NHS crisis: Never have so many been ignored by so few

The NHS is in an unparalleled crisis and the whole system seems at the edge of breakdown. Everything from care primary from ambulances, A&Es, staffing of hospitals, through to discharge to care is in crisis. Yet, the NHS is being almost ignored in the leadership debate and by the zombie government.

Last night, ITV news ran a short item on the crisis ahead of tonight’s report on the crisis on Tonight (ITV 8.30pm). Ed Davey said the item was “hard to watch”:

Many might find the leadership debates, or perhaps I should say leadership debacle, hard to watch. The economy is vastly important but it is not the only game in town. The NHS should not be a sideshow in the pursuit of politician’s ambitions.

Never have so many been ignored by so few.

Daisy Cooper said:

It doesn’t need to be like this. We don’t need to stand for this. These scenes are the product of political choices. Choices by the Conservative government. The Tories are destroying our NHS. We can and must vote them out.

* Andy Boddington is a Lib Dem councillor in Shropshire. He blogs at andybodders.co.uk.

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  • Geoff Walker 28th Jul '22 - 3:51pm

    The staff shortages created by brexit and demography (baby boom generation retiring} needs to be addressed. The cost of training should be off-set by a requirement to work in the NHS or reimburse the cost of training.

  • Nonconformistradical 28th Jul '22 - 4:21pm

    @Geoff Walker
    How would your proposal that training costs should be reimbursed if the qualified trainee doesn’t then work in the NHS address the immediate shortage of qualified people?

    And how would you enforce it if the person went to work abroad?

  • The way forward is to invest in the physical capacity of the system and shift the balance away from treatment in hospitals into primary and preventive medicine.

    The UK spends just over 10% GDP on healthcare, which places it among other wealthy European countries. The trend over the last 2 decades has broadly aligned with comparable nations.

    The number of qualified permanent GPs in England has fallen by 8% since 2009, but that of hospital doctors has grown by a third. Nurse numbers continue to grow despite more departures this year.

    The result is that the UK allocates most of its healthcare spending to hospital services compared to other nations and far less to preventive medicine, residential and outpatient care.

    In other words, ever growing resources are being used to treat ever more sick people but increasingly fewer resources are being used to prevent people getting sick in the first place.

    The long term focus should be on infrastructure, IT systems and beds – which is a big bottleneck for the patient. For a full decade the UK has invested less in infrastructure resulting in fewer beds and diagnostic equipment.

    Monitor, a now defunct health service regulator, found that A&E wait times were not affected by increased staffing levels in the emergency department, however they were highly sensitive to bed shortages in the rest of the hospital. These shortages in turn created delays in discharges and a steady increase in bed demand.

    (Data from OECD)

  • Jenny Barnes 28th Jul '22 - 4:55pm

    “The cost of training should be off-set by a requirement to work in the NHS or reimburse the cost of training.”
    Didn’t this used to be called bond slavery?
    Reintroduce bursaries and state paid tuition for those studying to be medics; manage the existing workforce properly to stop them burning out – which probably means saying the NHS will have to stop providing certain sorts of care. Sort out the social care sector.
    proper pay rises would be a good idea – at least inflation. What happened to the nightingale hospitals? Move the bed-blockers there- not sure how you would staff it.

  • Voter: “The Conservatives have delivered low taxes and a thriving economy, so I shall vote Conservative.”
    Me: “What about under-funding of health and education?”
    Voter: Because the Conservatives allow me to keep more of my own money, I can afford private medicine and education.”

    That was canvassing in the 1992 GE. Nothing has changed.

  • Steve Trevethan 28th Jul '22 - 5:29pm

    Why do we charge people for learning skills which are vital for the survival and improvement of our society?

  • @Geoff I wouldn’t make it a requirement but if you work in an essential front line public sector role the state should cover your student loan payments for as long as you’re in the job.

    In addition to bringing back training bursaries, etc

  • nigel hunter 28th Jul '22 - 10:22pm

    Jim Dapre. Yes indeed. Make the NHS a disaster area, reduce taxes, put into savings and that saved money can pay for private health care.As in the US it then makes public health,slowly, less important and US style private health system comes into operation.The Conservatives have long since wanted to weaken the NHS.What is ha[[ening is a long term project to reduce the NHS.

  • Junior Doctors work long hours while they are training that more than cover the costs of their training.
    The degree apprenticeship is available for nurses. NHS trusts need to make full use of it usually in collaboration with local universities to ensure there is a stream of new recruits being trained at all times. The problems are not insurmountable but do require flexibility on the government’s part with respect to the apprenticeship levy on the NHS and some joined-up thinking between higher education regulation and healthcare regulation Nursing degree apprenticeships

  • Helen Dudden 29th Jul '22 - 11:07am

    There has been so much talking, but little action with this government. Where are the 40 hospitals? To clap for the NHS is one thing, but to treat the staff with respect is another.
    My granddaughter works on a covid ward in a local hospital, and I have been so concerned for her and their young family. Those of us with familes working on the front line will have the same experience.

  • @ Geoff Walker and others re training:

    It has been recognised since at least Adam Smith that training is subject to a classic market failure. It’s very expensive, so the best strategy is to do none and poach other’s finished trainees – hence chronic undertraining. Despite that, Britain has never had a sensible approach, arguably because people who don’t go to Oxbridge don’t matter to the establishment and never did.

    Happily, there is a proven and cost-effective way to deliver training which incentivises all parties to act responsibly. It works as follows:

    1. Arrange the formal tuition element into subjects grouped into modules where each module comprises a (nominal) year’s study at evening class or block release as appropriate plus some on-the-job training.
    2. So, for instance, four subjects might make a module (a nominal year’s study) and three modules might make a complete course.
    3. Advancing to the next year’s module to be conditional on passing the previous year’s module but repeat of subjects is allowed.
    4. The syllabus should be set and examined by professional bodies with teaching delivered by colleges (evening and/or block release as appropriate).
    5. Employer bears the cost of training fees in the first instance but is reimbursed by government for each subject successfully passed. There can be a bonus for shortage disciplines and/or deprived areas.
    6. Those who don’t complete the course finish up as ‘Part Qualified’ (PQ) or switch to another course and qualify in that.
    7. There are NO age limits.

  • Advantages for trainees include:

    1. Many will have family or other contacts employers happy to give a leg up with the right incentives.
    2. They can change employer if his support is poor or course if the trainee’s interests change.
    3. Employers can’t just treat trainees as cheap labour but must provide effective support or risk losing them to another employer.
    4. PQs are surprisingly useful and often readily employable, both as such and for their cross-disciplinary skills.
    5. Qualifications are nationally recognised and hence portable.
    6. Retraining at any age is possible as changing interests or job markets dictate.

    Advantages for employers include:
    1. Training is funded by government effectively ending the market fail.
    2. The residual risk (that someone doesn’t complete) is small and manageable.
    3. They can risk hiring unpromising youngsters if they see any hope.
    4. They can compete better with a more skilled workforce.

    Advantages for government include:
    1. Training demand is controlled primarily by the market, not by Treasury central planning as now.
    2. Workers will swiftly accumulate the sorts and levels of skills needed by the economy.
    3. Employers are incentivised to be effective sponsors/supporters of trainees or risk losing out.
    4. The purchaser/provider split in providing training is good practice.
    5. There is an easy path to ‘supercharging’ training in shortage disciplines or derived areas.
    6. The availability of a well skilled labour force is the biggest single attractor for potential inward investors.
    7. Bureaucracy (and therefore admin cost) is minimised.

  • Doh! Gremlins ate ate fist half of twopart comment. Hopefully they will soon disgorge.

  • If the government grasped the nettle of the lack of care homes/carers, it would go a long way to easing the current burdens on the NHS. But all they came up with was the NI increase, most of which will be soaked up by the NHS, and which the new PM is likely to reverse anyway.

  • Nursing shortages are not just a UK problem. It is an international issue for much the same reasons including in the US private health care sector https://nursejournal.org/articles/post-pandemic-nursing-shortage/

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