Health Imperialism UK
“Healthcare UK is a joint initiative of the Department for International Trade, NHS England and Improvement (NHSE/I) and the Department of Health and Social Care (DHSC)...We work with the NHS to strengthen its capability and capacity to operate and succeed internationally.” In fact there is more to it than that. The Department for International Trade (DIT), at least in theory, helps the private sector export profitably and helps overseas bodies, private and public, export into the UK. Provided the DIT adds value after deducting the costs it creates for itself and its clients, few would argue with the former objective. Quite why a country with an adverse balance of trade wishes to support the latter, is another matter.
Helping NHS providers succeed in export markets is not just good for themselves and the UK trade balance, it also helps the NHS to buy state-of-the-art goods at competitive prices. What is less obvious is why our overstretched National Health Service should devote its time, energies and resources to the rest of the world. The BBC World Service is funded, as part of demonstrating the UK’s soft power, by the Foreign and Commonwealth Office. They may not wish to fund the NHS World Service for the same reason.
Healthcare UK’s Annual Review, and perhaps Healthcare UK itself, is a huge muddle. It is based on the premise that, now we have given up on the USA, the rest of the world should become more like us. Britain rules the air-waves and “In 2019, the NHS Long Term Plan pledged the creation of a new initiative to provide a ‘front door’ for NHS family organisations looking to grow and coordinate their international commercial engagement, and for other countries wishing to access the NHS’s extensive expertise.” (p.40)
On the plus side, the Review notes that it was “Supporting UK business and NHS in 22 countries” and its financial achievement was “Contributing to the healthcare sector’s part of DIT’s overall £27bn export wins” (p.8). We are not told the size of that contribution, nor the staff employed nor the costs of Healthcare UK. The Egyptians invented the maze over 2.500 years ago but it could not match the labyrinthine connections that Healthcare UK has with all the government bodies known to Whitehall. Whenever you see the term “working with”, read “talking with”.
“Digital health” is the application of IT to health matters, diagnosis, cure, records, communication etc. Healthcare UK claims we lead the world and can make megabucks by exporting our skills worldwide. On the other hand, an October 2018 policy paper from the DHSC said: “Technology systems used daily across hospitals, GP surgeries, care homes, pharmacies and community care facilities don’t talk to each other, fail frequently and do not follow modern cyber security practices. As a result, some people are getting suboptimal care, staff are frustrated and money could be saved and released for the front line.” The reality is that the NHS has sponsored a series of IT disasters and (the Test and Trace App) is still doing so. The causes are always the same: the NHS is so big it talks a big game but then cannot deliver. Some people would consider that the DHSC should sort out its own systems before claiming world leadership.
Similar considerations apply to mental health: “Northumberland, Tyne and Wear NHS Foundation Trust (NTW) has launched a partnership with one of India’s largest providers of mental health services, Cadabams Group. The partnership offers both organisations the opportunity to share expertise in the delivery of mental health care to different populations. As part of the partnership, NTW will provide support for the Cadabams Group to develop new ways of working within areas including addictions, smart prescribing, school mental health, community and home-based care.” “Maudsley Health was formed as a joint venture between South London and Maudsley NHS Foundation Trust and the local United Arab Emirates (UAE) partner, MACANI.”. Learning through sharing has much to commend it but with such a shortage of mental health support in England, one has to wonder if this empire-building is worthwhile. In any case, Britain’s mental health hospitals have a great deal to learn from one another before turning to less developed practitioners.
These concerns may be misplaced: the NHS in foreign parts may benefit both the UK and our overseas partners but that is not the picture the Annual Review paints. There are no clear objectives and no performance nor progress that can be assessed against such objectives. The pictures are attractive and the intentions are fine but so they were for the Victorians.