Lord Nigel Crisp

Abstract

Lord Nigel Crisp wants to start an argument. The former UK National Health Service Chief Executive, now an independent member of the House of Lords, examined health systems worldwide and determined they need serious rethinking, not just to meet the needs of the developing world, but those of rich countries too. To make his point, he is challenging health professionals about the part they can play and questioning the arrogance of some western aid schemes imposed on developing countries. “Just stop telling people what to do and start listening to them”, Crisp said recently at breakfast in Washington, DC, USA. “The truth is that there is a great deal rich countries can learn from poorer ones.” Crisp developed his view during a 2006 tour of developing countries to determine how the UK “could help improve health and bolster their health workforce”. He was impressed by what he saw in many places and concluded the health-system conversation should become more of a dialogue. Many donor countries export not only their funding but also their bureaucracy and their ethos; they usually overlook the innovation and resource savvy occurring in many countries. Crisp gives many examples in his new book Turning the World Upside Down—the Search for Global Health in the 21st Century. He argues, among other things, that health-care staffing structures should strive for a wider base of lower level, community-based and mid-level workers with a smaller proportion of highly trained specialists at the top. In an example of what he calls “training for the job and not just for the profession”, Crisp cites how nurses in Mozambique are trained so that they can do caesarean sections; these nurses stay in their communities rather than migrate out and achieve the same results as physicians. The broader model that Crisp supports not only provides more dependable, community-level care but saves money as well. “It's not that we don't need the highly skilled people, it's about proportions. How many of the most highly skilled do you need compared with how many at the middle and how many at the bottom?” Crisp recognises this idea could alarm health professionals and organisations. “You don't really need to take on the doctors' trade unions”, he says. “My argument is the most important place to make change is actually in the hearts and minds of individual doctors and nurses.” Crisp hopes to galvanise a movement towards more patient-centred, affordable care. “In reality it is mostly doctors and nurses who are leading and will lead these changes.” Crisp is optimistic that such change is possible: “We need to foster much more interchange and mutual learning between clinicians and organisations around the world to help make this happen.”