The NHS is a global role model for universal health coverage | Layla McCay

Layla McCay

The UK is a leader in global health – and the NHS has become a global role model for universal health coverage. So what’s next, asks Layla McCay, director of international relations at the NHS Confederation.
As Dame Sally Davies prepares to step down from her role of CMO, she has taken an unusual approach to her final report. In ‘Health, our global asset – partnering for progress’, she has essentially published a collection of letters by the great and the good in global health, describing the trickiest of current global health challenges, celebrating the UK’s leadership thus far, and looking to our future role: how can the UK add most value to health around the world? Their words provide insights into what the world is gaining from the UK’s commitment to spending 0.7% of GNI on international development – and some interesting insight into how the NHS itself is influencing the world. 
The UK has had universal health coverage (UHC) since 1948: all individuals and communities have been able to receive the health services they need without suffering financial hardship, from health promotion to prevention, treatment, rehabilitation, and palliative care. With the advent of the Sustainable Development Goals, the whole world is now seeking to achieve this outcome by 2030, and Ban Ki-moon, now deputy chair of The Elders, says that other countries are looking to learn from the NHS’s famously impressive, efficient and equitable system. Building on that international renown, he calls upon the UK to take a global leadership role in promoting and championing the health, economic and political benefits of universal health coverage, primary care, and public financing, with services provided free at the point of delivery.
It is a hope reiterated by Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. He too recognises the NHS as having “played an important role in developing the concept of UHC and how it can be adapted to the health challenges of the 21st century” and encourages us to “be more proactive in sharing these lessons in the face of political and commercial pressure from the well-organised private healthcare and pharmaceutical lobbies”.
Several respondents share a hope that the UK will help to make the global case for primary care as the foundation of universal health coverage, and to build on our historic global leadership role in mental health to support countries to champion and build their mental health care systems.
Our own nation’s health will also benefit from this international leadership. Dame Sally attests that the NHS should be learning from countries delivering high-quality, equitable health services in resource-poor settings, and innovating together to manage demand and achieve sustainability. The report describes exchanges and collaborations between nurses in Jamaica and Leeds; between researchers in India and the UK; between public health workers across Africa and the UK Public Health Rapid Support team (PHRST).
Dame Sally also recommends acting together to reduce the threat of infections that spread across borders. Several respondents highlight how the UK can help prevent potentially deadly infectious diseases spreading throughout populations and across borders by sharing information and by investing in strengthening health systems, including through immunisation programmes and preventing anti-microbial resistance (AMR) so antibiotics will work effectively on diseases before they spread.
Clearly the NHS and the wider UK health sector has made its mark on the world. According to Dr Matshidiso Rebecca Moeti, WHO Regional Director for Africa: “The UK has been at the forefront of providing support for health systems’ strengthening.” Bill Gates says the UK has already been “indispensable”. Looking forward, Dame Sally speculates on our future as a ‘global’ health system. She proposes a focus on developing guidance and standards using the best evidence in the world; monitoring progress and trend analysis to develop services and provide advice; well-coordinated technical support and financing for health system strengthening towards universal health coverage; supporting countries to prevent, detect and respond to emergencies; and contributing to coordinated efforts to end the epidemics of AIDS, TB, malaria, and neglected tropical diseases.
The NHS has already play a role in these activities, but the letters within the CMO report remind us that we have an additional role in inspiring the world that universal health coverage is achievable and, with the right approaches, can be sustainable. Ban Ki-Moon summarises the international thinking well: “we hope the UK will share these lessons with political leaders across the globe to help realise the right to health and achieve all of the Sustainable Development Goals.”
Layla McCay is director of international relations at the NHS Confederation. Follow her on Twitter at @LaylaMcCay.

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