Author Archives: Catherine Royce

The NHS is dying … it’s about the  workforce

While everyone is focused on the very real and acute cost of living crisis and the war in Ukraine the NHS is quietly imploding, more staff leaving than joining and therefore services collapsing.

It’s not simply a matter of throwing more money at it, we are way past that stage, and as we learned from the Nightingale hospital fiasco, you can build all the hospitals you like but if there is no workforce to staff them, they are just so many white elephants.

The workforce is on its knees and many who stayed on or returned during the Covid crisis are now leaving or returning to retirement, others simply leaving because they are exhausted, increasing the strain on those left behind. The crisis is particularly acute in psychiatry and general practice, where services are collapsing just when they are needed most to deal with the fallout of Covid.

So the fact that there are 10 new medical schools should be good news, except that they will only add about another 1,000 doctors to the workforce annually and only in 5 years’ time, against a calculated shortfall of 15,000 annually. So you may be as surprised as I was to learn that 3 of those new schools; Chester, Brunel and Three Counties, will only be accepting private students from overseas this coming October, and why is that? – simply that the Treasury has not made funds  available to support home grown medical students, £35,000 each annually for the 3 clinical years of undergraduate training; yes, medical training is expensive. The government’s solution being to let these new medical schools admit overseas students instead, who bring with them £40,000 each a year in overseas fees.

Whilst that may be an attractive business model for the medical schools concerned it does nothing to address our own needs and exacerbates the workforce crisis into the future. Meanwhile applications from home-grown candidates have soared and many are being turned down, even though they have top grades and should have been able to expect medical school places.

I think you can agree with me that students coming from countries such as Australia, Hong Kong, Canada and India with that kind of money at their disposal, are most likely to be from wealthy, well-connected families, and are unlikely to be planning to make a long-term contribution to the NHS workforce or make the UK their permanent home. They may stay long enough to complete their postgraduate training but my guess is that they will be returning to privileged positions back home just as soon as they can.

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The long road to eliminating FGM… is too long

It’s nineteen years since the Female Genital Mutilation Act of 2003 became  law, and seven years since mandatory reporting of cases was introduced in 2015. So how are we doing? – and is FGM still an issue? – short answer, we are making some progress but it is still very much an issue affecting thousands of girls living here in the UK on the same streets as us, and millions of girls globally.

February 6th  will mark the 10th anniversary of  the International Day of Zero Tolerance of Female Genital Mutilation (FGM) with all UN agencies moving towards elimination by 2030 by ‘collective abandonment’ of this ancient but cruel cultural practice which is carried out on 2-3million girls every year, thousands of them  here in the UK.

It is worth reiterating that there is no religious obligation or reason, in any religion for this practice, it is purely cultural.

It is estimated that globally 100-200 million women survivors are living with the consequences of FGM, which has devastating effects on their lives, health and well-being. For comparison, approximately 40 million people are living with HIV/AIDS.

Last weekend I attended a medico-legal conference on the multidisciplinary approach being taken to Female Genital Mutilation in the UK, and here is what I learned.

There has now been a successful prosecution in England (2019) resulting in a lengthy prison sentence for the perpetrator. A handful of other cases are currently under investigation, but it is increasingly clear that we cannot prosecute our way to elimination, we were told by a police specialist. Successful prosecutions are likely to remain few and far between, although they do send a very strong signal.

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We need to talk about drug addiction, decriminalisation, legalisation and regulation

It’s time to look again at our policy on drugs,  a topic which we can ‘own,’  which will get us noticed In the media and, which will differentiate us from Labour and Conservatives.

I’m not talking about cannabis, recreational use has become almost mainstream, is  more or less ignored by the police and is certainly far, far less harmful than either tobacco and /or alcohol, -that is established medical fact.

The medicinal uses of cannabis are now being acknowledged and established, even if there is a long way to go on further research and getting the medical supply chain organised.

No, I want us to talk about the hard stuff; class A, like heroin and cocaine. This is the topic where a change in mind-set is needed,  an end to ‘the war on drugs’, and if that can be achieved the medical and societal gains will be huge.

Since the general election in 2019 we Liberal Democrats and to a lesser extent Labour have become more or less invisible; – not surprising in the face of a national and international health emergency of monumental proportions. But, as the total incompetence of the Johnson Tory government on almost every front becomes  more obvious with every  passing month, it’s high time for us to emerge from the shadows and start some proper debate on some fresh topics both in health and beyond, and  which might get us some useful media coverage as a bonus.

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We need to shout about …….. Community choirs


No sooner are we past the so-called freedom day than the Johnson government finally starts believing in the vaccine programme, having systematically undermined it for the last two months by pretending that vaccinated people pose a risk, should not socialise, travel  and must be treated in the same way as those who have not been vaccinated. This makes a complete nonsense of the vaccination programme and has sent the message to vaccine ‘hesitants’ that there is therefore no point in getting the jab and maybe even that there is something bad about vaccines we aren’t being told. Quite why Chris Whitty and Patrick Vallance have allowed themselves to be part of this anti-science strategy is a subject for another time.

I’ve enjoyed watching all those mostly young, male, football fans hugging each other and shouting their heads off over the  last few days, but bearing in mind that very few if any will have been vaccinated, what exactly is going on? – is this a social experiment in herd immunity? Perhaps so, and why not, as most, if not all, of them are very unlikely to be ill enough to need hospital if they do get infected. We do need to test the herd immunity hypothesis; and although it’s unfashionable I still believe it has an important role to play. Many middle and low income countries, which are unable to hoard vaccines far in excess of any possible requirements (e.g. UK and USA) are relying on herd immunity, and are doing a lot better than we are – that’s interesting.

There have been several sporting event pilot studies in England over the last few months but we have not seen the results of any of them, I wonder why that is? Possibly because the results are clear-cut and don’t fit the muddled and contradictory messaging from Ministers? What is very clear is that the current messaging strategy has far more to do with saving the Prime Minister’s political skin than with science.

For context, currently ten times more people are dying every day from alcohol-related diseases than from Covid.

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We need to talk about the Healthcare workforce – again

So what’s changed since my last piece for LDV on this ten months ago? – nothing and everything, in a phrase, it’s got much worse.

Last March the fear of an unknown, rapidly spreading and possible deadly virus, the prospect of the NHS being overwhelmed; inadequate ventilators and ITU beds, terrifying pictures from Italy of a modern health system crumbling in front of our eyes and our own government indecisive and floundering, with no plan and even less preparedness, galvanised the NHS workforce as never before in living memory. Things happened fast; the NHS workforce rose to the challenge, found the energy, carried on under almost impossible odds, and paid the ultimate price.

I won’t recite all the twists and turns, everyone knows them very well, except to say that you can build all the Nightingale hospitals you want, but if you don’t have the skilled workforce to staff them, they are pretty useless.

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Are we being led by the science?

Well, that’s what we are told at the daily press conference, but is it true?

It’s becoming evident that the 2-metre social distancing rule is exceedingly problematic if it’s to be continued once businesses re-open, particularly for small cafes, restaurants and shops which are too small to implement it and will cease to be viable. So, the evidence to support it must be very strong, mustn’t it?

I have not been able to find that evidence anywhere, and significantly the WHO has settled on a much more pragmatic, achievable and sustainable one-metre distance. I made a few more discreet enquiries yesterday, and the answer came back that ‘there is no evidence’.

Does Chris Whitty, Patrick Vallance and SAGE know something we don’t?  – we certainly hope so, but if this secret society does not publish its membership and meeting minutes how can we trust the government to have taken their advice seriously, rather than manipulated it, particularly now we know who else attends these meetings.

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We need to talk about the healthcare workforce

As a nation, we have spent the last month endlessly talking about PPE, testing and even ventilators, remorselessly picking over the technical details of things which most people still do not understand. The government is pleased for us to do this because it keeps us off the one topic they have no answer for; the elephant in the room of a totally inadequate healthcare workforce stretched to breaking point. Even with all the goodwill in the world, re-calling retired doctors and nurses doesn’t solve it.
There are many good reasons why the NHS is supposed to run at 85% of capacity; one is so that there is then some slack in the system for unforeseen emergencies. That has not happened in the last few years as successive Conservative governments have squeezed the service harder and harder driving capacity dangerously close to 95% and beyond, not addressed staffing shortages at all levels and reduced the bed numbers by too much (by at least 7,000) Eventually acknowledged by Jeremy Hunt himself towards the end of his 7+year tenure as Secretary of state for Health and Social Care.

The summer ‘respite’ for the health service didn’t happen last year or the year before, or the year before that, and the workforce has remained thousands short across the board; GPs, hospital specialists and trainees, nurses and care workers, result; an exhausted workforce close to burn-out. Add to this the wanton neglect of an able and willing EU workforce over 100,000 which was pushed out by a hostile environment as Brexit became a reality at the end of 2019 and here we are reaping the whirlwind.

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July meeting of Liberal International in London

You might have been so be-dazzled by the London Pride parade back in July that you missed the 202nd Liberal International Executive Committee meeting which took place on the same day at the National Liberal Club (and which incidentally gave perfect grandstand viewing of the parade in the streets below) .

I’ve only recently started going to these international political meetings (since I retired and now have the time!) but the dynamic is quite different from UK political meetings and very energising. There are many younger participants and many, many more women to offset the usual pale, older males, and where else could I sit next to the Foreign Minister of Somalia? -and very interesting he was too.

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Assisted dying – an expression of individual freedom

This resolution proposed by PLC, Partido Liberal de Chile and supported by D66 of Netherlands and LIBG Liberal International British Group was hotly debated during the Human Rights Committee session at the 200th Executive Committee meeting of Liberal International held at the headquarters of the Free Democratic Party of Germany in Berlin this weekend.

Despite strong reservations from several delegates to the original wording and a proposal to refer back, a ŷlast minute re-write during the session which addressed all of the reservations expressed led to success, with a large majority of delegates voting for the resolution during the following …

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Will the last doctor to leave the NHS switch off the light

 

Whilst the media concentrate on  shortages of beds, longer waiting times and the increasing indebtedness of Trusts,  all of which can easily be solved by investing more money, ie. a choice (or not) of the government of the day, something far more fundamental is happening – doctors are leaving the NHS.

This cannot be solved by money, or government dictat,  because the goodwill of medical staff which successive governments have taken for granted has run out, and frankly, doctors have sufficient skills to go anywhere in the world.

From its inception, the NHS has relied on imported staff from abroad; in the ‘50s and ‘60s it was mainly porters, cleaners and cooks from the Caribbean. In the ‘70s and ‘80s it was doctors from the Indian subcontinent and nurses from south East Asia and since the ‘90s from Europe.

The UK has never produced sufficient home grown doctors, partly because of the idiotic insistence of the system in pretending that almost no-one is academically gifted enough to get into medical school. Getting 4A* has little to do with becoming a good doctor; it’s just an effective way of stopping perfectly good candidates getting into medical school. The medical school expansion programme in the ‘70s didn’t fix the problem and neither will Jeremy Hunt’s offering of 6,000 more places over the next five years; the problem is much, much worse than that.

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Update on progress tackling Female Genital Mutilation in the UK

February 6th was Zero Tolerance Day for Female Genital Mutilation.

Mandatory reporting of all cases of female genital mutilation identified in the UK has now been in place for about 18 months and useful data are emerging.

However, there has still not been a single successful prosecution in the UK, although several cases are currently under police investigation.  A major barrier to prosecution is the understandable unwillingness of girls to give evidence in court against family members.

In the last 12 months 8,656 cases were reported of which 5,702 were new referrals to the specialised clinics that treat and care for these women and girl survivors. 106 cases were below the age of 18years. These are people living in the UK who have previously suffered FGM either in their home country or since arrival the UK. 

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Profound Brexit implications for the UK’s Life Science industry

Last week I was hoping to hear Liam Fox speak on ‘Maintaining the UK life sciences’ leading position’ at a Royal Society of Medicine symposium ‘Brexit; the Implications for the UK’s Life Science Industry’.

He cancelled (what an (un)surprise). The implications for academia, industry and the NHS are profound.

Already universities, research institutes and individual researchers are feeling the chill, particularly for long term EU grants.

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The junior doctors’ strike is about the existence and future of the NHS

I’d like to clarify a few points raised in the LDV comments thread related to the Doctors strike and Tim Farron’s remarks about it. First, I will state my potential conflict of interest: I’m a doctor (retired) a life-long member of the BMA (yes, I do still pay my union subscription) and my daughter is also a junior doctor.

The strike is happening because Jeremy Hunt has stated that he will impose a new contract on juniors against their will in August 2016. Negotiations, which have been conducted over the last three years with the BMA, have broken without any agreement and, thus, junior doctors are withdrawing their labour, as a last resort.

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Opinion: Time to dump the 4 hour A & E target

To be frank, as a doctor, I have been underwhelmed by our Liberal Democrat offering on health issues over the years; certainly we are not as strong on health as we should be.

The almost daily drip feed from the right wing press on NHS shortcomings and failures is demoralising to staff and frightening to patients and designed to be so. It serves no-one except those who want to undermine the public’s confidence in the NHS. The service treats three quarters of a million patients every day of the year, and for most people there is no alternative.

So I am  relieved that at last we have something distinctive to offer with Norman Lamb’s ideas on mental health; parity of access and delivery, more  research and funding. This is important, and we need to ‘own’ it as Liberal Democrat policy.

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