What’s the best birthday present the NHS can get? More capacity


As he celebrates his birthday, I like to think the NHS will look back with pride on how it got through his 72nd year; probably the most difficult he has ever encountered. This pride in a challenge well met (but by no means finished) should, of course, be shared by so many – doctors and nurses, public health and social service professionals, and many others too numerous to consider. be mentioned.

There will be warm words of appreciation for these staff, I’m sure, but what I and many other colleagues hope to hear is how we will learn from the pandemic. I am supported by the persistence and tenacity of my colleagues and everyone who works in the NHS and who have expertly helped us through such difficult times. But having worked in the Covid-19 services myself, I know how badly the NHS has been affected. The Royal College of Physicians found that more than one in four doctors requested mental health support during the pandemic – a startling figure that reflects the intensity so many have faced.

With a new Secretary of State for Health and Social Affairs, the best gift we can give NHS staff for the 73rd anniversary of the health service is more capacity.

The key to the solution is more people. Even before the pandemic, nearly half of the consultant positions advertised in England and Wales were unfilled. The NHS cannot provide optimal patient care without the right number of people to staff it – which is why Nightingale hospitals have gone largely unused. The UK has significantly fewer doctors and nurses per capita than our international counterparts, with just under three doctors per 1,000 people. This is less than New Zealand (3.35), France (3.37), Germany (4.3), Norway (4.93) and Austria (5.24). The UK is well below the average of 3.7 in the 37 countries of the Organization for Economic Co-operation and Development (OECD).

It’s worse for nursing: we only have 7.78 per 1,000 people, compared to 9.95 in Canada, 10.1 in Denmark, 11.89 in the United States, 13.22 in Germany and 17 , 97 in Norway.

The challenge of too few staff will become more difficult if we don’t act now. The population is aging and clinical demand is increasing as experienced senior doctors retire and a growing number of those entering the NHS work part-time.

A new RCP survey finds that 27 percent of consulting physicians plan to retire within three years, and 42 percent of that group plan to retire within the next 18 months. The same survey showed that more than half (56 percent) of interns would be interested in working less than full time.

One-fifth of physicians are currently working less than full-time and this number is expected to continue to grow as expectations for work-life balance change. This compression of capacity at each end of the system requires a long-term workforce recruitment and retention strategy, as well as proper workforce planning to assess the number of professionals in the field. health that we need in the system to meet patient demand. It takes about five years to train a doctor, so we need to start planning for that now.

The RCP has long called for doubling medical school places to train more doctors in the UK. Students entering medical school in 2028 will not be experienced consultants until around 2040. And by then, the Office for National Statistics (ONS) predicts that the number of people aged 85 and over will have doubled and those over 65 will account for a quarter. Population. The patient population will be significantly different 20 years from now, but we know this is a challenge we can prepare for by acting now.

Training doctors costs money, but not training doctors is not free. The RCP has calculated that doubling the number of places in medical schools would cost around £ 1.85bn annually – less than a third of the £ 6.2bn spent by hospitals in 2019/20 on branch and bank staff (The RCP’s 2019 census found that on average locals made up around 10% of consultants in UK hospitals, with 4% having 30-40% of locals).

More staff and better workforce planning would also reduce the pressure on the workforce – so that they would be less likely to leave due to burnout and stress and improve the workforce. ‘access to care for patients.

More capacity in the system means more staff – but that should also mean less demand. A sustainable funding deal for social services would help more people live as independently as possible in the community. Currently, the funding gap is leading people who cannot access social care services to turn to the NHS for help or, worse yet, unmet social care needs, resulting in a deterioration so serious to their health that they need urgent NHS care.

But when we consider ways to reduce the demand for NHS services, we need to look beyond the Department of Health and Welfare to focus on the wider inequalities in our society that so often lead to poor health. Avoidable differences between different parts of society and between (or even within) different parts of the country have been around for a long time, but have been severely exacerbated by the pandemic.

We know, for example, that obesity is twice as prevalent among adults living in the most disadvantaged regions of the country than among those in the least disadvantaged regions. With 30 percent of UK Covid-19 hospital admissions directly attributed to overweight and obesity, it is indisputable that lives could have been saved if the poorest in our society had not been neglected for so long.

We need an intergovernmental strategy to tackle health inequalities, with a strategic review of housing, jobs, education and more, to give people the best possible chance to live longer and live longer. better health.

It’s only natural that birthdays are a time to look back, but let’s make last year a turning point and look forward to a new future for the NHS.

Andrew Goddard is President of the Royal College of Physicians

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