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.

We can only assume the Treasury has decided that allocating sufficient funding for new medical schools is not a priority, rather it will allow the workforce crisis to continue and the NHS to fail, and in fact is ‘baking it in’.

Quietly, but in plain sight, the long term Tory agenda of privatising the NHS continues, the Lansley plan moves ahead slowly but surely, and the largely American healthcare provider sharks continue to circle a very juicy prize, our NHS.

During Covid private health provision continued and even grew, both for insured patients and for self-funding ones. The NHS also used private providers for some elective services e.g. hip replacement, whilst there was no prospect of being able to do any of this work in NHS hospitals, where treating Covid patients absorbed all resources. This practice is continuing, and has a massive negative impact on clinical training particularly for surgical trainees.

The workforce crisis is NOW not in 10 or 15years (the time it takes to train GPs and hospital specialists respectively)

There are two immediate solutions which should be considered; licencing the many refugee doctors who are already here and willing and able to work, many of them specialists just needing refresher training.

Secondly, actively facilitate the return of European doctors (and nurses) who left as a result of Brexit, but then that would require an honest admission of the disastrous failure that Brexit really is. This is the only source of readily available, quality staff in the required numbers who can quickly integrate.

Meanwhile the drip, drip media stories of shortcomings in the service have recommenced very promptly. Don’t get me wrong, there are some real and very serious problems which need to be addressed urgently but in the process, public confidence in the only comprehensive service available for most people is being systematically undermined. We are sleep-walking, it’s time to wake up, ‘smell the coffee’, and start campaigning if we truly value the NHS we have, and want it to continue, improve and provide the care people need.

* Catherine Royce is a medical doctor and was previously PPC for Uxbridge (2001) and Romsey (2017). She is currently a member of the Federal Policy Committee.

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  • Barry Lofty 20th May '22 - 2:37pm

    It is really sad to see the NHS under so much pressure and services deteriorating mainly because of the reasons given by Catherine Royce. The NHS is something this country has been proud of and it would be a tremendous loss for us all to lose it. Having said that my family has had to resort to private health care very recently especially my eldest daughter who needed an urgent operation that could not wait for the uncertainty of a NHS waiting list, she was lucky to have the choice and is thankfully recovering well and with an excellent outlook, I know many people in the country are not so fortunate.? Whether intentional or not the Conservatives do give the impression that they would like to see a reduced NHS in favour of a more insurance based service, it would be a great loss if that were happen!

  • Steve Trevethan 21st May '22 - 8:03am

    Thank you for a heartfelt, knowledgeable and important piece.
    All the short term measures you suggest are all practically and financially straightforward to to.
    Alas, they are obstructed by a party which, currently, is so much more concerned with its own power and egos than the welfare of the general public and their children.
    Such attitudes are profoundly dangerous, medically, socio-economically and politically.
    We need to recognise this and do something about it.

  • David Garlick 21st May '22 - 10:58am

    I agree with the analysis of this article. Barry I think that there is an unspoken plan to allow the NHS to deteriorate to the point of no return untill complete privatisation is the only way forward.
    Herd immunity/Devil take the hindmost, call it what you will, is good for us! It makes work harder for less and ensures that the rich to get richer. Simple as that. We must work with others to defeat this idiology.

  • David I am afraid you are right, the NHS has been a shining beacon that many people in the world look on with envy, to lose it for the reasons you state would be an utter catastrophe but sums up the direction of the present government in so many areas, but I am so glad that my daughter was seen so quickly by the private sector and same goes for my wife when we had to go private for dentistry for urgent treatment which was unavailable from our NHS dentist, we have nothing but praise for our present dentist practice but we are well aware that is not a choice for so many people, perhaps we were being selfish but there are times when decisions needed to be made for personal reasons, oh to see back of this government!

  • Lorenzo Cherin 21st May '22 - 2:53pm

    Catherine, much here makes for intelligent critique. But we, you, must not fall into the trap of the Socialist myth about the NHs. There is nothing wrong in the NHS link with actual private medical provision. A lot is wrong with privatising management of services, but not with utilising private provision with actual available practice.

    You refer to the excellent use of hip replacement, from the private sector. This is invaluable, and ought to continue. It often works very well indeed, we need to integrate and make unified, all provision, not distinguish between, public good and imply, private, bad!

    This is a Line we must draw with Labour, who accept no criticism of the NHS. Many of us have very poor experience often, with it. You allow for and make it clear we need to criticise. But it is not good enough to imply privatisation is use of private provision.
    There is great difference between a small private clinic or service, or a medium size private hospital being given a contract to work for and with the NHS, and a big American multi-national given a contract to run already managed NHS services, administration etc.

    We must utilise other European models, where public and private can and do combine well and often. The sacred cow that is the NHS, is no more. People have woken up to the fact thast we underfund and mismanage and accept both when we should not.

  • The key problem facing the NHS is the massive underinvestment in training and developing health care professionals over many years – under both Tory and Labour governments. This country should train at least enough health care professionals for the country’s needs so we are not reliant on other countries (especially poorer ones) to staff our own health and social care system (whether employed in the NHS or the private sector). It is scandalous that we rely on countries like the Philippines to train nurses in “our” NHS. Brexit is a problem but only in so far as it makes it harder for UK-trained health care professionals to gain experience in other systems.

  • Helen Dudden 23rd May '22 - 12:27pm

    I had to pay £2000 for dental treatment as the lockdown closed down NHS dentists. Four broken teeth that were caused health problems.
    The NHS should have more protection against the interference it’s had from this government.
    It is a great model but sadly abused, it can’t cope with draining of the services and needs the support of those who pay into the financial support.
    Less draining, from those making financial gains and accountability.
    Who ever benefitted from services that were over priced, should have repaid back the sums owed.

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