LORD NIGEL CRISP used to run one of the biggest organisations in the world: the UK's National Health Service. Since leaving the role, he has become a global health advocate in UK politics and around the world. In our latest How To Build Community podcast (which you can listen to here) he shares stories and lessons from his work. Here are some highlights.
He began his career as a community worker. After graduating from university, Nigel worked in a deprived area of Liverpool. In this community, he learned about the importance of building on people's strengths, but also "how difficult it was [for local people] to connect with the formal system" - the health and social services. Looking back at this time, he thinks not much has changed: "that is still very, very true."
He joined the National Health Service in his mid-30s, and worked there for 20 years. He said that working in the health service "was building on that early time in the community". For six of those years he was Chief Executive, which meant he was running an organisation that employed 1.4 million people. He was also head of the UK's Department of Health, linking the NHS to politicians. "So I was one of the people whom I had found it difficult to contact when I was doing the community work in Liverpool!"
Health is global. "There are lots of things that divide us, but lots of things that link us." He said that there are two primary pressures on global health at the moment: the first is the increase in long-term conditions and chronic illnesses, and the second is a lack of health workers. With 42 million trained health workers in the world, it is believed that there is a shortfall of 18 million, a number which is increasing.
Health is more than just healthcare. "The biggest impacts on health are nothing to do with healthcare," Lord Crisp told us. Estimations suggest that health services, like hospitals, contribute "about 30%" to health and longevity. More important are environmental issues, poverty, unemployment, and education. This is why community and community development are so crucial to understanding global health: "health is not something that is done in hospitals, health is something that is done in the community." Progress has been made in understanding this idea in the U.K., he said, "but we’re in the foothills, we’ve got a long way to go.”
Everyone's got something to teach, everyone's got something to learn. “The West finds it difficult to learn. People tend to think we in the West have got the answers. The truth is, we’ve got some of the answers; other people have got some of the answers. And between us, we don’t know some of the answers." This is why community development needs to be a two-way process, and why he emphasises the idea of "co-development". An example of this is the growing movement of community health workers, which began in the 1970s in Kenya, with a programme training local people - often women - in basic curative and preventative health care. The idea of community health workers, who receive some training but not full professional training, is spreading into the West. In New York a programme was developed that was very similar to the African model. Health workers who are part of the community can provide that crucial link that Nigel identified as missing between community, professionals, and then the larger health service systems.
Doing this work takes time. Nigel emphasised "co-development" and the importance of building global partnerships. In partnerships between British and other organisations that he's been involved in, "you’ve got a very positive two-way benefit - people are learning from each other. But those sorts of partnerships don’t just happen." Instead, he estimates that it takes two or three years of relationship building to gain the mutual trust, respect and learning necessary for these partnerships. This means it can be a challenge to convince funders to invest in this long-term work; for people unfamiliar with it, "the planning and implementation cycle might be three times as long" as they expect.
Leadership is about relationships. When reflecting on his time as head of the UK's National Health Service, he emphasised that he wasn't leading it alone, but with help, especially from the Chief Medical Director and Chief Nursing Officer. "In a complex organisation, it's about shared leadership." Also crucial is communication: "you've got to be explaining to your people what's going on and how this will pan out [...] you're not a dictator." Ultimately, he emphasised again, "your basic start should be building on strengths."
Listen to the interview in full here.