NHS: Global Health

Earl Howe Excerpts

Monday 20th December 2010 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, I thank the noble Lord, Lord Crisp, for calling this debate and express my gratitude for his strong and continuing commitment to issues of global health. I found his speech extremely helpful and thought provoking.

The Government are deeply committed to issues of international development. In this year’s spending review we confirmed that, as well as protecting the NHS budget, we will keep our promise to spend 0.7 per cent of gross national income on aid from 2013, helping the billion people who live in extreme poverty around the world. We are equally committed to doing everything we can to meet the millennium development goals. In particular, we are taking bold action to tackle malaria and to improve reproductive, maternal and newborn health. In answer to the noble Baroness, Lady Thornton, we are currently reviewing the previous Government’s cross-Whitehall global health strategy to ensure its relevance and effectiveness in the coming years.

The noble Lord, Lord Crisp, has linked issues of development with those of the appropriate education of health professionals, which itself has enormous implications both for our nation’s health and for that of the rest of the world. As he knows, there are many aspects of the education of health professionals, encompassing pre- and post-registration training, as well as continued professional development. The responsibility for setting the standards required for professional pre-registration sits with the professional regulators. The higher education institutes then design training curricula to meet these standards in partnership with NHS service providers and the regulators. The Department of Health, along with the local NHS bodies that commission professional training, continues to work with the regulators and higher education institutes to ensure that their standards and curricula reflect the changing needs of patients and service delivery.

In terms of pre-registration education for doctors, we look to the General Medical Council for leadership. Its 2009 publication Tomorrow’s Doctors provides the framework that UK medical schools use to design detailed curricula and methods of assessment. I was glad to see the framework was well received by the authors of the recent Lancet Commission publication, Health Professionals for a New Century. The framework also highlights the importance of a global dimension. New graduates must be able to demonstrate awareness, from a global perspective, of the determinants of health and disease and of the variations in healthcare delivery and medical practice. Postgraduate medical training curricula are developed by the medical royal colleges for approval by the GMC. Most of the topics highlighted in this debate are covered in the foundation programme curriculum and core competence framework for doctors developed by the Academy of Medical Royal Colleges.

We have come a long way since the noble Lord wrote his report on medical training, Global Health Partnerships, in 2007. My noble friend Lord McColl is absolutely right that there is already significant good practice in the UK in terms of incorporating the global dimension into pre- and post-registration training. This is one part of the answer to the noble Lord, Lord Crisp, who asked me to consider what more might be done to support this type of activity. Medical students can study global health; they can spend a year studying international health as part of an intercalated degree or can choose to travel to developing countries for the elective component of their undergraduate training. There are also opportunities for post-registration medical doctors to spend part of their specialty training in developing countries, as part of the out-of-programme training and research arrangements. Here, I reassure my noble friend Lady Tonge and the noble Baroness, Lady Hollins, that, if prospectively approved, training of this type counts towards the certificate of completion of training. Details of this initiative are provided in the Gold Guide, a guide for postgraduate specialty training in the UK agreed by the four UK health departments for core and/or specialty training programmes. This sets out a clear process as a guide for post-graduate deans.

My noble friend Lord McColl—

[Lord Davies of Stamford]

I am extremely grateful to—

--- Later in debate ---

[Earl Howe]

Perhaps the noble Lord and I can speak after the debate.

My noble friend Lord McColl stressed the need for taking longer periods overseas and providing greater support for achieving the goals that we have all been talking about. Universities support medical student electives as long as the plans are carefully drawn up to ensure the best possible experience for them and, of course, for the host institution abroad. I emphasise to the noble Lord, Lord Patel, lest there be any doubt in his mind, that we strongly support the principle that trainees should have opportunities to gain experience overseas both for their own benefit and that of the host countries. Also, the noble Baroness, Lady Cox, was right to say that there are opportunities for postgraduate medical doctors to spend part of their specialty training in developing countries, as I have mentioned, and these can count towards clinical medical training.

In answer to my noble friend Lady Tonge, we take on board comments about reducing the level of bureaucracy in this process, and we welcome suggestions for improvement. However, we need to ensure both that service can continue to be delivered effectively in the NHS and that training overseas is appropriately recognised, supervised and assessed, which is not necessarily straightforward in every case.

Earlier this month, the Lancet Commission published a report, Health Professionals for a New Century. In response to some of its specific proposals, I should like to highlight the progress that has already been made in a number of areas. For example, the Department of Health is taking forward its technology-enhanced learning strategy to promote greater use of information technology for learning, harnessing and sharing global education resources. The Medical Training Initiative allows a small number of doctors from developing countries to work and train in the NHS before returning home. The National Leadership Council works with clinicians from all professions to develop their leadership skills and embed leadership across all undergraduate and postgraduate curricula. The Health Partnership Scheme, launched in November by my honourable friend in another place, Stephen O’Brien, will enable NHS professionals to share their skills with nurses and doctors in developing countries through teaching, training and practical assistance. We should also mention the report from the noble Baroness, Lady Deech, entitled, Women Doctors: Making a Difference. It makes recommendations on a range of issues that include improving access to mentoring and career advice, improved access to childcare, more flexible and part-time training, and encouraging women into leadership positions.

We must always look to improve the standards of medical education in this country. For this reason, as has been mentioned, we have today published Liberating the NHS: Developing the Healthcare Workforce, the consultation on the education and training aspects of the NHS White Paper, Equity and Excellence: Liberating the NHS. The White Paper signals a new approach to workforce planning, education and training by,

“giving employers greater autonomy and accountability for planning and developing the workforce”,

alongside greater professional ownership of the quality of education and training. The consultation will enable my department to do the second thing proposed by the noble Lord, Lord Crisp, which is to meet with relevant parties to consider the findings of the Lancet Commission report. With the changes set out in the NHS and public health White Papers, the system of healthcare in England is changing, and it is imperative that our system of education and training reflects that change.

The noble Baroness, Lady Hollins, asked whether curricula include global competences. They do, and in acknowledgement of the case presented by Medsin UK, a global health dimension is included in the 2009 GMC guidance, Tomorrow’s Doctors, which states that new graduates must be able to demonstrate,

“an awareness from a global perspective of the determinants of health and disease, and variations in healthcare, delivery and medical practice”.

In fact, most of the topics highlighted by the report of the noble Lord, Lord Crisp, which I mentioned, are covered in the foundation programme curriculum published this year. All topics are at least partly described in the core competences for doctors in the Academy of Medical Royal Colleges’ Common Competences Framework for Doctors, published last year.

The noble Lord, Lord Crisp, urged that we should find ways to give active support for doctors to take part in health partnership schemes. We agree that we need to support doctors and other health professionals to take part in that scheme and I can reassure him that the Department of Health is working closely with the Department for International Development on this initiative. I mentioned the partnership scheme earlier.

The noble Lord, Lord Butler, referred to the role of academic health science centres and I welcome the initiatives taken by the AHSCs, both in teaching and research, in global issues. They can contribute a huge amount but perhaps two things above all: the partnerships which they can and do form overseas and their ability to develop cultural competence in UK graduates.

My noble friend Lady Tonge referred to the need for ethical recruitment. She is absolutely right. She probably knows that the UK was the first country to produce international recruitment guidance based on ethical principles and the first to develop a robust code of practice for employers.

The noble Lord, Lord Crisp, made some extremely constructive and important points, as did all other speakers, for which I am very grateful. I shall make sure that these are taken into account during the consultation process.

In closing, I should like to take this opportunity to invite all interested parties to engage with the consultation to help us develop the recommendations made in the Lancet Commission report and to help shape the future system of education for health professionals.