World Health Organisation

Lord Crisp Excerpts

Wednesday 2nd July 2014 Lords Chamber

[Lord Crisp (CB)]

I, too, congratulate the noble Lord on securing this debate, on his excellent speech, which laid out the issues extremely well, and on continuing to keep this issue live. He is right to choose this moment to seek to use the United Kingdom’s enormous prestige and influence in the world of international development to press the point home even further.

The noble Lord described the problem well, and I shall pick up some of his points. First, there are just 15 interventions that will, between them, cater for about 80% of surgical need. That relates to the other point that he and the noble Baroness, Lady Brinton, made: the fact that those interventions need not be carried out by surgeons who are physicians. They can be done by non-physician surgeons—and we now have the evidence about where that can work and where it cannot work. I declare an interest as chair of Sightsavers, which works on avoidable blindness and in preventing blindness. In Africa almost all cataract surgery is done by nurses with additional training, and it is done to the same standards and with the same outcomes. As has already been said, we have seen that pattern in other disciplines too.

I also totally agree with both the noble Lord and the noble Baroness that this is a two-way street. We can learn, and some of the things that are happening in Africa can be imported back to the UK; indeed, the Ponseti technique can be reimported back to the UK. The noble Lord made the further point that seven conditions which can be prevented by surgical intervention amount to almost all the medical conditions that need to be tackled to prevent disability and death. We know what to do—that is the simple point here.

This problem is becoming more visible. The noble Lord and his noble friend Lord McColl have pressed for measures to resolve it, as have others around the world, and the issue is now on the agenda of the World Health Organisation. It has been picked up by the Lancet Commission on Global Surgery, and there is a real opportunity here for the UK to take a lead on this issue on a practical level and in policy. Sometimes just pushing the policy is fine but offering practical support is also important. Indeed, the UK is already doing that but it could do more. Noble Lords may not be surprised to hear me talk specifically about partnerships in this regard—that is, partnerships between UK organisations and African organisations or, indeed, Asian organisations. The All-Party Parliamentary Group on Global Health, which I co-chair, recently produced a report entitled Improving Health at Home and Abroad, which argued strongly that if our doctors, nurses, managers and others spent some time working in Africa they would learn new skills, abilities and flexibility which they could reimport to this country, thus providing scope to improve health at home and abroad at the same time, which would be fantastic.

I wish to reinforce that concept with some related points. It has been stressed that the brain drain is very important, but even more important is the need to offer people education and training. The UK has a fantastic tradition of education and training in health which we can offer to others and thus put it to more effective use. Put simply, if every African who acquired some medical or nursing training before they emigrated went home, it would deal with about 10% of the problem. Therefore, a big increase in training is needed.

I congratulate DfID on extending the partnership scheme and hope that it will continue to extend that scheme, as one would expect. However, it is not just a question of our people working and training in Africa and people from Africa coming here; British surgeons have been innovative in this field. I think of people the noble Lord, Lord Ribeiro, will know such as Bob Lane, a retired surgeon, who has developed a programme to enable doctors to deal safely with a few general surgical procedures—I hope the doctors present will forgive me for describing those procedures in non-technical terms—and one can train trainers to deliver that programme in a relatively short time. This is a real gift to the world. I also think of people such as Professor Chris Lavy, professor of trauma at Oxford University, who has trained orthopaedic clinical officers in Malawi. Therefore, we have a lot to offer in terms of training.

Getting from where Africa is today to where it needs to be cannot be achieved in the short term by training alone. A lot of young doctors take a year out of their training but many of them go to Australia and other places where they are not necessarily needed. I hope that we can find a way to encourage more of them to work in rural African hospitals when they have received enough training in the UK to enable them to provide general medical services and undertake general surgery. There is an organisation based in South Africa called Africa Health Placements and, if a doctor wants to work in Africa, that organisation will find him or her a placement. It is a not-for-profit job agency, as it were. The young doctor from the UK—it could, of course, be an older doctor—will receive a wage paid by the South African Government, which is enough to live on while they are there, and return to the UK at a later stage.

I think that Africa Health Placements is on the verge of persuading the Americans that if a young doctor takes up a placement in Africa for a year at the end of their training in America, they should get some money taken off their student loan. I ask the Government to consider that initiative. That is a very neat, interesting and relatively cheap way to incentivise people to work as surgeons or doctors in rural hospitals which lack such personnel. As I say, they are paid by the South African Government, the Zambian Government, or whichever Government are involved.

That measure is significant but not as significant as some of our other development initiatives. I merely ask the Government to consider that, in the short term at least, by which I mean 10 or 15 years, there will be a need for more non-African doctors in Africa. There is also a need for some doctors from other countries to come to this country to acquire more specialist training. There is a programme, which I believe is called the international medical training scheme, and I hope that the Minister will comment on it, or write to me on the numbers that are involved. Therefore, we can offer practical measures and we should make the most of them because they are impressive. Indeed, the UK is already doing a great deal in this regard, but it could do more.

However, we also need to introduce measures at the policy level. I echo what the noble Lord, Lord Ribeiro, said about the Government’s commitment to the resolution that he mentioned. I congratulate the Government on their disability-inclusive programme in international development. What better way is there for the Government to signal that they have such a programme than to do something which prevents disability? It is very much of a piece with the great announcement the Government made on that last week.

What are the Government doing to promote partnerships? Given that I suspect that the noble Baroness who will reply to the debate will speak from a Department of Health perspective as well as from a government perspective, what is being done to encourage the NHS to be more active in this field, as this issue is about improving health at home as well as abroad? Will the Government allow me to bring personnel from Africa Health Placements to meet government officials to consider ways in which we can persuade more of our young doctors to work in Africa? Will the noble Baroness write to me or let me know how many people are involved in the international medical training placement scheme?