The vision of a comprehensive health service is as relevant today as in the 1940s, but new and different societal challenges require a rethink on how to deliver the NHS as it faces a national health and care emergency

The vision of a comprehensive health service is as relevant today as in the 1940s, but new and different societal challenges require a rethink on how to deliver the NHS as it faces a national health and care emergency

We, a group of medical professionals, researchers, patient representatives, and politicians, call for the UK government to commit to a reversal

An open letter by healthcare professionals calls for specialist NHS services to support patients harmed by taking prescription medications

Turning the World Upside Down is a search to understand what is happening and what it means for us all. It is based on Nigel Crisp's own journey from running the largest health system in the world to working in some of the poorest countries, and draws upon his own experiences to explore new ideas and innovations around the world.The book has three

There are critical shortages of health workers globally, with an estimated 43 million additional workers needed to achieve universal health coverage. 1 Haakenstad A Irvine CMS Knight M et al. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022; 399: 2129-2154 Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar The health workforce is unevenly distributed between and within countries, many health workers are exhausted and demoralised, and there are problems with recruitment and retention. 2 Elsevier HealthClinician of the future: a 2022 report. Elsevier, Oxford2022 Google Scholar Increasing demand for health services and growing financial pressures on populations and health systems exacerbate these problems. Global and national innovative action is needed to deal with these challenges and support and sustain the health workforce.

Short-term experiences in global health (STEGH), also known as short-term medical missions continue to be a popular mode of engagement in global health activities for students, healthcare providers, and religious groups, driven primarily by organizations from high-income countries. While STEGH have the potential to be beneficial, a large proportion of these do not sustainably benefit the communities they intend to serve, may undermine local health systems, operate without appropriate licenses, go beyond their intended purposes, and may cause harm to patients. With heightened calls to ???decolonize??? global health, and to achieve ethical, sustainable, and practical engagements, there is a need to establish strong guiding principles for global health engagements. The Advocacy for Global Health Partnerships (AGHP), a multi-sectoral coalition, was established to reflect on and address the concerns relating to STEGH. Towards this end, AGHP created the Brocher Declaration to lay out six main principles that should guide ethical and appropriate STEGH practices. A variety of organizations have accepted the Declaration and are using it to provide guidance for effective implementation of appropriate global health efforts. The Declaration joins broader efforts to promote equity in global health and a critical reevaluation of volunteer-centric, charity-based missions. The current state of the world???s health demands a new model of collaboration ??? one that sparks deep discussions of shared innovation and builds ethical partnerships to address pressing issues in global health.

Cancer mortality rates in low-income and middle-income countries (LMICs) are unacceptably high, requiring both collaborative global effort and in-country solutions. Experience has shown that working together in policy, clinical practice, education, training, and research leads to bidirectional benefit for LMICs and high-income countries. For over 60 years, the UK National Health Service has benefited from recruitment from LMICs, providing the UK with a rich diaspora of trained health-care professionals with links to LMICs. A grassroots drive to engage with partners in LMICs within the UK has grown from the National Health Service, UK academia, and other organisations. This drive has generated a model that rests on two structures: London Global Cancer Week and the UK Global Cancer Network, providing a high-value foundation for international discussion and collaboration. Starting with a historical perspective, this Series paper describes the UK landscape and offers a potential plan for the future UK's contribution to global cancer control. We also discuss the opportunities and challenges facing UK partnerships with LMICs in cancer control. The UK should harness the skills, insights, and political will from all partners to make real progress.

ContextPalliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal.Objectives1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services.MethodsEmpirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce.ResultsNurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships.ConclusionAn estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

This Viewpoint discusses the global lack of surgical care in mass-casualty disasters and for daily health and proposes integrating civilian, military, national, nongovernmental, and international resources to address the challenges.

Researchers estimate the number of people who will die with serious health-related suffering is projected to increase by approximately 87% by the year 2060.1Sleeman KE de Brito M Etkind S et al.The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions.Lancet Glob Health. 2019; 7: e883-e892Summary Full Text Full Text PDF PubMed Scopus (123) Google Scholar Palliative care is the discipline devoted entirely to preventing and relieving serious health-related suffering. WHO has called for the universal accessibility of palliative care at all levels of health care and in the home because palliative care is an indispensable component of universal health coverage.2WHOStrengthening of palliative care as a component of comprehensive care throughout the life course.http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R19-en.pdfDate: 2014Date accessed: January 21, 2020Google Scholar The report of the Lancet Commission on Palliative Care3Knaul FM Farmer PE Krakauer EL et al.Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report.Lancet. 2018; 391: 1391-1454Summary Full Text Full Text PDF PubMed Scopus (328) Google Scholar emphasised the need for cost-effective investment in expanding the capacity of palliative care, including required palliative care training for specialist and primary care clinicians, and task shifting to help make basic palliative care accessible in community settings. The purpose herein is to identify how global health-care systems can encourage the nursing workforce to implement the recommendations of the Lancet Commission and WHO guidance on palliative care.4WHOIntegrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers.http://apps.who.int/medicinedocs/documents/s23558en/s23558en.pdfDate: 2018Date accessed: January 21, 2020Google Scholar Specifically, the skill set, experience, and perspectives of nurses are crucial to optimum palliative care policy development, strategic planning, service implementation, and research. The vision of WHO's Global Strategic Directions for Strengthening Nursing and Midwifery is “accessible, available, acceptable, quality and cost-effective nursing and midwifery care for all, based on population needs, in support of universal health coverage and the Sustainable Development Goals”.5WHOGlobal strategic directions for strengthening nursing and midwifery 2016–2020.https://www.who.int/hrh/nursing_midwifery/global-strategic-midwifery2016-2020.pdf?ua=1Date: 2016Date accessed: January 21, 2020Google Scholar This vision indicates the indispensability of nursing to palliative care, especially in low-income and middle-income countries where this care is less accessible. WHO's declaration of the International Year of the Nurse and Midwife makes 2020 the ideal time to promote nursing contributions to palliative care policy, training, and services in low-income and middle-income countries. First, governmental and health ministry support of nurse optimisation initiatives, such as Nursing Now (based on the Triple Impact report6All-Party Parliamentary Group on Global HealthTriple impact: how developing nursing will improve health, promote gender equality and support economic growth.https://www.who.int/hrh/com-heeg/digital-APPG_triple-impact.pdf?ua=1Date: 2016Date accessed: December 16, 2019Google Scholar), is a crucial step. A programme of the Burdett Trust developed in collaboration with WHO and the International Council of Nurses, Nursing Now is a 3-year (2018–20) international campaign that aims to improve the health of the population by raising the profile and status of nursing globally.7WHONursing Now campaign.https://www.who.int/hrh/news/2018/nursing_now_campaign/en/Date: 2019Date accessed: December 16, 2019Google Scholar Campaign advocates call for increased contributions from nurses to policy making, greater investment in workforce development, recruitment of more nurses to positions of leadership, additional research that measures the effect of nursing in certain areas, and sharing of best practices across the profession. As the ability of nurses to influence care delivery increases, so does their opportunity to ensure the development and implementation of palliative care programmes throughout the illness trajectory. Second, there are models of education for palliative care nursing that can be readily adapted to the cultural, resource, and practical needs of varied international settings.8Ferrell B Buller H Paice J Anderson W Donesky D End-of-life nursing and education consortium communication curriculum for interdisciplinary palliative care teams.J Palliat Med. 2019; 22: 1082-1091Crossref PubMed Scopus (11) Google Scholar In Uganda, enabling nurses with 6 months of advanced training in pain relief and palliative care to prescribe morphine extended the reach of palliative care in the community throughout the country.3Knaul FM Farmer PE Krakauer EL et al.Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report.Lancet. 2018; 391: 1391-1454Summary Full Text Full Text PDF PubMed Scopus (328) Google Scholar Additionally, nurses briefly trained in palliative care in a major general hospital are able to identify patients with palliative care needs and request palliative care consultation, thereby improving access for hospitalised patients.9Downing J Batuli M Kivumbi G et al.A palliative care link nurse programme in Mulago Hospital, Uganda: an evaluation using mixed methods.BMC Palliat Care. 2016; 15: 40Crossref PubMed Scopus (21) Google Scholar In Vietnam, basic training in palliative care will soon be a required part of the undergraduate curriculum of a leading nursing school.10Krakauer EL Thinh DHQ Khanh QT et al.Palliative care in Vietnam: long-term partnerships yield increasing access.J Pain Symptom Manage. 2018; 55: S92-S95Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar Third, nurses in high-income countries must partner with colleagues in low-income and middle-income countries to exchange knowledge using respectful, inclusive, mutually beneficial, and sustainable mechanisms. These models have been established in Rwanda and Liberia through health-care capacity building initiatives and ventures with non-governmental organisations, such as Partners In Health.11Rosa WE Male MA Uwimana P et al.The advancement of palliative care in Rwanda: transnational partnerships and educational innovation.J Hosp Palliat Nurs. 2018; 20: 304-312Crossref PubMed Scopus (5) Google Scholar, 12Rosa WE Karanja V Kpoeh JDN Liberia's steps towards alleviating serious health-related suffering.Lancet Glob Health. 2019; 7e1489Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Long-term partnerships that meet the host country nurses' learning and practice needs are key to ensuring pragmatic solutions to palliative care delivery gaps locally and globally. Finally, nurses should be engaged as full interdisciplinary team members in the planning and delivery of patient-centred and family-centred palliative care. In addition, nurses can be valuable in advocacy for palliative care and the generation of much needed research. Nurses and midwives account for more than 50% of the health-care workforce in many countries and if universal palliative care access is to be realised, policy makers, ministries of health, and health system leadership must strategise nurses' intelligent deployment accordingly.3Knaul FM Farmer PE Krakauer EL et al.Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report.Lancet. 2018; 391: 1391-1454Summary Full Text Full Text PDF PubMed Scopus (328) Google Scholar Including nurses to an equivalent degree as other disciplines at all levels of palliative care implementation is foundational to palliative care philosophy and effectiveness. The international health-care system must prepare for a substantially increased prevalence of serious health-related suffering among all patients, particularly the poorest, the oldest, and those affected by dementia and dying from cancer.1Sleeman KE de Brito M Etkind S et al.The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions.Lancet Glob Health. 2019; 7: e883-e892Summary Full Text Full Text PDF PubMed Scopus (123) Google Scholar Competent, equitable, and compassionate palliative care is a primary mechanism to relieve serious health-related suffering for all people and populations everywhere. The nursing workforce is a prime stakeholder in making high-quality palliative care accessible, especially for the rural poor, and an invaluable contributor to universal health coverage. We declare no competing interests.

In 2015, the UK's All-Party Parliamentary Group on Global Health (APPG) mapped the UK's contribution to health globally, showing that it had world-class universities and research, was a global leader in health policy and international development, had strong life sciences and biomedical and biotech industries, and had a vibrant and diverse not-for-profit sector.1All-Party Parliamentary Group on Global HealthThe UK's contribution to health globally: benefiting the country and the world.http://www.appg-globalhealth.org.uk/reports/4556656050Date: 2015Date accessed: January 16, 2020Google Scholar In 2019, the APPG looked at what had changed in the intervening time and in the context of understanding the likely impact of Brexit on the UK's global role in health. We gathered data from published and unpublished sources and interviewed 78 health and academic leaders—half from the UK and half from other countries—about their perceptions of the UK's current and potential future role. On Feb 6, 2020, the APPG publishes its new report, The UK as a Global Centre for Health and Health Science.2All-Party Parliamentary Group on Global HealthThe UK as a global centre for health and health science.http://www.appg-globalhealth.org.uk/Date: 2020Date accessed: February 5, 2020Google Scholar There have been considerable improvements in the past 5 years with, for example, big increases in funding for research, new regional collaborations between universities and National Health Service (NHS) bodies, and increased foreign investment in UK life sciences. There have also been advances in genomics, mental health, artificial intelligence, and other areas. The health and academic leaders from outside the UK who were interviewed saw the UK as a force for good in health in the world. They commented positively on the UK's track record in improving health globally and on its values, scientific and business standards, the strengths of its institutions, and its achievements in health and health science. They were, however, concerned about the UK becoming more inward looking and neglecting its global contribution, particularly at a time when other countries were already becoming more insular and protectionist. The UK health leaders largely had similar views and raised concerns about the potential loss of access to European collaboration and funding and the problems in staffing health services and research institutions. Our new report proposes that the UK now needs to act decisively to maintain and strengthen its role as a global leader in health and health science.2All-Party Parliamentary Group on Global HealthThe UK as a global centre for health and health science.http://www.appg-globalhealth.org.uk/Date: 2020Date accessed: February 5, 2020Google Scholar The UK must grasp the many opportunities represented by the fast-growing health and health sciences sectors and at the same time recognise, plan for, and mitigate the difficulties and risks. Our vision is for the UK to become a global centre for health and health science, a go-to place for all aspects of health globally. We propose a two-part strategy that maintains the UK's position as a trusted leader in health, with high standards and strong values, and at the same time invests in further development in and greater collaboration between all the UK organisations working in health and health science. The two parts of the strategy are shown in the panel.PanelThe UK as a go-to place for health globallyThe UK needs to act decisively to seize the opportunities and manage the risks. We propose that it should: 1Re-state its commitment to improving health globally, advocating for the right to health for all people everywhere, and working to the highest standards in science, business, and partnerships.2Bring together the combined strengths of its academic, government, commercial, and not-for-profit sectors to realise synergies and create a shared vision for the UK as a global centre for health and health science. The UK needs to act decisively to seize the opportunities and manage the risks. We propose that it should: 1Re-state its commitment to improving health globally, advocating for the right to health for all people everywhere, and working to the highest standards in science, business, and partnerships.2Bring together the combined strengths of its academic, government, commercial, and not-for-profit sectors to realise synergies and create a shared vision for the UK as a global centre for health and health science. The timing is perfect. The health sector is growing fast, science and technology promise new breakthroughs, and the UK has a well established core of expertise and institutions that are able, given the right support, to take advantage of them. The new APPG report2All-Party Parliamentary Group on Global HealthThe UK as a global centre for health and health science.http://www.appg-globalhealth.org.uk/Date: 2020Date accessed: February 5, 2020Google Scholar makes 12 recommendations that address both the risks and the opportunities. Two are highlighted here. The first recommendation emphasises the importance of international partnerships and global solidarity in tackling health globally. This is not a zero-sum game. The APPG recommends that the UK should further strengthen and develop its existing global partnerships, collaborations, and networks with international organisations, partners in high-income countries, and the fast-growing economies that are working to develop their health systems, as well as continuing to support low-income countries to improve the health of their populations. The second recommendation focuses on the importance of supporting and developing regional UK collaborations and institutions. It recognises the as yet untapped potential for growth and development, particularly in the Northern Health Sciences Alliance, Edinburgh BioQuarter, Life Sciences Hub Wales, GW4 Alliance in southwest England and southeast Wales, and MedCity in the southeast of England. The UK is well known as a world financial sector. We believe it has the potential to be equally well known as a global centre for health and health science. The APPG paid for the relevant research from its own resources. The APPG has received funding from the London School of Hygiene & Tropical Medicine, King's College London, University College London, Imperial College London, the University of Oxford, the University of Edinburgh, the Wellcome Trust, the National Institute for Health and Care Excellence (NICE), The Lancet, and the Bill & Melinda Gates Foundation. We declare no other competing interests.