The NHS is facing an existential crisis, shadow health secretary Wes Streeting said last week. The health service needs to ‘reform or die’. Cue the reaction.
Sam Tarry, the recently unelected Labor MP, expressed “dismay” at his colleague’s comments on the health service, while Diane Abbott has warned his Twitter followers that Streeting is ‘trying to push for a privatized/insurance based NHS’.
Following his comments, the shadow health secretary admitted he was now out of favor with several of his Labor Party colleagues, but said he had received “some kind words from unexpected sources”, namely writers in the Times Y Telegraph – following his speech. And he has yet to try to retread his ‘reformist’ ideas, holding a question-and-answer session at the center-right think tank Policy Exchange on Friday, titled: ‘A roadmap to doubling places in law schools. medicine’.
Last Friday was also the first time that nurses from England and Wales had taken part in industrial action in NHS history. Eager to avoid tiptoeing past the elephant in the room, Streeting opened up about this. He blamed the strikes on ’12 years of failure to grow our economy, 12 years of freezes and pay cuts’. He spent four years on the Treasury Select Committee and could not “remember that the Bank of England’s monetary policy committee ever blamed the poor growth of an NHS waiting list.”
But while his speech was unsurprisingly extremely critical of the Conservatives, Streeting it didn’t come much easier for the NHS. “When the NHS is failing patients, as is so often the case today, it hurts all of us,” he said. Half of those on the long waiting list of seven million are of working age, he continued, and “the cost of the NHS failing to provide the standards of care patients deserve” means these people are unable to live their lives to the fullest.
Streeting has backed a Policy Exchange report, authored by Dr Sean Phillips and Iain Mansfield, which lays out a seven-step scheme for expanding the number of places in UK medical schools. Addressing the shortage of doctors facing the health service, Streeting agreed that the government should commit to doubling the number of medical students, “to enable 15,000 medical students a year to enroll in courses in England by 2029.” This should feed into existing plans in Scotland, Northern Ireland and Wales and by 2040 the report predicts this would result in an additional 45,000 doctors. While the suggestion to increase places in medical schools is by no means original, the shadow health secretary believes this it would present new opportunities to ‘modernize curricula, incorporate new technologies and training techniques’ and find ‘a new balance between generalism and specialisation’ in healthcare.
Labor’s plan would also involve training 5,000 new community health workers a year, as well as focusing on fair wages and working conditions to ensure care workers do not retire.
Of the seven ‘critical pathways’ that form the cornerstone of the Streeting-backed Policy Exchange report, ‘diversify the talent pool’ is one. This could be achieved, for example, by allowing entry of participants with lower grades but higher scores on relevant entrance exams, and by improving access for applicants from disadvantaged backgrounds and underrepresented groups. The idea is not new: the University of Glasgow is one of many institutions in Scotland that employs a ‘Attain’ program for those applying from more deprived areas, but expanding entry requirements by accepting that the able and bright students are not necessarily represented by their grades is definitely a useful, if obvious, way to expand admission to the course. There will always be concerns that this will reduce the quality of graduating physicians, but as long as university standards do not drop, this should not be the case.
The report contains several other interesting recommendations. Joining the drive for more medical students is a requirement for more medical schools in “underserved” areas of the country. This reflects the University of Cumbria’s recent partnership with Imperial College London, which resulted in plans to build a new medical school at Carlisle. More medical schools mean more medical professors. The report highlights the need to encourage more doctors, particularly recently retired ones, to stay involved in medical education. And as medical courses become increasingly clinical, deaneries and medical schools should be encouraged to work together to ‘strategically plan’ the allocation of medical school places in doctors’ offices and hospitals. header.
Neither of these ideas is particularly innovative, as one audience member pointed out. And while Streeting’s focus on medical school locations is a start, there are still some pretty big questions left unanswered. Implementing his plan would cost at least £1.2bn between 2024 and 2029. One way to support “the financial viability of [this] The plan suggests the expansion may be to increase the proportion of international students studying medicine at UK universities, from 7.5% to 10%. While increased medical school places will logically lead to more doctors graduating in the UK, international students often return to their home countries or work abroad soon after qualifying.
That’s not to mention the number of British doctors who move elsewhere, often to Australia, to work after finishing their years of basic training. In 2011, the UK provided Australia with 13 per cent of its GPs and 22 per cent of its specialists. Six years later, a 2017 BMJ report found that the number of British doctors working abroad in Australia and New Zealand continued to rise. increasewith an increase of 17 percent between 2014 and 2016.
There is a huge retention problem in medicine, and many of my former classmates are planning to move to Australia after qualifying. Some are already there. I lobbied Streeting about this in the Policy Exchange talk: as much as we want to attract more medical students, how do we keep them in the UK without inadvertently funding doctors for other countries?
“Over the next few years, there will be more to say not just about recruitment, but also retention and return,” Wes Streeting responded. (Here, ‘return’ refers to the push to bring back doctors who have left the health service to help ‘replenish the workforce.’) But clearly, Streeting can’t offer much on this right now. Indeed, while the shadow health secretary has clearly spoken to a large number of healthcare students across the UK, including those on nursing and midwifery courses, to understand the reasons why newly qualified doctors want to leave the NHS, after Receiving your medical degree is much lower on your priority list. Wes Streeting seemed convinced that creating more positions for young doctors would encourage current medical professionals to stay. However, his plan does not seem to take into account the obvious time lag between the increase in places in medical schools and its reflection in the number of workers, or the aforementioned dilemma of international students.
Undoubtedly, there are many positive aspects to be drawn from Streeting’s proposals. Medical school curricula have evolved dramatically over the last 30 years, and focusing on the development of clinical and simulation-based teaching will only help better prepare medical students for hospital work. It is vital to consider new approaches to help applicants gain access to medical courses. But for the NHS to reform in a way that puts its patients first while keeping healthcare staff on the side, politicians need to better show how the solutions they offer will actually help, in real and practical terms. And they need to fully understand the issues facing healthcare workers if they want to retain them. Right now, I’m not convinced they do.