Access to healthcare is largely dependent on where you live and how much money you have. It is far from equally accessible to all. The National Health Service (NHS) was established in 1948 to improve access to reasonable standards of healthcare to all residents of the United Kingdom (UK) and to ensure that this was free at the point of delivery. The NHS has been described as ‘the envy of the world’ despite the well-documented challenges it faces. The NHS has driven quality and consistency of clinical care within the UK for decades, and along with universities and many other organisations, it has also fostered a reputation for excellent academic research and teaching. However, the long shadow of the UK’s colonial past on health care provision elsewhere is increasingly recognised. Far from producing and sharing its ‘commonwealth’ equally with people inhabiting the countries it colonised, the UK has been accused of exploiting them in a variety of ways. This opinion piece describes and discusses the past and present influence of the UK in African healthcare and offers some examples of practices that might facilitate improved clinical and academic outcomes for all marginalised people in the near future.