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.
Those Indian doctors who have been the backbone of the NHS for the last 30+years are all retiring, as are the post-war home grown baby boomers, and, of course, with Brexit there won’t be any new doctors coming from Europe or beyond.
Formerly, it was quite common for doctors to carry on working for a number of years after 65, many into their 70s. Not that I’m advocating that, doctors have their sell by dates, just like everything else.
But now, on top of the stresses and strains of medical life, comes the issue of re-validation. The generation of doctors nearing the end of their career face, for the first time, a complex, tedious and stressful procedure to re-validate if they want to continue working. This is pushing many into taking prompt, or even early retirement, rather than slog through a process which few believe is useful at this stage of their careers, and with the small but real chance that one may be found wanting. Why risk it? -take the pension and sit in the sun, they’ve worked hard enough, for long enough.
At the same time, at the other end of the career path, the unresolved dispute between the Department of Health and the junior doctors means that for the first time ever, many junior doctors are simply not entering the postgraduate training programme, the only mechanism by which one can build a career in medicine in the UK, either as a GP or hospital specialist. There will even be unfilled places on the foundation programme (the first 2 years after medical school) for the first time ever, 444 spaces as of March 2017.
In the 5 years of the unresolved junior doctors dispute, with Jeremy Hunt imposing a new contract in 2016, the proportion of doctors immediately entering the post-graduate training programme has reduced from more than 70% to less that 50%. That simply means there will be far fewer GPs and hospital specialists coming out at the other end of the programme in the next few years. As the gaps open up, the quality of life for those who make it through deteriorates and so fewer embark. A quarter of middle grade paediatric training posts are vacant, that means a 25% shortfall of specialists in child medicine in 4 years’ time.
This week we hear that more and more hospitals are relying on locums every week to close rota gaps, a totally unsustainable and thoroughly undesirable situation for both patients and doctors, not to mention the finances of the NHS. Something needs to be done, and fast, and frankly Jeremy Hunt is not up to the task.
* Catherine Royce is a retired medical doctor, a former member of the Federal Policy Committee and a member of LibDem Women and Liberty Network.
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13 Comments
The Tories always run down the NHS. They did it all through the 80s and they are doing it now. Along with making more people homeless and franchising assets to their mates it just what they do. Fundamentally, their political ideas are a bit unpleasant and they’ve managed to sell this as “realism”.
Im more concerned about the nurses.
I thank Catherine for this clear exposition of the longstanding problem. Caribbean nurses were in British hospitals in the 1950s. In my home town in rural Northern Ireland the first newcomers form the Indian sub-continent (about 1960) were hospital doctors.
In parts of eastern Europe, doctors are not particularly well paid, so they have been a resource that the NHS could draw on.
In 1950s and 1960s, medical professionals were part of the Brain Drain from Britain, heading towards the Commonwealth and North America. We could be heading this way again.
Like so much of what is wrong with UK society, the NHS suffers from the lack of realistic forward planning.
A very insightful piece from Catherine , much appreciated.
As I say regularly and do today, we must make more of all this.
Too often international importing is seen as the answer rather than home growing.
What is right for the environment can be in other sectors.
Yes for free trade . And in the trade off of skills.
But yes , definitely for trade and training in our own skills and people.
We very much need a holistic approach to replace the mindset of internationalist vs nationalist when it comes to jobs . The lack of funding and doctors is at crisis level.It needs a real end to old thinking.
“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.”
I seem to remember from a conversation with my brother, that it was the BMA who set the entrance requirement – they didn’t want an oversupply of doctors. The Royal Colleges also, at the times he sat his various specialisation exams (needed to advance beyond “Junior Doctor” status and grades), determined the pass rate on the number of vacancies currently in the NHS for his specialisation (paediatric pathology); hence not only was it rare to pass but also candidates had to judge when to sit, given they only had three attempts…
@Roland, I’ve heard similar about some of the Royal Colleges. Supply is kept deliberately short in order to maintain prestige, and of course there are the fees for all of the resits!
The BMA is not a trade union for Drs and the Royal Colleges have sold the specialties out for 20 pieces of silver. As a younger consultant I’m completing my final few forms for a new life down under. If that falls through I’ll try Canada. It’s not just the NHS outlook which is bleak. I voted Brexit as given the binary choice in the referendum I couldn’t vote to remain, not knowing what was on offer. In the GE I’m undecided between Labour, Lib Dems and spoiling my do as I’m still angry as the Lib Dem U-turn on tuition fees. If you could put together a coherent argument and make this an election on reviewing the terms of Brexit, or even a second referendum, you may return a greater number of MPs and bloody May’s nose.
I’ve spent the last three years around my retirement from an NHS consultant job trying to get my MP, a party health spokesman, a life peer in NHS England’s management, and four different sets of investigative journalists interested in this story. The poster doesn’t go half way to fully explaining the problem, which is compounded by pension changes encouraging early retirement. Brexit and Tony Blair’s ending of work permit free arrangements mean medical immigration is no longer attractive.
As other posters have said the BMA have colluded with various governments to restrict training places and the supply of Doctors. We have one of the worst ratios for patients to GPs in Europe. In most specialisms hospital doctors have to survive a really unhealthy long hours culture to make it to the top. If the BMA wanted to change these things they could, but they prioritised pay and Governments prioritised spending as little as possible on training. Its like this because this is how the Government and the Doctors’ union planned it.
The BMA (British Medical Association) doesn’t set the criteria for entry to medical school. The posters above are possibly confusing the BMA with the GMC (General Medical Council), which has “a statutory role to promote high standards and co-ordinate all aspects of medical education and training” http://www.gmc-uk.org/about/25275.asp
To correct a common misperception:
The Department of Health (DH) and the Higher Education Funding Council for England (HEFCE) share responsibility for determining the medical and dental school undergraduate intakes in England. (The strict constitutional position is that DH is responsible for determining overall numbers, and HEFCE has responsibility for the individual distribution to medical and dental schools).
The BMA and mainstream medics have little/no representation (the working party feeding information to HEFCE has several medical politicians on board, and some academics, but no wider representation, and they also acknowledge that CFWFI on which they base their decisions is fairly ropey).
Labour shortages may drive medical salaries up, and be advantageous to the BMA, but successive governments have chosen to limit numbers. Increased medical school intakes and lower salaries will just fuel a medical exodus.
A bigger problem is nursing staff: we’re about 30,000 short and annual leave rates are >9%, having been <6% until several years ago.
Working for the NHS has to be more enjoyable and attractive, but it is difficult to see how to break this spiral.
At the start of the year my other half was in hospital for 9 nights. (We’re a married gay couple: I’m in my 50s, he’s in his 70s.) On the ward, I have nothing but praise for the staff who were from other countries or BME. The ‘indigenous’ white British staff were a different matter apart from the kind, helpful receptionist. The junior doctors came across as emotionally immature and more interested in their lunch breaks and their weekend plans. The nurses had no empathy because their training was quasi-academic (‘yooni’) rather than connected with empathy and care. The lady dressed up as a ward sister was a bureaucrat. The health care assistants were ‘Vicky Pollard’ stereotypes who shouted and screamed at deaf patients. Nobody was really in charge. Fortunately I was able to visit every day, complain like hell, make sure he got the specialist he needed (Indian and first rate) and bring him home – I am self-employed and so I could take time off to give him 24/7 care.
For the British staff, their work was just a ‘job’. For the foreign staff it retained the quality of a vocation.
Worst of all, because British staff refuse to work at weekends, the ward was a virtual desert at the weekend with a few inexperienced agency staff. My husband became very distressed and deteriorated alarmingly during that time. Worse still, he might never have been in hospital had the GP surgery not been closed for the whole – and I mean the whole- Christmas break.
@David Agbamu & Ian Nesbitt – thanks for your clarifications and additional background information.