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Could we save the NHS by applying cross-cultural competence?

The category: Inter-cultural, The International Profiler, Uncategorized, WorldWork Blog

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Perhaps the NHS could do with some self awareness development? The news headlines tell us that the NHS is facing a stark financial situation; it urgently needs to save £22 billion somehow. There are fears that it may not survive as a public health service… 

For those of us who have had the benefit of NHS care and who appreciate how lucky we are not to have to worry about what it will cost to get medical care, this is very sad news. It has made me think about how we can find a solution that doesn’t involve privatisation.  How can we save our dear NHS, this pioneering and inclusive British social invention?


I am of the belief that a national health system benefits the population as a whole. And as a parent, I may worry about my children’s education or chance of future employment, but at least I know that if they get sick, there is a safety net for them. They and I will not have to worry about whether they can afford or not to pay for medical treatment.

I grew up in Norway, a country that also has a public health service, inspired by the NHS, but where patients pay a subsidised fee each time they get medical treatment. This version of public healthcare is common all over Europe. European countries, like the UK, also have their own version of welfare and benefit arrangements. It may be relevant to look at how the UK compares with the Nordic welfare models.

While the UK welfare model is mainly based on means testing, the Nordic welfare models are based on universalism; everyone is entitled to government support. Examples are childcare benefit, unemployment benefit (62%-90% of your most recent salary) and free third level education. Meanwhile, in the UK, childcare benefit and most other benefits are means-tested. Apart from one huge exception: the NHS. Everyone gets every kind of medical treatment for free. And we don’t even pay for appointments that we don’t turn up to. This struck me as a paradox. Although in the UK we apply means testing as an accepted policy, why don’t we also apply to the NHS?

I have come to realise how important our cultural expectations are for how we perceive the world and what we think is right and wrong. Expectations may be set early on, and they are hard to change. We grow up in a particular system and it fosters certain expectations in us. For someone who has grown up in the UK, one expectation is, that the NHS should be totally free for patients

So I am going to propose that if we think a bit differently about how we all can contribute to saving the NHS we may be ok with means testing the services it provides. We may accept that we have to pay a fee each time we seek medical treatment or advice, just like we have to when we go to the dentist.

If you notice that this idea generates some resistance in you, I invite you to ask yourself why. Could it just be because you have grown up with an expectation of the NHS being a totally free service?

Some of my expectations, growing up in the Norwegian system were different. One expectation I grew up with was that we should all contribute to our national health service, not just by paying tax, also when we get medical treatment. There is no right or wrong here, I am just acknowledging that my, and probably your, expectations have shaped how we see the world and our health service.

Change is never easy, and we all feel some resistance to losing advantages that we have grown up with. I believe awareness and developing intercultural competences can be a great help when facing changes in society, whether they are in your home country or host country. How could we use intercultural competence to help us find a solution to the NHS crisis?

I believe that three intercultural competencies, taken from WorldWork’s The International Profiler (TIP®), could be particularly relevant in this situation; New Thinking, Flexible Judgment and Creating Alternatives.

New Thinking implies that we are open to new ideas, and seek to extend our understanding into new and unfamiliar fields.

Developing flexible Judgment allows us to also to keep an open mind and question our assumptions. We can become aware of our own expectations and values, and this awareness is a starting point for finding out how and why we judge people or systems.

When we have to come up with a solution to a problem, Creating Alternatives acknowledges that people and systems may well have different approaches to issues, different ideas about how things should be done and different solutions to common problems.

If we bring this back to the NHS issue, wouldn’t it make sense to also have means tested NHS services in a welfare state model where most benefits are based on means testing? I am not suggesting that we should foot the whole bill of our treatment (we do pay NI after all), but as this tax doesn’t cover anywhere near the costs faced by the NHS, should we not (those of us who earn enough to be UK tax payers) pay some form of fee when we are treated by the NHS? In Norway you pay between £20 and £60, for a medical appointment depending on the type of treatment. And you pay if you miss your appointment. There is also an upper limit of what you pay for medical treatment and medicines each year and if you exceed this limit, further medical services are free.

Doesn’t this sound quite reasonable?

For those of us who want to avoid the NHS being privatised, we may need to contribute a bit more, like the rest of our European neighbours, to keep a national health service.

– Agnes Bamford