Sub-Saharan Africa: Healthcare

Baroness Walmsley Excerpts

Thursday 16th July 2015 Grand Committee

[Baroness Walmsley (LD)]

My Lords, I thank the noble Lord, Lord Boateng, for introducing this very important debate. It is a pleasure for me to pay tribute to the more than 1,000 UK health workers who have volunteered to go to Sierra Leone to help combat the terrible Ebola virus. Eradication of this virulent disease presents particular cultural challenges as well as the need for rigorous medical practice. That is what makes it special.

The UK has made a tremendous contribution to the global effort due to three things: first, the willingness of so many generous skilled people to go to Africa to help others; secondly, the preparedness of the UK to help in such medical and disaster emergencies due to the training and care programmes for volunteers of the UK International Emergency Trauma Register; and, thirdly, the support for the campaign offered by DfID, the Department of Health and the NHS.

That support has been vital in providing the cash and facilities necessary to ensure that the volunteers are well trained, well supported and well cared for on their return. It is a tribute to the rigour of the systems that UK-Med and its NGO partners have put in place that only a handful of UK health workers in Sierra Leone have contracted the virus. Thanks to the quality of care that they have received, they have, thankfully, survived.

Currently, despite a small resurgence in the disease that the noble Lord mentioned, the support that the UK has given to developing local health services has meant that UK-Med and the International Emergency Medical Register are not looking for any more UK volunteers for the Ebola programme at the moment. In a way, that is encouraging, because it means that the local health services are sort of coping. Sadly, it is clear that the outbreak was so serious in the first place because the health system in Sierra Leone and the other victim countries was broken. However, local health services need to be forever vigilant, since rapid response to any small outbreak will be vital to ensuring that the outbreak is contained. So perhaps I could ask the Minister what the UK is doing to ensure that the improvements in local health services are maintained and taken even further, as the noble Lord demanded.

As for the NHS, we need to help the organisation to be geared up for releasing staff for this important work and other medical emergencies that will arise in future. We must remember that, by building a capacity to respond to health emergencies overseas, we increase our own capacity to respond nationally here at home at the same time. Following Ebola, we now have a cadre of NHS staff who have first-hand experience of treating and caring for patients with a highly contagious and lethal condition, exercising full barrier nursing and care. This will be a huge advantage when we have a major outbreak of what is likely to be an airborne infection in this country. We constantly hear about new virulent strains of influenza, for example, and the travelling habits of the world’s population make it inevitable that they will reach our shores sooner or later. Not only are these well-trained former volunteers a direct asset themselves but they can also train their colleagues wherever they work, so that these difficult cases can be managed safely and effectively.

By responding to Ebola and, indeed, earlier medical emergencies, we have built a national emergency healthcare workforce, which can quickly be mobilised to respond to emergencies overseas but is equally available for emergencies in this country, should we need it. What is to be done to ensure that we continue to have that workforce? Three initiatives have been suggested to me by Professor Tony Redmond, a trustee of UK-Med and professor at Manchester and Keele universities, to help to strengthen our response readiness.

First, on humanitarian posts, as he points out there is a great deal of altruism within the NHS and many staff wish to volunteer to help vulnerable people in other countries. However, they can find it difficult to take a break from their job, so he proposes that humanitarian posts be established in specialties and areas where it is difficult to recruit and therefore there are vacant posts. Those who take these posts will be guaranteed a period each year where they can be seconded to work overseas, either in an emergency or to help to build the capacity in vulnerable countries to which the noble Lord, Lord Boateng, has referred.

Secondly, there should be cross-trust volunteering. At present, it is difficult to work across two NHS trusts when you are not formally employed by both. The suggestion is to establish an agreement across the NHS so that volunteers who are on the register and appropriately trained and accountable can also deploy as cover across different trusts when teams are deployed overseas. This volunteering to cover for colleagues should have equal recognition with those who actually go overseas. This would also strengthen the UK’s resilience in the event of a major outbreak or mass casualty event at home.

Thirdly, volunteering needs to be incorporated into job plans and appraisals. As I have highlighted, many staff in the NHS are already engaged in volunteering to help support more vulnerable countries and also support the emergency response to disasters overseas, but this work is not recognised in training or in professional development and appraisal. Not only does volunteering help some of the most vulnerable in the world, it also increases overall job satisfaction, because healthcare workers, by and large, enjoy the opportunity to exercise their altruism. Most importantly for the UK, volunteering builds up very relevant skills and experience in managing conditions in difficult circumstances, managing resources effectively, and being exposed to a wide range of conditions and diseases that are rarely seen in the UK but which are important to recognise and to know how to deal with when they occur. The All-Party Parliamentary Group on Global Health has produced a very good document on volunteering and Professor Redmond and his colleagues would look for its recommendations to be widely supported.

I would like to ask the Minister whether the Government will consider these proposals and let your Lordships know whether they will be supported. I know that the NHS is keen to have a positive legacy from its response to the Ebola crisis. By facilitating volunteering overseas, that legacy will be strengthened. However, it is vital that, for volunteering to be safe, effective and of true benefit to the countries to which volunteers are invited, those volunteers are fully trained, insured, vaccinated, accountable and registered to practise in the relevant country. All of these things are promoted and facilitated through the International Emergency Medical Register.

Finally, I will say just a word about those left behind after the Ebola outbreak. I understand from recent research that the number of women who have been widowed by Ebola is considerable. Many have children but find themselves unable to look after themselves, let alone their families. Widows and their female children are often left in particularly vulnerable situations. Reports in the media highlight the disproportionate effect that the situation is having, as it unleashes secondary effects on economic and social development, all of which have harmful implications for women and girls. The charity Street Child reports the story of a young girl who, on the death of her father, became pregnant when she sold herself for sex in order simply to get food for her family. Widows can also face further hardship and abusive practices, such as losing their property and being shunned by society because they have no man to protect them. Therefore, I ask the Minister whether the Government are adding something to address these problems to the very significant medical programme that they have launched to eradicate this disease. Ebola will never be yesterday’s story for these people.