in global health issues, and will he comment on what more the professional regulatory bodies can do to ensure that enough appropriately supervised and integrated global health training placements are provided so that trainees have a realistic chance of acquiring some of those core competences?