The warnings have been around for years. After five years of turbulence in the National Health Service following the Health and Social Care Act (2012), and with increasing demands from an ageing population, plus the need to increase safe staffing levels following the recommendations of the Francis Report (2013), it has become more than apparent that we are going to need an increased NHS workforce.
The new government of 2015 raised the bar even further by making seven days-a-week NHS one of their first key pledges. Anyone watching from the side-lines knew this would not end well when one of the cornerstones of this policy, the new contract for junior doctors, headed from fraught negotiations to a full on industrial dispute and strikes.
Nursing and midwifery student bursaries are being scrapped in an attempt to increase the number of places that universities can offer on training courses. Yet it’s almost certain that starting professional life with £20-50,000 student debt will deter prospective students.
Most NHS trusts face a recruitment shortfall of up to (and in some cases, over) 10% among nurses and allied health professionals. And more NHS trusts are going into the red, in part because they are relying on more expensive agency staff to cover gaps. There was a significant shortfall in the number of GP trainees over the last few years. This means that long-term we may not have enough doctors working in primary care to keep the backbone of the NHS working properly.
Other factors signal trouble. For instance the long-term pay freeze faced by most NHS staff over the last five to six years or the potential impact of the vote to leave the EU on overseas recruitment. So we can understand why retaining and recruiting staff is getting tougher in the NHS. Many commentators fear the NHS is heading towards a ‘perfect storm’.
Earlier this week two British news outlets published the findings of a leaked risk analysis by civil servants in the Department of Health. It assessed the likely impact of a move to a seven day a week NHS. Increasing the demands when ‘it is not possible to fill all roles (consultants, doctors in General Practice and AHPs) with sufficiently skilled/trained staff to agreed timescales, [means] the full service cannot be delivered’. The whole strategy faces a huge uphill struggle, and staffing issues are at the core of it.
These recruitment and training issues are long-standing. Demographic projections have, for years, shown that we would need more staff just to maintain current service levels, as the population ages and lives longer with more complex health needs. Steps have been taken, but we are just not keeping pace with the need.
The UK is not alone in this – it is a crisis that most wealthy nations face. Different countries are trying to deal with it in different ways, but the biggest problem we all face is that the only way we can get enough staff is to recruit from overseas. Less than half the overseas workers in the NHS come from the EU. Significant numbers come from developing nations which have their own, even more serious health needs that require a strong health workforce.
The WHO estimates that global health worker shortages currently run at 4.2 million worldwide, but could go to nearly three times that figure in the next twenty years. With the West drawing in so many health workers, the developing world bears the brunt of this shortfall. Nations struggling with high infant and child mortality, poor maternal health, largescale health crises from communicable and non-communicable diseases are, by and large, also the ones with the fewest health workers.
This then is the crux of the problem and the route to a solution. Globalisation of the health workforce means that doctors and nurses can move surprisingly freely to where the best pay and conditions are to be found. They will train where they can get the best training to travel the world. Some countries are explicitly training more nurses than they need, knowing that the remittances these mobile workers send back will have a positive economic impact. So no solution will be found by one government working in isolation. We need to work with the EU, with the WHO, the UN, the OECD. The ICN, the WMA and other global professional bodies all need to be involved. For all their faults, these global institutions are the only mechanisms that exist to find a global solution.
I would add into that mix the church. It is the most globalised, networked community on the planet. It is engaged in health work in many of the world’s poorest nations. We should be working more than anyone across borders and political and professional divides.
For individual doctors and nurses in this country, this can seem too big a problem to even begin to address. But we can all do something. It may be taking time out to serve with a mission agency providing healthcare to the least well served communities. Or teaching on a training programme to help upskill and encourage national health workers. We can make real contributions to what happens beyond our shores.
Welcoming, befriending and encouraging migrant health workers in the NHS, especially in the ‘post-Brexit’ environment, can have a real impact on morale as well. In fact, in terms of staff retention, the sort of welcome we give newly qualified staff – from FY1s taking up their first rotation, to newly qualified nurses and midwives starting their first jobs – can have a meaningful and lasting impact. Political action is also needed, and we should not be afraid to get behind campaigns pressing for action on all these issues.
No-one in power has quite grasped the nettle of training, retaining and recruiting health professionals to benefit not only our own nation, but those in need across the world. Maybe it is time we showed them how to do it?