One of the most critical aspects of global health practice is creating and fostering good relationships. Having trusted partners around the globe not only allows us to get the proper resources where they need to go, but also facilitates opportunities for mutual learning. Bruce Compton, CHA's Senior Director of Global Health, and Edmund Nigel Ramsay Crisp, The Lord Crisp KCB, House of Lords, United Kingdom and former Chief Executive of England’s National Health Service, join Health Calls to discuss ways we can learn from each other in our shared goal of increasing health equity across the globe. Lord Crisp recounts lessons he learned from his time spent as the Chief Executive of the NHS, as well as the benefits of doing work outside your home country. Compton also adds insight into CHA's new discussion paper, The Future of Health Workforce: Insights and Opportunities to Transform International Health Workforce Recruitment and Capacity.
One of the most critical aspects of global health practice is creating and fostering good relationships. Having trusted partners around the globe not only allows us to get the proper resources where they need to go, but also facilitates opportunities for mutual learning.
Bruce Compton, CHA's Senior Director of Global Health, and Edmund Nigel Ramsay Crisp, The Lord Crisp KCB, House of Lords, United Kingdom and former Chief Executive of England's National Health Service, join Health Calls to discuss ways we can learn from each other in our shared goal of increasing health equity across the globe. Lord Crisp recounts lessons he learned from his time spent as the Chief Executive of the NHS, as well as the benefits of doing work outside your home country. Compton also adds insight into CHA's new discussion paper, The Future of Health Workforce: Insights and Opportunities to Transform International Health Workforce Recruitment and Capacity.
Resources
Access CHA's new Global Health discussion paper here
Visit CHA's Global Health page for more resources and insights into Global Health policy
Brian Reardon (00:00):
Bruce Compton. Good to see you.
Bruce Compton (00:01):
Good to see you, Brian. Glad to be here.
Brian Reardon (00:03):
Where are your next travels taking you?
Bruce Compton (00:05):
As I leave here today, I'm headed off to Uganda, to the Uganda National Academy of Sciences to be a part of a consensus study on global health partnerships.
Brian Reardon (00:13):
Nice. Well, I think that trip will kind of lead into the topic that we're going to talk about today, and that is going to be on mutual learning and global health. You ready to go?
Bruce Compton (00:22):
I'm ready.
Brian Reardon (00:28):
This is Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon. Joining me again for this episode is Bruce Compton. Bruce is the senior director of Global Health for CHA. Great to have you back on the show. And in a moment, we're going to bring in Nigel, Lord Crisp. He's an independent member of the House of Lords at the United Kingdom and former Chief Executive of England's National Health Service. And we'll explain why we have Nigel joining us in a moment. But Bruce, want to start by talking about a recently published discussion paper that CHA put out, it's called The Future of Health Workforce. It's on the topic mostly about global workforce recruitment, ethical considerations in that, can you provide a little bit of background about why CHA worked to put this discussion paper together?
Bruce Compton (01:15):
Yeah, Brian, as we came out of COVID, my Global Health Advisory Council really thought that we needed to do a sort of landscape analysis of what had happened during Covid, what changes had happened because of the epidemic, how had technology changed things and what do we need to look at. And as a result of that, they did a paper which highlighted 10 areas that had really had some significant changes, and this global health workforce crisis and the ethical considerations was one that the committee thought we really needed to have more focus on. So we did a second research projects with Accenture. They actually interviewed Lord Crisp as part of this paper. And so it's the continuation of sort of how we have approached our global health to make sure that we do some research and then turn that into opportunities for education, networking, collaboration amongst our members and partners.
Brian Reardon (02:12):
And Bruce, we're going to bring in Lord Crisp in just a moment. What were some of the, I guess, highlights or perspective that you found important to have him part of this project?
Bruce Compton (02:21):
So I had met Lord Crisp as part of my interactions with the Tropical Health Education Trust in the uk, which works on partnerships between NHS hospitals and hospitals and health facilities in Africa and Asia. And Lord Crisp has been extremely active in the global health workforce. He's a renowned author in global health. He's also worked with the WHO and the International Council of Nurses on a workforce initiative called Nursing now. And so his insights were very important and he directed us to other people that we could interview as well.
Brian Reardon (02:57):
Yeah, and I'm excited to bring him in. Now joining us from England is Nigel, Lord Crisp again. He's an independent member of the House of Lords in the United Kingdom, and a former Chief Executive of England's National Health Service. Nigel, thanks for being with us.
Lord Nigel Crisp (03:10):
Delighted to be joining you.
Brian Reardon (03:11):
And Nigel, you've served in several different healthcare related roles in your career, including Chief executive of the Oxford Radcliffe Hospital, NHS Foundation Trust and Chief Executive of United Kingdom's National Health Service. I wanted to share that with our listeners just to give them some context of your background. And in the last 20 years or so, you become a major advocate for global health work. And so to start the conversation, could you tell us a little bit about how that advocacy work and advocating for Global Health came about?
Lord Nigel Crisp (03:42):
Yes. Well, I ran the National Health Service in England, which is, I think it's the largest, it's the fourth largest organization in the world. It's got 1.6 million people working in it. Basically all the healthcare in England. And I noticed when I was running it that actually a lot of doctors particularly, but also nurses, if they went off and worked in Africa for a bit, they came back refreshed. They came back as one radiologist told me this was remembering why she'd become a doctor in the first place because she didn't have all the kit around her and she suddenly had a sick child that she had to deal with and had to go back to first principles. And it reawakened in a way the sort of passion in her. So here was me with this vast organization and I found that one of the ways to motivate staff, to keep staff engaged, to refresh staff, particularly that doctors may end up doing in a sense the same sort of job, the same clinic for 30 years almost or sometimes more indeed and can sometimes get a bit stale, that actually if they were to spend two or three weeks in Africa as part of one of our partnership programs or something, they came back refreshed.
(04:52):
They came back with new ideas and they remembered that healthcare was about health and not just the care bit of it. There's a wider sense here that we need to be thinking about health and not just about healthcare. So that was the sort of start of it. And I seconded somebody to an organization that then set up some of these partnership schemes and it really went from there. And then I got a bit more involved when I left the NHS and joined the House of Lords. I then got involved with the World Health Organization and with various other schemes and projects. And that's where somewhere along the line I came across your organization, the Catholic Health Association, and indeed Bruce Compton.
Brian Reardon (05:37):
Yeah, and Bruce I believe reached out to you. We mentioned the paper, the Future of Health Workforce, and you were interviewed for that paper that again, a consultant Accenture had put together really talking about ethical and other considerations when recruiting globally for healthcare workers. Can you share a little bit about what you discussed in that and what were some of the contributions or insights you provided for that paper?
Lord Nigel Crisp (06:01):
Well, I think the single biggest issue that comes through, and it comes through in the paper as well, well, perhaps there are two. The first one is that there's a workforce crisis globally numbers. We are something like 43 million health workers missing as it were or needed to provide a basic level of healthcare to everyone in the world. That's the goal of having universal health coverage for everyone in the world. So there's a big gap, but what's also obvious is that the rich countries of the world can attract health workers from the poorer countries of the world. And America obviously attracts a very large number of health workers. And I think it's great that the Catholic Health Association has taken on board, and I've seen some of the comments made on that report subsequently to having read it from people having read it, that people have realized how much that international recruitment can actually be taken away from a country, some of their very scarce resource of doctors and nurses.
(07:01):
So I think that's the biggest issue. How do we support low and middle income countries, the poorer countries around the world at a time when they've got even less resource than we have, even greater shortages than we have. I mean, massively greater shortages than we have. How do we support them? How do we work with them so that we're not just robbing them of their staff as it were, the so-called Brain Drain as it's often called, but also supporting them to grow and develop and to train more staff and having some level of partnership between us.
Brian Reardon (07:34):
And I think the reason we're talking about this topic and why it's gotten heightened attention with the Catholic Health Association really stems from the workforce shortages we're now experiencing in the US and around the world. I think when you look at post covid, even look at the Ukraine war and healthcare workers from that country coming to the us, I think it is put a different perspective on things to make sure that we're sensitive. And one quote that Bruce had, he said, our solutions can't be creating other people's problems because eventually they'll become our problems again. So is that one way to look at this is that we have to be sensitive to, I guess, unintended consequences as we look to bring healthcare workers, particularly for the United States?
Lord Nigel Crisp (08:17):
Well, I mean absolutely. I think we can't solve all problems by harming other people or whatever the line was from. Bruce is a very good line, I suspect. And I got the sense from reading the reactions to your report that people hadn't realized that, that it's not been a live issue in the us It's quite a live issue in the uk. And we have a list of countries who have agreed that we can recruit people from those countries and others where we just don't recruit from those countries. And I know that you've got some similar sorts of arrangements in some parts of the United States as well.
Brian Reardon (08:54):
And looking back on what you know now, are there some things you would've done differently in your career in healthcare in the United Kingdom, particularly as chief executive of the NHS? And how might some of those lessons inform healthcare leaders here in the US and around the world as we all confront these challenges in recruiting and retaining healthcare workers?
Lord Nigel Crisp (09:16):
Well, I've learned an enormous amount from African countries. I have been working in African countries voluntarily for the last 15 years or so, and there's an enormous amount of where people who don't have our resources, but they don't have our baggage of history and our vested interests. And sometimes they can do things much more innovatively than we can. So let me just give you a couple of examples of that. So you'll see in a lot of places, nurses playing very advanced roles. For example, in Mozambique, a country down in southern Africa, when they threw Portugal out, which was the colonial power in 1974, essentially they lost all their doctors because all the doctors were Portuguese. So a young minister of health who I happen to know is now an older man, obviously from 1974, he ended up recruiting nurses and training them to do obstetrics training them to do the delivery out in the rural areas of Mozambique.
(10:23):
And what's interesting in some of the great peer reviewed journals of the world that have studied what's happened with these, they're called technical surgical technicians actually who are trained to do these obstetric operations, that they are as successful as physicians doing them. They stay in their own country more likely than the doctors who will immigrate to well as they're Portuguese speaking very often to Brazil, but also to the United States. And they're also costing about a third of the amount that they would do if it were doctors doing it. And all this time on from 1974, that system is still running in Mozambique and they've still got pretty good maternity care. And that's what that does for somebody like me running a big system is it opens my eyes to the fact that actually we need to think about some of these things differently. We need to think about who needs what training in order to be able to do what sort of procedures. And I think it really challenges us. Now, I don't think your country or my country is going to start having cesareans done by highly trained nurses, or at least not in any great numbers, but it does make us think about things in different ways and recognize that some of the ways we do things are just habit. They're just things that we have done all the time and the professions have told us we have to do. So I think it's extremely useful and extremely challenging to see and hear about those sort of things.
Brian Reardon (11:52):
And no, the example you gave is really consistent with what I've heard Bruce say over the years is that the work we do, particularly when we look at CHA members who are involved in global health, they will send again teams of physicians and nurses to other countries. And the takeaway is you do those medical missions not to go in and say, Hey, we know best, but really it is a two-way street to learn. They can learn from us, we can learn from them. And I think that's exactly what you just articulated, is that recognition that we maybe don't have all the answers in our particular country. And that sharing of knowledge is so critical, I think, to understanding how the global workforce can help each other, I suppose.
Lord Nigel Crisp (12:33):
Let me give you another example because you absolutely hit the nail on the head there. In a lot of African countries, and actually also in Brazil, you have what are called community health workers. Now what they mean by community health workers is people almost always women as it happens with six months training who work very locally. Now, health workers normally respond to you or me coming to them with a need and asking for help. Actually, what these community health workers do is they visit every house in their village or their neighborhood once a month and they talk to people about health and they ask what the issues are, and they deal with things like, well, family planning for example, but they also deal with things like increasing vaccination rates or they may end up encouraging men because men, we men are very bad to seeking help when we need something.
(13:24):
And so we will often end up coming into the health system rather later than we should, encouraging people to go and find some help or whatever. So they've provided a really interesting link and we've started to use them in the uk. So we actually have a number of them working in London, and they're starting to reduce inappropriate use of hospitals. They're starting to reduce emergency admissions and so on because things are picked up out in the community before people even realize that they've got a problem. So there's a really interesting example there of semi-skilled semi trained people, six months training who can play a really important role right at the front end of the health system. And we've just taken the model from Africa and from Brazil.
Brian Reardon (14:10):
No, a great example. And we see a little bit of that with some of our members that are using community health workers in the manner that you just described, are there other examples or solutions that you might share with our listeners here in the US who are interested in, again, a different perspective on how we can address some of the challenges we're facing, not just in the clinical workforce shortage, but we are talking a lot here and I'm sure in England and other places about addressing, we call 'em the social determinants of health. Exactly. They could be described as vital conditions. Those conditions sort of outside a clinical diagnosis that impact people's health because of their community they live in, their access to things like safe water, adequate food, shelter, those type of things. Other lessons that you've come across over the years that you might share?
Lord Nigel Crisp (15:03):
I think there absolutely are, and you've absolutely hit on a point that is very live here in the uk and that is that the health of the individual is intimately connected to the health of the community they live in and the sense of belonging and so on intimately connected to wider society and the health there and intimately connected actually to the health of the planet. And when we develop health policy, we should be developing health policy that addresses all those areas and links them together. And the sort of examples that I would see in Africa and the way of using some of them in the uk, and I know you have some in the United States as well, is that linked between the individual and the community. So you work with people in the community. Let me give you an example of, again, something that's come from us, which we have been using but has been partly developed through this, which is called social prescribing.
(15:57):
So our family physicians, the sort of primary care, the first line people who you may see now are starting to prescribe social activities. So if you have COPD or something like that, actually joining a dance class or joining a singing class, even if you can't sing very well is actually good for you on a number of levels. It's good for you on the level that maybe it exercises your lungs, but it's actually good for you. It gets you out of the house, it gets you into a social environment, it gets you doing physical activity and so on. So we've been trying to get away from prescribing pills. And of course in a lot of the African countries I'm talking about they don't have the pills. There have to be other sorts of solutions to how you might treat people's health problems. So those are some of the areas that I think we see.
(16:44):
The other thing that you definitely see was in the planning aspects, which is that health is seen as part of the economy, part of the poverty planning in a number of low income countries where actually they have an anti-poverty plan. They're trying to get their country out of poverty, they're trying to grow, and as part of that, they know they need a healthy workforce. Now in our country, we still treat health care as a cost, not as an investment. And I think that's a very big shift that we need to make and to understand that having a healthy workforce really benefits our economy. It's about prosperity and not just about health and wellbeing.
Brian Reardon (17:25):
I'm glad you said that because I think the work that we've done at CHA around encouraging broader adoption of Medicaid, which is essentially our public health insurance that is kind of a safety net health insurance program, and some states have not decided to expand it. And I've always wondered, well, isn't that shortsighted? Because if you want your economy to grow, you want your people to have at least a very basic level of access to care. So I think that point can't be stressed enough that this is not just about money spent caring for people, it's about an investment in society, essentially.
Lord Nigel Crisp (18:02):
Investment in the economy too. I mean, it really is that sort of fundamental. And we're also starting to move much more towards recognizing and doing something about the fact that poor housing, bad housing is really damaging for people's health. And you see that massively of course in African countries, but in my own country, I've introduced what's called a private member's bill. In other words, I as an independent have introduced a draft act of parliament called the Healthy Homes bill, which is actually about the requirement for homes to promote health, safety and wellbeing. Now, I won't say it's been totally inspired by Africa, but on the other hand, being in Africa, working with people in Africa, you really see the impact of the problems in society leading you into health problems because sometimes that's hidden in the UK and the US because actually people end up in hospital and you don't see 'em, but actually they end up on the street in Africa or wherever, and you do see them.
Brian Reardon (19:01):
I appreciate that perspective, Nigel. Let me bring in Bruce Compton again. Bruce, you've heard from Lord Crisp. Any final thoughts or a question for him?
Bruce Compton (19:11):
Well, first I'd love to say thank you, Nigel, for all that you've done and for this great podcast. I guess my question would be, given all that you've said today and what we've talked about with the pandemic and what the lessons learned, what advice would you give to Catholic Healthcare to continue the spirit of solidarity that we've had in the past? And given all of these things you've talked about today,
Lord Nigel Crisp (19:37):
There are perhaps two levels here. One is the technical level and the other one is the people level, the technical level. Well, there's stuff that we all learned about how you need to respond to a pandemic, how quickly you need to respond, how you need to respond in terms of getting the data out there and the information out to people and how quickly you need to respond in terms of making sure that you get access to the treatments that you need or indeed develop the vaccinations. I mean, it showed how weak we were in terms of developing vaccinations. In fact, actually we did pretty well, but there were very, very few suppliers. So I think there's a lot of technical things that we need to do to get right. But I also think, and this may be even more for your country than mine, your country is so large, I mean geographically large rather than just population large, is that the more that people work with other people around the world, the more that people have contact with them, the more that we realize that the people living in those poor countries to the south of us or wherever are people just like us and we have some kind of relationship with them.
(20:44):
And maybe it's a partnership between one of your hospitals and one the other hospitals. We have a lot of those in the UK and so on that you start to then to take a much more global view of these things and recognize that we are in this together. We're dependent on the same sources of knowledge, we're dependent on the same areas of the same staff in many cases, we're dependent on the same vaccines and so on. And that actually working together, we can learn a great deal and people find it fun. I have to say that when I'm talking with some of our older doctors who are perhaps a little bit disgruntled, having worked in their professions for a very long time and getting a bit bored and so on, actually I can get them enthused by talking about what they might do if they came and spent a few weeks in Africa and dealt with some of the real problems that they see there. So I think there's an awful lot that we can do to just open our doors a bit as hospitals and as systems make friends with people around the world. And that will stand us in so much more stead, so much more good stead when things really go wrong and things will go wrong on a global level as one of the national level.
Brian Reardon (21:57):
Well said. Any final thoughts you want to add?
Lord Nigel Crisp (22:00):
Well, I just add that I'm delighted to see that a large grouping like the Catholic Health Association is well a, has a global health department, but also has a real interest in these things, and a real interest in opening up and sharing with the world your expertise, but learning from other people. It's the old saying, isn't it, of everyone's got something to teach and everyone's got something to learn. And one of the things we've got in the West and you more than us even is we've got the technology and the know-how, but actually people without our resources know more about engaging the community and the sort of people side of it in some ways. I was with a interesting doctor in Ethiopia actually recently who said, these people here, these young doctors here are better clinically than our young doctors are, because our young doctors look at the machinery. There isn't many machinery here, so they have to look at the patient. So my final words really is to absolutely encourage the work that Bruce and you and colleagues are doing to bring out your talent and expertise as organizations into the world. So we can share it from the uk, but we can share it with our friends and colleagues around the world.
Brian Reardon (23:18):
Nigel, Lord Crisp, he is an independent member of the House of Lords in the United Kingdom and a former chief executive of England's National Health Service. Thank you again for being our guest and for sharing your insights. It's been a pleasure talking with you.
Lord Nigel Crisp (23:30):
Thank you very much. It's been good to talk with you.
Brian Reardon (23:32):
For Bruce Compton, I'm Brian Reardon, the host of Health Calls, the podcast of the Catholic Health Association of the United States. As always, you can download and listen to Health Calls at the CHA website, chausa.org. You can also access the future of health workforce discussion paper that's on our website, chausa.org/global-health. Thanks to Josh Matejka, our producer, and Brian Hartmann, our engineer here at Clayton Studios. If you like this episode, be sure to give us a five star rating and all of your favorite podcast apps where you can also download and listen to this episode. And again, thanks for listening.