Global Health

Lord Collins of Highbury Excerpts

Monday 25th March 2013 Grand Committee

[Lord Collins of Highbury]

My Lords, I, too, thank the noble Lord, Lord Crisp, for initiating this debate. In particular, I thank him and the all-party groups for their excellent report. Its evidence-based approach with best practice case studies not only makes fascinating reading but shows how capturing people’s aspiration can be a positive force in meeting the healthcare challenges that we face both here and globally. As we have heard today, health is global and interdependent. It is no longer possible to separate health issues between countries. We increasingly face the same global threats and rely on the same people and technologies for solutions.

In previous debates in this House, I have referred to the book of the noble Lord, Lord Crisp, on the search for global health in the 21st century, but it is worth an extra plug. The book gives an excellent analysis of global health and provides a superb description of how richer countries such as ours can learn about health from low and middle-income countries. I note what the noble Viscount said about how proud we can be of our centres of excellence. I certainly also note what my noble friend said about volunteering and how training and support can be vital. We also need to understand how low and middle-income countries, with their innovation with limited resources, can be extremely valuable to us. If we see it as a two-way dialogue, perhaps we can gain public support for positive change.

As we have heard, there is growing interest in exploring how we use all the talent, skills and experience of health workers to their full extent. Developing a team approach so that all members of a team, under direction and leadership and with training, can collectively hold casework and workload can bring huge benefits that we have not been able to garner so far.

However, as the report recognises, attempts to make change without addressing those factors may well fail and can damage existing health services. Alongside the examples of success there are many cases where innovations have failed to achieve positive health outcomes and have not been sustainable because, as the noble Lord, Lord Crisp, said, of poor design and an unsupportive environment.

In the report we are given examples where health workers in Africa have not been trained properly and in the UK where nursing assistants received little or no supervision when taking on new tasks. As the noble Lord said, training programmes must be relevant and lead to some formal qualification necessary for recognition or promotion if they are to be sustainable.

An interesting quotation was from Dr Peter Carter, chief executive of the Royal College of Nursing. He said:

“You don’t need registered nurses to do all of the tasks that historically have been carried out by qualified nurses. Healthcare assistants can do many of those tasks, perfectly satisfactorily, providing they’ve had the proper induction, training, and education. And where it goes wrong, in some parts (and I do stress some parts of the NHS) is where there has been task shifting onto unqualified people who’ve not been given even the most rudimentary induction into the fundamentals of nursing care”.

The All the Talents report shows us that giving people extra skills, designing jobs that allow them to work to the limit of their capabilities, providing better supervision and creating more effective teams can bring enormous improvements to healthcare. Under the right circumstances—and we have heard examples in today’s debate—nurses can prescribe and take on additional roles. Nursing assistants and community workers can treat common conditions, and we have even had examples of patients supporting each other. Someone who has been diagnosed as a diabetic can self-manage, and non-communicable diseases, which pose the biggest health threat, are good examples.

The report describes where such changes have greatly increased the population’s access to services, improved the quality of a service and reduced costs. The noble Lord, Lord Crisp, gave some extremely good examples of that. However, I repeat that improvements can be achieved only if the changes are planned carefully and are implemented well. This of course is where the Government’s support and role are vital. There have been as many failures as successes, with examples of people taking on tasks beyond their competency without adequate training and support which can result in poor quality and even dangerous care being provided, as the noble Baroness, Lady Flather, indicated.

However, one of the fantastic things about this report is that such failures can be avoided if the lessons highlighted in it are learnt. I, too, should like to ask the Minister how the Government will support research to evaluate and strengthen evidence on best practice and what steps her department will take to ensure that that is shared as widely as possible across all nations. What action will she take to provide more education and training through DfID programmes, and what steps will the department take to assist national Governments to develop their human resource and workplace capacity?