Many diagnoses have been offered for the malaise racking the National Health Service (nhs). Like lots of 74-year-olds, its vital signs are poor. It has a backlog of 6.2m people on waiting lists. There were 110,000 unfilled hospital and community-care posts in December—a figure that included 8,000 doctors and almost 40,000 nurses. The number of people waiting over 12 hours for admission in a&e is around ten times higher than it was pre-pandemic. As Kevin O’Kane, a consultant in acute medicine, says: “The situation is bad and it’s about to get worse.”
The national mood towards the nhs is souring. “Our nhs” has long had a tender—perhaps too tender—place in British hearts. Britons danced for it in the Olympics; clapped for it in the pandemic; painted rainbows for it everywhere.
An almost religious reluctance to criticise the nhs is now giving way to more audible grumbles. Data from the National Centre for Social Research show that between 2020 and 2021 overall satisfaction with the nhs fell by 17 percentage points, to 36%—an unprecedented drop. Two recent scandals—one over woeful maternity care, another over an epilepsy drug that caused birth defects—have not helped.
There are both immediate and underlying causes for the nhs’s condition. Of the immediate ones, covid-19 continues to complicate the treatment of patients while also depleting numbers of staff. Burnout is a big issue: a survey conducted last year for the British Medical Association (bma), which represents doctors, found that a fifth of health-care workers were considering another career. The situation for those who are still left is “intolerable”, says David Wrigley, deputy chair of the bma council.
A pandemic is bound to put bodies under stress. But it causes a lot more stress to bodies that are already weak and unfit. And the nhs has been unfit for years, in large part because of poor workforce planning. Even before the pandemic, Britain was light on medics (see chart). In oecd countries in the eu, the average number of doctors per 1,000 patients is 3.7. Austria has 5.4. England has 2.9. As Jeremy Hunt, a Conservative mp who is a former health secretary and current head of the health and social care committee, sees it, doctor shortages are “the biggest single challenge facing the nhs now”.
To understand how bad the government’s control of the nhs workforce is, consider its reservoir of doctors. The government more or less knows the current level of this reservoir but neither monitors the pressure in the pipelines that feed it nor the volume needed in future. It has little idea how many doctors it will need next year, let alone in ten. Its workforce planning is, says Dr Wrigley, “non-existent”.
Meanwhile, older and experienced doctors are seeping out of the system with particularly alarming rapidity. One in ten senior doctors are expected to retire in the next 18 months. This is partly due to the difficulty of working as a doctor when older. It is a physically and mentally demanding job. Some things—such as going back to sleep after a 2am phone call—become harder with age.
Yet the nhs operates a one-size-fits-no-one approach to planning medical careers, so a doctor who is 60 is expected to do the same work as one who is 40. Many cannot, or will not. Older doctors are also leaving for financial reasons: a kink in the pensions system means that doctors can lose thousands of pounds in benefits by continuing to work beyond 60. Many may simply hang up their stethoscopes.
A host of factors led the nhs to this mess, but one of the biggest is political. The timescales of doctors and politicians do not mesh well when it comes to workforce planning. “Because it takes seven years to train a doctor and ten years to train a gp,” says Mr Hunt, “it is never a priority for health secretaries or chancellors in spending reviews.” By the time new doctors come onstream “neither of them are expected to be in their current post.”
The slow process of training new doctors means it is too late to fill the reservoir up now. But the government could try to stop existing doctors from leaking away. Changing pension rules so they do not punish people who keep working would help. So would a cleverer approach to career planning: greybeards could be used to train new recruits, for example.
The opacity of the pipeline of future doctors must also be tackled. A coalition of over 100 organisations, including the bma, has written to the government asking it to require independent estimates of how many health-care workers are being trained and how many are needed. Officials, says Dr Wrigley, “are just ignoring it”. Meanwhile, the patience of patients wears thin. The sound of applause fades
Worth pointing out that Jeremy Hunt is one of that architects of these issues. It’s important to say that they can be fixed but only at a price.
The problem is mutlifactorial. Contraversial opinion but..
People not looking after their own health thinking the excessive calories and drinking, smoking is not going to do anything. Ticking time bomb of the education system/ families not teaching adequate health education to their children.
People not being able to AFFORD clean food whilst high sugar, empty calorie trash food being cheap. Chronic disease not being managed properly due to understaffing and miseducation. Aging population that is not only sidelined but full of complex chronic and acute disease that we do NOT have the staff or expertise to deal with (we will need an army of geriatricians).
The NHS being staffed by overseas workers poses a problem. In the sense that how have we got into a position where we HAVE to rely on overseas workers for the NHS to even function. Why are we not training our own? Simple. No one has expanded the entry seats for medicine, and the number of training posts has NOT increased (barely any).
The NHS needs more:Nurses -> arent training moreHCA -> supplied from over seasDoctors -> arent training moreConsultants -> competitive low volume posts
Ontop of the above the seer inappropriate private outsourced contracts that the NHS and trusts use are actually borderline criminal. IT contracts worth millions for no reason. Overly expensive medical equipment because “they can”.
A bristol maid notes transfer trolley, 3rd party, costs £480.00. Locked notes trolley can range to £1000-1500. Painters and decorators being paid 10k just to paint a room. Trusts and the administration staff have lost the plot. A lot of trusts are lead by people who do not believe in change and want to keep the status quo.
Trusts are not run holisitically anymore. They are based on unrealistic targets and figures. And people fiddling the results to earn bonuses, yes bonuses, at the top end of management and pop out the champagne whilst people on the ground suffer.
GPs practises are doing less and less work, outsourcing the jobs to locum/ private GPs for convenience. And here lies the problem. People cant access their GP so the next step for them in their minds is to pop into hospital. One thing to note here is that the very same NHS gps who are working less and less in their GP practises, are working more and more in a private setting. I.e you can get an appointment with your local GP in their private clinic (bupa etc) than with the local practise they work in. Quite funny.
Secondary care in the NHS was never designed to take up the work load of primary care. Theres many other reasons and problems. Some of the solutions are that the NHS needs a ground up rework done properly. No one will do it because the people who are in power to change it don’t know what the NHS needs, and the people who do know how to change it have no power or voice in the NHS.
Meanwhile throughout this a patient is dying of cancer that was not diagnosed because there was no capacity to in a first world country.
You get the NHS you voted for. And the people voted.
All according to plan. Tories salivate at the thought of US style healthcare system in the UK.
of course its in bad shape its supposed to be, or weren’t you born when they did it to British Rail ?
So many issues, management structure, targets as a priority wether they are feasible or not, staffing levels and use of resources etc,etc. They need people who know what they are doing in a hospital as much as they need money.
The biggest problem with the NHS is the shortage of staff which appears to be getting worse. It’s a vicious cycle.
Work pressure and stress seem to be the main non-retirement driving factors.
A shortage of staff is just going to make that situation worse.
With things as they are and the future of the NHS looking like its going down a very dark path you would have to be a Bojo tier moron to not be taking every possible precaution to protect your health.
As worrying as growing public dissatisfaction with the NHS is, it is probably the catalyst that is required for change. I have always been perplexed, even slightly amused, by the way British people would worship the NHS, almost in the manner that football supporters fervently follow their favourite teams. It always seemed to me to be such a strange thing that I hadn’t seen in any other country except the US where people would openly cheer random fire engines as they hurtled down the streets of New York City. How strange. Anyway, my own frustration with the NHS reached a boiling point during the pandemic when scores of masked nurses wrongly felt that choreographed dance routines would be the solution to lift the spirits of the nation. Dancing in the same corridors in which people were dying: audacious. There was a time and place and this was neither. Of course, this is trivial relative to the actual problems the NHS faces but it’s symptomatic of a completely dysfunctional environment in my opinion.
when the population of Britain pays for an NHS that treats the rest of the world that never contributed what did they think was going to happen ???
He we go again, Tory press and sponsored posters, big US healthcare companies all smashing in anti NHS stories, is this the 3rd time in the last couple of weeks. All you Mail readers will miss it when it’s gone and your medicine is £350 a course instead of free.
11 comments
Many diagnoses have been offered for the malaise racking the National Health Service (nhs). Like lots of 74-year-olds, its vital signs are poor. It has a backlog of 6.2m people on waiting lists. There were 110,000 unfilled hospital and community-care posts in December—a figure that included 8,000 doctors and almost 40,000 nurses. The number of people waiting over 12 hours for admission in a&e is around ten times higher than it was pre-pandemic. As Kevin O’Kane, a consultant in acute medicine, says: “The situation is bad and it’s about to get worse.”
The national mood towards the nhs is souring. “Our nhs” has long had a tender—perhaps too tender—place in British hearts. Britons danced for it in the Olympics; clapped for it in the pandemic; painted rainbows for it everywhere.
An almost religious reluctance to criticise the nhs is now giving way to more audible grumbles. Data from the National Centre for Social Research show that between 2020 and 2021 overall satisfaction with the nhs fell by 17 percentage points, to 36%—an unprecedented drop. Two recent scandals—one over woeful maternity care, another over an epilepsy drug that caused birth defects—have not helped.
There are both immediate and underlying causes for the nhs’s condition. Of the immediate ones, covid-19 continues to complicate the treatment of patients while also depleting numbers of staff. Burnout is a big issue: a survey conducted last year for the British Medical Association (bma), which represents doctors, found that a fifth of health-care workers were considering another career. The situation for those who are still left is “intolerable”, says David Wrigley, deputy chair of the bma council.
A pandemic is bound to put bodies under stress. But it causes a lot more stress to bodies that are already weak and unfit. And the nhs has been unfit for years, in large part because of poor workforce planning. Even before the pandemic, Britain was light on medics (see chart). In oecd countries in the eu, the average number of doctors per 1,000 patients is 3.7. Austria has 5.4. England has 2.9. As Jeremy Hunt, a Conservative mp who is a former health secretary and current head of the health and social care committee, sees it, doctor shortages are “the biggest single challenge facing the nhs now”.
To understand how bad the government’s control of the nhs workforce is, consider its reservoir of doctors. The government more or less knows the current level of this reservoir but neither monitors the pressure in the pipelines that feed it nor the volume needed in future. It has little idea how many doctors it will need next year, let alone in ten. Its workforce planning is, says Dr Wrigley, “non-existent”.
Meanwhile, older and experienced doctors are seeping out of the system with particularly alarming rapidity. One in ten senior doctors are expected to retire in the next 18 months. This is partly due to the difficulty of working as a doctor when older. It is a physically and mentally demanding job. Some things—such as going back to sleep after a 2am phone call—become harder with age.
Yet the nhs operates a one-size-fits-no-one approach to planning medical careers, so a doctor who is 60 is expected to do the same work as one who is 40. Many cannot, or will not. Older doctors are also leaving for financial reasons: a kink in the pensions system means that doctors can lose thousands of pounds in benefits by continuing to work beyond 60. Many may simply hang up their stethoscopes.
A host of factors led the nhs to this mess, but one of the biggest is political. The timescales of doctors and politicians do not mesh well when it comes to workforce planning. “Because it takes seven years to train a doctor and ten years to train a gp,” says Mr Hunt, “it is never a priority for health secretaries or chancellors in spending reviews.” By the time new doctors come onstream “neither of them are expected to be in their current post.”
The slow process of training new doctors means it is too late to fill the reservoir up now. But the government could try to stop existing doctors from leaking away. Changing pension rules so they do not punish people who keep working would help. So would a cleverer approach to career planning: greybeards could be used to train new recruits, for example.
The opacity of the pipeline of future doctors must also be tackled. A coalition of over 100 organisations, including the bma, has written to the government asking it to require independent estimates of how many health-care workers are being trained and how many are needed. Officials, says Dr Wrigley, “are just ignoring it”. Meanwhile, the patience of patients wears thin. The sound of applause fades
Worth pointing out that Jeremy Hunt is one of that architects of these issues. It’s important to say that they can be fixed but only at a price.
The problem is mutlifactorial. Contraversial opinion but..
People not looking after their own health thinking the excessive calories and drinking, smoking is not going to do anything. Ticking time bomb of the education system/ families not teaching adequate health education to their children.
People not being able to AFFORD clean food whilst high sugar, empty calorie trash food being cheap. Chronic disease not being managed properly due to understaffing and miseducation. Aging population that is not only sidelined but full of complex chronic and acute disease that we do NOT have the staff or expertise to deal with (we will need an army of geriatricians).
The NHS being staffed by overseas workers poses a problem. In the sense that how have we got into a position where we HAVE to rely on overseas workers for the NHS to even function. Why are we not training our own? Simple. No one has expanded the entry seats for medicine, and the number of training posts has NOT increased (barely any).
The NHS needs more:Nurses -> arent training moreHCA -> supplied from over seasDoctors -> arent training moreConsultants -> competitive low volume posts
Ontop of the above the seer inappropriate private outsourced contracts that the NHS and trusts use are actually borderline criminal. IT contracts worth millions for no reason. Overly expensive medical equipment because “they can”.
A bristol maid notes transfer trolley, 3rd party, costs £480.00. Locked notes trolley can range to £1000-1500. Painters and decorators being paid 10k just to paint a room. Trusts and the administration staff have lost the plot. A lot of trusts are lead by people who do not believe in change and want to keep the status quo.
Trusts are not run holisitically anymore. They are based on unrealistic targets and figures. And people fiddling the results to earn bonuses, yes bonuses, at the top end of management and pop out the champagne whilst people on the ground suffer.
GPs practises are doing less and less work, outsourcing the jobs to locum/ private GPs for convenience. And here lies the problem. People cant access their GP so the next step for them in their minds is to pop into hospital. One thing to note here is that the very same NHS gps who are working less and less in their GP practises, are working more and more in a private setting. I.e you can get an appointment with your local GP in their private clinic (bupa etc) than with the local practise they work in. Quite funny.
Secondary care in the NHS was never designed to take up the work load of primary care. Theres many other reasons and problems. Some of the solutions are that the NHS needs a ground up rework done properly. No one will do it because the people who are in power to change it don’t know what the NHS needs, and the people who do know how to change it have no power or voice in the NHS.
Meanwhile throughout this a patient is dying of cancer that was not diagnosed because there was no capacity to in a first world country.
You get the NHS you voted for. And the people voted.
All according to plan. Tories salivate at the thought of US style healthcare system in the UK.
of course its in bad shape its supposed to be, or weren’t you born when they did it to British Rail ?
So many issues, management structure, targets as a priority wether they are feasible or not, staffing levels and use of resources etc,etc. They need people who know what they are doing in a hospital as much as they need money.
The biggest problem with the NHS is the shortage of staff which appears to be getting worse. It’s a vicious cycle.
Work pressure and stress seem to be the main non-retirement driving factors.
https://www.nuffieldtrust.org.uk/resource/the-long-goodbye-exploring-rates-of-staff-leaving-the-nhs-and-social-care
A shortage of staff is just going to make that situation worse.
With things as they are and the future of the NHS looking like its going down a very dark path you would have to be a Bojo tier moron to not be taking every possible precaution to protect your health.
As worrying as growing public dissatisfaction with the NHS is, it is probably the catalyst that is required for change. I have always been perplexed, even slightly amused, by the way British people would worship the NHS, almost in the manner that football supporters fervently follow their favourite teams. It always seemed to me to be such a strange thing that I hadn’t seen in any other country except the US where people would openly cheer random fire engines as they hurtled down the streets of New York City. How strange. Anyway, my own frustration with the NHS reached a boiling point during the pandemic when scores of masked nurses wrongly felt that choreographed dance routines would be the solution to lift the spirits of the nation. Dancing in the same corridors in which people were dying: audacious. There was a time and place and this was neither. Of course, this is trivial relative to the actual problems the NHS faces but it’s symptomatic of a completely dysfunctional environment in my opinion.
when the population of Britain pays for an NHS that treats the rest of the world that never contributed what did they think was going to happen ???
He we go again, Tory press and sponsored posters, big US healthcare companies all smashing in anti NHS stories, is this the 3rd time in the last couple of weeks. All you Mail readers will miss it when it’s gone and your medicine is £350 a course instead of free.