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 is a medical doctor originally trained in the NHS, but has spent many years as a surgeon and medical researcher working in east Africa, Asia and China. She has also been a Lib Dem PPC.