Embracing opportunities to strengthen and engage diaspora contributions to the NHS

The United Kingdom is home to some of the largest diaspora communities in the world. This is especially reflected in the NHS, with 1 in 6 NHS staff reporting a nationality other than British. As the Chief Nursing Officer of Wales, I stand in admiration of the profound expertise and knowledge that our diaspora staff bring to the NHS. Connecting us to over 200 global health systems, it is critical that the NHS harness and leverage the untapped potential that diaspora staff can bring to healthcare delivery, not only in shaping our healthcare interventions but also in crafting national policies alongside other key actors. This is particularly true for our nurses, with approximately ¼ of nurses in the UK reporting a nationality other than British. 

The NHS has increasingly looked beyond the borders of the UK to recruit the best talent in healthcare, and it is imperative that we take steps to understand and appreciate the value that diaspora staff bring to the NHS. This feels more critical than ever as we face increasing challenges around recruitment, retention, and gaps in our health workforce. By 2030, the World Health Organization predicts that we will face a global shortage of up to 13 million nurses. Low- and middle-income countries (LMIC) and low-income countries (LIC) will no doubt bear the brunt of this deficit.    

Diaspora NHS staff are powerhouses of creativity and innovation in their countries of residence and origin. They have knowledge, skills and global connections that have been crucial to deliver healthcare in under-resourced areas and on much larger scales. This dual insight of healthcare in the UK and overseas can be a conduit for bilateral learning and growth, which can lead to improvements in patient care and system efficiencies.  

However, the barriers of racial bias and prejudice within the NHS persist. For diaspora staff, this means that they often face challenges in capitalising on their potential, causing poor knowledge transfer and valuable expertise left unshared. As a result, diaspora staff are significantly underrepresented in leadership positions within the NHS. The Tropical Health and Education Trust’s (THET) 2021 policy report,  ‘Experts in Our Midst: Recognising the contribution NHS diaspora staff make to global health’, sheds light on these issues, urging actionable and crucial change.   

 We need to do better when it comes to recognising the skills and expertise that internationally recruited staff bring to the table. That’s why I am supporting THET’s Experts in Our Midst programme, working with NHS trusts across Wales and England to build a Diaspora Network for Global Health aimed at harnessing the knowledge diaspora staff have of other health systems to develop practical solutions that improve health service delivery in the UK and overseas.    

Throughout 2023, THET has partnered with 7 Health Boards across Wales, and 5 NHS Trusts across England to recognise and capture the knowledge and expertise of diaspora NHS staff in the UK. This has included THET’s Diaspora Staff and Global Health Survey, which launched in January 2023, to capture diaspora knowledge of overseas health systems and understand how this knowledge is being applied to health in the UK, and in countries of heritage. 

The survey received 686 responses and its insights, alongside in-depth focus groups and interviews, will be the cornerstone of THET’s forthcoming policy report, ‘Voices of the Experts in Our Midst’ launching this December 2023 in England, and January 2024 in Wales.  

We know that diaspora NHS staff offer invaluable experience and expertise gained from working in over 200 global health systems. By recognising and utilising their knowledge, the NHS can seek to improve its capacity to provide high-quality care. THET’s ‘Voices’ report will aim to provide an impactful amplification of the valuable contribution made to the NHS by diaspora staff and their unique perspective on the value of a globally engaged NHS.   

Most important, however, is the report’s focus on the “voices” and stories of diaspora staff that are often unheard or unrecognised. The report is enriched by case studies illustrating the transformative impact of diaspora staff in the NHS, who have been able to leverage their connections to the UK and their countries of origin to enhance eye health initiatives in Uganda, modernise gastroenterology training and practices in Bangladesh, and extend online mentoring and guidance to doctors in Pakistan.   

The report also highlights NHS Trusts and Health Boards that are pioneering in recognising and harnessing diaspora expertise. Betsi Cadwaladr University Health Board’s Betsi-Kenya Health Link, which, since 2018, has catalysed a collaborative exchange of skills and knowledge with Busia County in Kenya, leading to the training of 68 local community health volunteers who have extended their reach to thousands. The link is strengthened by the health board’s diaspora colleagues whose local knowledge of Busia County and their commitment to sharing skills, expertise and knowledge facilitates their mission to tackle health inequalities at home and abroad. Similarly, the report spotlights the work of Nottingham University Hospitals NHS Trust which has maintained an institutional link with Jimma University Hospital in Western Ethiopia, focusing on skills and knowledge sharing, since 1993. The partnership is mutually beneficial, providing staff at Nottingham with opportunities to take on placements in Ethiopia, learning about a different health system, improving professional and leadership skills, and gaining exposure to conditions less common in Nottingham, such as tropical diseases, trauma, and non-communicable diseases.  

As we anticipate the upcoming policy report from THET, it is a momentous opportunity to reflect on the NHS’ 75 years of progress and success. We must continue to create platforms within the NHS that amplify diaspora voices and provide opportunities for the sharing and integration of international expertise and knowledge. It is through such exchanges that the NHS can evolve, continue to lead globally in healthcare delivery, and most importantly, develop practical solutions that improve health service delivery in the UK and overseas.  

Find out more about THET’s Experts in Our Midst Programme: https://www.thet.org/our-work/policy-work/experts-in-our-midst/