THET Chief Executive address to Uganda Nurses and Midwives Association UK
3 August 2023
Ben Simms, Chief Executive Officer of THET was invited to address the Uganda Nurses and Midwives Association UK on Saturday, 15th July. In his moving speech, Ben praises the contribution being made by NHS diaspora staff to the development of healthcare at home in the UK, and at home in countries of heritage. Referring to THET’s programme, the Experts In Our Midst, he talks about how diaspora staff are contributing to the ambition of creating a world where everyone, everywhere has the right to access quality healthcare which is free at the point of use.
Ben celebrates the ties between the UK and Ugandan health systems, including the several Health Partnerships which have focussed on diverse issues from AMR to mental health, before reflecting on the impact of the cuts to UK ODA funding in recent years.
The funding cuts have challenged the health partnership community and requires collective action to make the case for a return to 0.7%, Ben argued passionately in his speech.
The valuable and valued contribution of Ugandan diaspora staff in the UK, or the “Experts In Our Midst”, form a central pillar of Ben’s speech. He asks why are diaspora staff under-represented in global health activity, and why are they so much less likely to have their projects supported by UK Aid? Ben encouraged diaspora staff to participate in THET’s Diaspora Staff and Global Health survey, which will form the basis for a new report on “The Voice of the Experts In Our Midst”, due to be launched by THET later this year. This report is designed to raise the profile of how NHS diaspora staff are contributing to the development of health systems around the world.
Read Ben’s speech in full below.
Please note that the text of the speech may differ from the delivered version.
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“Dear Lord-Lieutenant, Ladies and Gentlemen, I am here to celebrate and to encourage, but first to thank. It is an honour and a pleasure to be invited to speak.
Thank you to the Uganda Nurses and Midwives Association UK, and a particular thanks from me to Elizabeth Pearson who I know has worked so hard to make today happen.
For me, today is an opportunity to celebrate the close ties between our two countries – to celebrate the home here in the UK and the home there in Uganda. I hope, like you, that these ties are valued. They should be.
Our health systems have been connected through our people for many, many years and it these connections – of institutions and people – that is the focus of my professional life and that of the organisation I run, the Tropical Health and Education Trust, known as THET.
Both THET, and all of you in this room I am sure, reject a world where your health and life expectancy are based on the accident of where you are born. We believe in a world where everyone, everywhere, has the right to access quality healthcare, free at the point of use. The connections between our countries that you are at the centre of, are a driver for the change we want to see.
I often find myself talking about the National Health Service as an example of what we all have the right to deserve. I did so this last month when writing an account of my visit to a border community in Myanmar where nurses and doctors have fled the violence of the military to establish a hospital in the dense foliage of Myanmar’s countryside. In just two years, they have increased the patient numbers at that village hospital from 130 people a month to well over a 1,000.
My visit to Myanmar fell just before our 75th anniversary of the NHS celebrations back home and so perhaps predictably, I found myself recalling the history of our National Health Service, founded in 1948 at a time of unprecedented austerity, but conceived even earlier, in the Beveridge Report of 1942, at a time when the whole world was consumed by war.
Universal Health Coverage, Health for All, is a political choice, and a human right. It is a choice, not a question of money. We believe in a world with everyone, everywhere, has the right to access quality healthcare, free at the point of use.
Health institutions in Uganda and the UK have collaborated for many years, as I have already acknowledged. My briefing on these relationships – and my organisation THET is just one small part of this equation – runs to a full 5 pages. There is:
- The partnership between Fort Portal Regional Referral Hospital and Salford University focused on the development of interventions to prevent and manage diabetic foot ulcers.
- The partnership between the Women’s Health Research Institute and Imperial College NHS Trust.
- The partnership between the Royal Free London NHS Foundation Trust and Mukono District Hospital focused on strengthening antimicrobial stewardship through a nurse-led program in Mukono District Hospital.
- The partnership between Butabika referral hospital and the NHS East London Foundation Trust, focused on the development of mental health services.
- The partnership between Nottingham Trent University and Makerere University.
- The partnership between Sheffield Health and Social Care NHS Foundation Trust and Gulu Regional Referral Hospital.
Indeed, there are more health partnerships between the UK and Uganda than there are between the UK and any other country in the world.
“The beauty of this collaboration” argues Dr Musa Sekikubo, a Consultant Obstetrician, senior lecturer at Makerere University, and one of the programme leads on a partnership with Cambridge University Hospital Trust… “is that it is not one partner imposing their will on the other partner, it’s like working together, identifying issues, and then working together to find solutions to those issues. So, it is a combination of existing ideas and exposure to ideas of how other people are working on the same issues. Then we come up with a collective approach that will be beneficial to our patients.”
And at THET, we acknowledge how much the UK health system benefits from the relationship with Uganda and other countries. This benefit has been well documented, by great thinkers such as Lord Crisp in his book ‘Turning the World Upside Down’.
Here in the UK, we must relish the opportunities to learn from what health professionals achieve, often with less resources, in countries such as Uganda.
The connections between Uganda and the UK have, however, been tested, time and time and time again, I would say. And in the past few years, we have more than enough examples of what I mean by this.
I’ve talked positively about the NHS, but I am acutely aware that, for many of you, working in the NHS has involved experiencing racism not just from patients but from other staff.
I salute the work you do organisationally and individually to challenge racism within the NHS and broader British society.
Have any of you seen, by the way, the fantastic BBC series ‘Our NHS: A Hidden history’? This programme reminds us of what we do not need reminding of: that without staff from Uganda and from other countries around the world, the NHS simply would not function.
And it has always been this way. Ever since the NHS was founded 75 long years ago, we have benefited from the talent and expertise of staff trained in other countries.
Racism is not only a scourge, but it is a self-defeating one. Where would the UK be without the contribution internationally recruited staff are making to our health and to our society.
I’ve talked positively about the institutional links between hospitals and clinics in Uganda and the UK – and the solidarity between our countries that is expressed through these links – but I am acutely aware that these links were tested to their limits during COVID.
In May of this year, I had the great pleasure of speaking alongside the enormously impressive Dr Jane Aceng, the Ugandan Minister of Health, during a side event at this year’s World Health Assembly.
Minister Aceng gave voice to a widely held view that there was a catastrophic breakdown of global solidarity during the COVID-19 pandemic. And then again during the more recent outbreak of Ebola.
“Some of our long-term partners deserted us at our time of need”, she told us. What else can explain the failure to prioritise the vaccination of frontline health workers in Uganda over young adults in the UK?
In this last period, we have seen another form of this collapse in global solidarity, with the savage reductions in expenditure on UK Aid.
In three short years, the UK has reduced its expenditure from a peak of £15bn to under £12bn, with some £4bn of that money being spent on Ukrainian refugees here in the UK. For THET, this has amounted to a £48m cut in funding.
To be clear, I would expect the UK to be spending less on UK Aid, because the UK is a poorer country than it was a few years ago. But the commitment to spend 0.7% of our Gross National Income on Aid was always designed to take account of this. If we have less money in our pockets, of course we will always have less to share. But give we must.
It feels like a very, very long time ago when David Cameron was Prime Minister, and when he stood up and argued “that it is a mark of our country, and our people, that we never turn our backs on the world’s poorest, and everyone in Britain can be incredibly proud of it.”
It is inconceivable that our current Prime Minister, or the one before that, or the one before that, would say such a thing. The UK is morally poorer as a result.
The harm this breakdown in global solidarity has done, will take a lot of healing and I think we in this room, should be part of that healing.
We all know how important it is to collaborate across borders and across health systems.
There will be another pandemic. In fact, arguably we are already in one in the form of growing resistance to antibiotics. Ebola is there. Climate crisis is upon us.
No nation or national health system can be or is an island to itself. Health is global. We must embrace each other, in partnership, and as equals, and rise to face shared challenges.
My argument being that, as well as contributing to the development of each other’s health systems, we can learn from the development of each other’s health systems.
So far, I have emphasised the myriad relationships supported by UK Aid, but beyond these relationships, there is another set of relationships that we do not celebrate enough.
These are the relationships that are managed by the people that I call, the Experts in Our Midst – you.
Above all other considerations, our two countries are connected by you.
And THET does not only celebrate you because of your contributions to the NHS, but because of your connections to Uganda. When I talked earlier about a belief in everyone, everywhere having access quality healthcare, I was talking from a position of principle. You speak from a position of lived experience. You talk about your relatives, your friends, your elders, your communities.
And I find it tremendously exciting to know that you have a knowledge not just of the UK health system, but also that of Uganda’s.
We do not do enough in this country to celebrate this knowledge. We talk about internationally recruited staff connecting us with over 200 health systems around the world, but we must go further: to document and celebrate this knowledge and think about how this knowledge can and is improving health at home in the UK, and health at home in Uganda, and other countries.
You are the people who can make this happen. You are the skilled clinicians. The health diplomats who move between our two health systems. You are the champions and advocates whose lived experience proves the reality of our interconnected world.
In this context, please allow me to say a few words about the programme that THET is running, and that Elizabeth referred to. She has of course written about similar themes in the thesis she recently completed and which she kindly shared with me.
Our programme is called the Experts in Our Midst. And it started with a journey involving figures such as Navina Evans, who sits on the executive board of NHS England; Mala Rao, who helped establish the racism observatory in the NHS; Frances Day-Stirk, a former THET Trustee and former President of the International Confederation of Midwives; and Onyekachi Wambu, Executive Director of the African Foundation for Development who provided the foreword to our 2021 report entitled ‘The Experts in Our Midst’. And others.
In 2019, we were exploring Nigel Crisp’s ideas around how the NHS can learn more from Africa and Asia. And it was only towards the end of that year that we realised that we had been focusing on sending UK staff out to study those health systems when, in our midst, we have people who have a knowledge of those health systems – such as the people in this room.
In 2021, we produced our report that argued that, although 1 in 6 NHS staff report a non-British nationality, the expertise and cultural knowledge of diaspora staff is undervalued and underutilised because of persistent unconscious bias and systemic racism. It called on organisations such as my own, and decision-makers in the NHS and in government, to change this.
Why, we now ask, are diaspora staff under-represented in global health activity. Why are they so much less likely to have their projects supported by UK Aid?
This year, and last, and next year, and the one after that, we are working to change this.
A centre piece of our work this year will be a report which we are calling “The Voices of the Experts in Our Midst”. This report will be launched in parliament on Universal Health Coverage Day in December and be designed to be read by UK parliamentarians.
It will celebrate the Experts in Our Midst by featuring individual case studies of how diaspora staff are working to improve health, drawing on their knowledge of health systems here in the UK and in Uganda, giving specific examples.
In doing so, it will help shift the dial in terms of how funding is allocated and whose knowledge is valued.
And by doing so, it will democratise the global health space, opening us up to appreciate the full diversity of talent and energy and ideas that flow between the UK and Uganda and beyond.
If I have one request of you this evening, it is to please take part in our survey. Over 500 diaspora NHS staff have done so, so far.
The survey is short, just seven questions, and you will find the link on your tables.
This will help us get to know you, and in getting to know you it is our hope that we can work in allyship to ensure your voice is heard, your expertise recognised, and ultimately, your ideas about how we can improve health at home in the UK, and at home in Uganda, can be supported financially.
The projects UK Aid supports are not all enormous. The health partnerships I talked about at the beginning of my address have modest funding for travel and the development of training materials, and such like. But the important thing is that you are aware of these funds and able to access them.
I have one final request – I talked earlier about the reduction in funding for UK Aid; I want to ask you all to play a part in campaigning to change this.
Andrew Mitchell, the Minister of Development at the FCDO, gave a rather wonderful speech a few weeks ago in which he said: “We must be honest and accept that we do not currently enjoy sufficient support for (UK Aid) from the British public.
“But I am determined that we shall win over the doubters and drive-up support. To do this, we will need to get out of London, and not to visit capital cities around the world but to visit small towns and villages in our own United Kingdom, to explain what we do in simple and straightforward language that everyone can relate to… Drawing on the numerous examples and experiences that make up the story of great British International Development.”
The hospitals, and GP surgeries, and clinics where Uganda nurses and midwives are working across the UK, are those small towns and villages that Minister Mitchell refers to.
I would like you to join the campaign to persuade the public, and politicians, that we should be restoring our commitment to give 0.7% of our Gross National Income in the form of UK Aid.
You can do this by signing up to our HEAL Campaign on the THET website. HEAL stands for Health Equity for All.
“Strength in Unity” is the rallying cry of the Uganda Nurse and Midwives Association UK, I have learnt in preparing for this talk.
Thank you for allowing me to experience that strength of unity here this evening, and for giving me the opportunity to lay out how I feel we can work together to create an even more powerful voice for you within the UK health service and the global health space more generally, one that fully recognises not just how lucky we are to have you, but how we benefit from the expertise you bring.
Thank you.”
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