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.