Learning Globally

The case for global health partnerships has never been clearer.

My name is Ged Byrne and I am the Director of Global Health Partnerships for HEE. I’m also (when I can be) a surgeon in Manchester.?

When so many people are concerned about the future of the NHS as we emerge from the COVID-19 pandemic, you may ask yourself why an ageing surgeon and ex-regional Director of Education and Quality (DEQ) is so passionately enthusiastic about the future of our NHS. The simple answer is that I have had the good fortune throughout my career to view the NHS as a global force for good. In 1988, as a naive fourth year medical student, inspired by fabulous stories told to me by a long-dead, merchant sailor uncle, I took my first ever flight on an ancient Russian plane to India on an undergraduate elective …and it changed my life.??

During that short experience I learned three key things which have driven my interests and professional behaviour ever since. First, that clinicians learn quickest and most intensely when they are immersed in a clinical, patient-focused environment (now referred to as a clinical learning environment or ‘CLE’). Second, that role modelling (good or bad) by other clinicians within that environment has a powerful and lasting effect on the behaviour of any clinician, and finally, that learning for a clinician is most intense when the clinical environment is very different from the clinical environments that they familiar with.??

With these experiences, it is perhaps no surprise that I believe that if you are going to be ‘the best that you can be’ then whilst you must inevitably work in a local healthcare system you must learn within a global context. Never has the need for us to recognise and promote ‘global learning’ been starker as we emerge from the single biggest global health crisis that all of us have faced in our lifetimes.??

The World Health Organisation recognise that for us to become genuinely prepared for further threats to our health and health systems, by a future pandemic, climate change, the growth of non-communicable disease or an ageing population, we need to substantially grow our healthcare workforce and ensure that those who work in healthcare are as effective as we can possibly be.?

The NHS is one of the oldest and certainly the largest Universal Health Systems in history and HEE, as the largest Education, training and workforce planning organisation for healthcare in the world, is in a particular position of influence. Navina, who has championed global learning through partnership for many years, and I both strongly feel that the NHS and HEE have a fundamental moral and ethical obligation to use our experience and knowledge to help the world to increase both the quantity, and quality, of the global healthcare workforce.??

We have an enormous legacy, and irrespective of the transition to the new organisation with NHS England, Improvement, X and Digital, our people possess unique experience of generating the right workforce and we will continue to use that expertise wherever we are situated.??

Why is global learning so vital?

The evidence now clearly demonstrates that when a healthcare worker moves into another care system, wherever in the world that is, they learn. Not only do they learn, but they develop skills which are really important for future-proofing the NHS- things like resourcefulness, intercultural skills and cultural intelligence, resilience, and team building. Mutual learning and peer sharing is so powerful to developing these , and we know that they are significantly enhanced when we facilitate workforce exchange.?

When we speak of global health security, we aren’t only talking about other countries. We ourselves need to be more secure, as the past two years have shown us. One of the best ways in which we can do this is by understanding, learning and developing knowledge pathways with colleagues who are not in the NHS, and accessing the wealth and diversity of knowledge available to us across the world. For example, if we establish a relationship between a doctor working in the UK and a doctor in Uganda, they will talk to each other and share ideas and innovations arising from their own context. It is critical that we start to broker and develop these robust relationships globally, for a globalised world. We have seen so many brilliant examples of this throughout the pandemic as healthcare practitioners across the world collectively took to the internet to rapidly share knowledge and best practice with each other, while coping with the same challenges in a myriad of ways.??

Finally, I’d like to touch on climate change and sustainability. This might seem like a tenuous connection, but bear with me!??

Healthcare workers are a global workforce, and they migrate and have access to populations across the world like no other workforce. Because of this, they are exceptionally well-positioned to champion sustainability practices and educate populations. This could have significant impact- for example, healthcare systems often have a large carbon footprint. The NHS alone accounts for around 5% of England’s total carbon footprint. Unfortunately, health practitioners often know little about how to promote best practices to fight the climate crisis across borders- but we have the power to equip them with this knowledge so that they bring it with them on their career journeys overseas and across systems.??

HEE is a very special part of a very special NHS. We’ve made every mistake under the sun over the last 73 years, but it is precisely that which has allowed us to create a system that works and is influential the world over. Because of this, we can use the NHS as a brand to help other countries develop their workforces. This is also very powerful in terms of diplomacy- HEE, along with the government, is part of key conversations globally, and our workforce planning expertise is fundamental to that. We are particularly concerned with encouraging sustainable partnerships between systems and governments, which are central to equity of growth and making sure that arrangements are mutually beneficial, rather than a “brain drain” on countries’ resources. We, as HEE have demonstrated our ability to respond and react effectively during the global pandemic through many ways such as sharing e-learning, developing virtual global fellowships and continuing to develop partnerships with a wide variety of institutions and people in countries who do not have as well-developed health services as we do.???

Some of our work on this includes things like the development of high-quality workforce exchange programmes, such as our Emergency medicine programme, which brings doctors from India to the UK for 3-year fellowships and the Thailand exchange programme; bringing Thai trainee doctors into the NHS to spend some time learning from our experiences whilst immersed in NHS clinical learning environments whilst simultaneously placing UK-trained clinicians in Thailand working on quality improvement programmes. We’ve also developed a series of mutually beneficial international recruitment pathways, including pathways for Allied Health Professionals (AHPs) and a fellowship in emergency medicine. We’ve created a programme sending NHS staff on Quality Improvement placements to work in low and middle-income countries for 6 months. We’re also working closely with countries in East Africa to grow sustainable and mutually beneficial educational partnerships, developing learning opportunities and workforce exchange. And we’re working with a lot of countries on technical collaboration and consulting and sharing the HEE STAR model globally. That is just to name a few!??

Our work in this area is about finding out how we can help countries to achieve what they want to achieve- saying, here’s what we do, how can we work with you to help develop what you need???

Like it or not, we are a fabulously global outfit already. Not only does this make global engagement a fact of our existence and suggest a moral responsibility to engage globally, but it also provides the most excellent platform to learn globally, by listening to the ‘Experts In Our Midst’.?

Let us celebrate this diversity, knowledge and creativity and commit to creating the circumstances in which people are valued by calling out racism and identifying unconscious bias where we see it. Our learning will be the richer for it. An inclusive NHS is the natural consequence of a globally aware NHS. Last week saw the publication of “Global Health and Wellbeing” following an extensive inquiry supported by HEE and the Tropical Health and Education Trust and chaired by Sir David Nicholson. This report clearly demonstrates the positive impact on well-being and job satisfaction for health workers who are given the opportunity to learn and engage globally.?

So. the cause of my enthusiasm is simple: the NHS is, in my opinion, the largest, most diverse clinical learning environment that has ever existed and we, as healthcare workers, are the largest and most powerful group of role models for health professionals across the globe. Over the next 50 years we can use this incredible organisation, through increasingly opening its doors for global learning, as a leading force for good for global healthcare transformation improving the quality of what do but simultaneously improving the health of all nations.??