At the recent Commonwealth Intergenerational Dialogue during the World Health Assembly, I found myself sat amongst global health leaders and frontline workers, each armed with all too familiar stories of the of challenges and determination from the health systems they serve. Whether in the UK, the Caribbean, or sub-Saharan Africa there were striking parallels around the concerns for the future of the healthcare workforce – namely health systems under strain, workforces under-supported, and leadership struggling to meet complexity with compassion and direction. As a youth leader representing the UK, I couldn’t help but reflect on what the NHS might learn if it were to listen to the voices outside its borders. The conversations I witnessed were grounded in the daily realities of delivering care amid scarcity, rapid change, and deep social need. Leadership in these settings has been redefined to one that champions resourcefulness, collaboration and adaptability, and in the wake of the NHS 10 year plan, these are the kinds of lessons we need now more than ever.

One pertinent truth was the need to hear the voice of young leaders when policy and decisions are being made. Across the Commonwealth, it is the younger generation stepping in to deliver services, build digital tools, and respond innovatively to healthcare challenges. From community clinics in rural India to grassroots mental health campaigns in Trinidad, young people are often closest to the needs of the population. Yet, their insights are rarely sought where it matters most; in the rooms where policy is shaped and priorities are set. In the NHS, we speak the language of inclusion and innovation, but we fail to practise it fully when we overlook the leadership already emerging on the ground. If we are to build health systems fit for the future, we must involve young people meaningfully, as valid partners in shaping the way forward.

Digital health, whilst so often hailed as the answer to system inefficiencies, was another theme that revealed uncomfortable truths. Many countries, with far fewer resources than the UK, are succeeding not because of what they build, but because of how they build it. Their digital tools are deeply rooted in local context, shaped by the people who use them. Too often in the NHS, digital transformation feels imposed, not co-created. If we are serious about delivering better care through technology, leadership must first understand the community it seeks to serve. The key message being that digital infrastructure needs to be appropriate, not just advanced.

Workforce retention is an all too familiar narrative across the globe – underpaid, overworked, and overlooked health professionals are leaving, and the NHS is not exempt from this. Whilst low pay forms part of the problem, leadership and workplace culture that doesn’t nurture progression also contributes. Healthcare workers are leaving systems they feel invisible in, taking with them a rich depth of knowledge and experience.

What was perhaps most inspiring was how people are building bridges across sectors. Health leadership, in the best examples, was extended to youth groups, tech startups, education systems, and the voluntary sector. There’s a humbleness in that form of leadership, a recognition that no one institution holds all the answers. For the NHS, the lesson is clear: effective leadership means reaching beyond traditional boundaries. To deliver person-centred care, we must move from siloed strategies to sustained partnerships and collaboration must be embedded within all work.

Migration discussions often centre around “brain drain” and fears that international fellowships syphon talent from local systems. Yet, many Commonwealth countries are reframing this as “brain circulation,” where professionals train abroad and return home strengthened to support their communities. The NHS has long benefited from the skills and dedication of global health workers. To truly lead ethically and sustainably, UK health leadership must prioritise retaining the talent it helps to develop through fellowships and training programmes, while actively supporting reciprocal exchanges that promote mutual learning. For the NHS to be a truly responsible global health leader, it must go beyond benefiting from international talent and commit to ethical recruitment and genuine partnership. By investing in reciprocal training opportunities and supporting the return and retention of skilled professionals, the NHS can help build a more equitable global health workforce.

And finally, one of the most frustrating yet common stories I heard was that of wasted potential—qualified professionals unable to practise, their skills disregarded due to bureaucratic or cultural barriers. Brain waste is perhaps the most silent and corrosive crisis in global health and is also present in the UK, especially among migrant clinicians and underrepresented groups whose leadership is stifled before it begins. If we cannot recognise and nurture the talent already among us, how can we hope to lead with credibility?

The NHS has long been a model of publicly funded, universally accessible healthcare. But models must evolve. What I learned from the Commonwealth Dialogue is that our challenges are not unique, but our responses can be. Leadership in healthcare today must be adaptable, innovative and bold enough to learn from beyond its own borders. It must trust young people not just with feedback surveys, but with decision-making power. It must value lived experience as much as clinical data. It must collaborate across silos, build equitable systems, and confront uncomfortable truths. The front lines of global health are not just places of scarcity; they are places of ingenuity.

Author

Bhavna Halai – Chief Pharmaceutical Officer’s clinical fellow – CQC

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none