The cracks in the NHS run deeper than Truss and Sunak think

The cracks in the NHS run deeper than Truss and Sunak think

The cracks in the NHS run deeper than Truss and Sunak think

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Hi, I’m running today’s newsletter while Stephen is on holiday in Lincolnshire. Until very recently, the NHS barely featured in the Tory leadership race. During Tuesday night’s roundups, Liz Truss reaffirmed her pledge to divert billions of pounds to tackle NHS backlogs to social care.

I will not go into that ad here (see John Burn-Murdoch’s illuminating thread why the NHS badly needs this money). The cracks are deeper than you think. Fears of a leaky national pipeline of NHS staff are rumbling across the country as figures show the share of UK doctors and nurses joining its workforce nationwide is at its lowest level in seven years . While an overseas hiring frenzy may fill the short-term shortages, it will not solve the problem of local talent that escapes us.

Inside Politics is edited by Jennifer Creery today. Please send gossip, thoughts and comments to

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There is nothing new in the NHS’ reliance on foreign workers, with around one in seven staff identifying as non-British. But the shift from EU states and the UK to non-EU states is brutal. BBC analysis of NHS Digital data showed that 34% of doctors who joined the health service last year were from overseas, up from 18% in 2014. The share of British recruits fell from 69 % in 2015 to 58%. Last year.

Line chart of nationality of doctors joining the NHS from England showing increasing numbers of doctors joining the NHS from abroad

It’s a snapshot of the movements more generally, as Brexit pushes thousands of EU citizens out of the UK. But non-EU workers are a precarious pool, with some leaving the UK due to expensive visas, as the BBC report points out.

The British Medical Association took the data as evidence of a dysfunctional workplace overcrowded by the 7 million people on its waiting list:

Doctors are cutting their hours or considering leaving the health service altogether for reasons such as: years of wage erosion, punitive pension tax rules, punitive workloads, stress and exhaustion, restrictive immigration rules and, unfortunately, verbal and physical abuse.

The r/juniordoctorsuk Reddit page is flooded with angry posts about working conditions, and MedTwitter tweets about the impact on doctors who are almost too heartbreaking to read. Does the NHS still attract aspiring doctors? I asked my brother, who is halfway through a postgraduate medical degree in the UK, to drop the question in his whatsapp group chat at university.

Without excluding the NHS, the majority of doctors thought going abroad would benefit from better conditions and pay, which in England starts at around £29,000 for young doctors (first year). Some planned to move to Australia or Canada. Although this is not a representative sample, it speaks to a government that does not take its workforce seriously.

A poster on the JuniordoctorsUK Reddit page encourages the junior doctors' strike, including the withdrawal of emergency care

Fight Speech © Social Media Post Reddit

Jack, a 25-year-old F1 doctor who wished to remain anonymous, said after his second year of founding he planned to take a job in another industry, instead of healthcare.

The first week, my hospital was in “code black” (meaning there were no beds available). There are no periods of “winter pressure” — it is now constant pressure, with staff shortages at all levels. When a consultant is on sick leave and there is no senior coverage, juniors do not get proper supervision. I just want to say that I tried it.

Jack would be among a growing number of F2s choosing not to start specialist or general medicine training immediately after completing the two-year basic programme, opting instead to take a break for a year or more, or leave completely. The proportion of F2s who “exit” has increased from 34% in 2012 to 63% in 2018.

The long-term challenge after doctors come through the doors is to retain them – an issue inseparable from salaries. The average NHS salary in real terms has fallen over the past decade. It’s gotten to the point where a junior doctors’ strike, which risks further sinking the health service, is on the cards. A BMA survey found that 72% of young doctors would support the planned industrial action if the government did not raise salaries in line with 2008/09 levels by next month (equivalent to an increase salary of 26.1%).

Groups of doctors have warned that top executives will quit. “The government is implicitly saying that we are going to allow the quality of services to deteriorate,” said Ben Zaranko, senior research economist at the Institute for Fiscal Studies.

Line graph of the average net salary in England in £, taking into account inflation (RPI) showing that real salaries for consultants have fallen by a third over the past 14 years

The remuneration problem does not only affect consultants; it potentially pushes lower-paid NHS workers – porters and cleaners – to move into warehousing and airport jobs. This anxiety is buried deep in the latest NHS pay review:

In oral testimony, employers and the personnel side told us that lower-tier personnel were leaving for other entry-level positions where organizations offered a higher base salary. . . Both Manchester and Stansted airports offer entry level security guard positions from £12.04/hr and £14.00/hr respectively. This is compared to NHS Band 2 roles which are advertised with a starting salary of £9.65/hr, Band 3 roles at £10.40/hr and Band 4 roles at 11 £.53/hr.

Aldi’s lowest strip jobs are increased to as much as £10.45 per hour, with middle warehouse picker jobs rising to £12.66 per hour. With NHS pay rises too slow to compete with the private sector, the government is being pushed into a humiliating corner. Health Secretary Steve Barclay backed the plan to send executives to “countries like India and the Philippines to recruit thousands of nurses,” The Times reported.

Column chart of members of the Nursing and Midwifery Council permanent register showing almost half of new nurses have come from outside the UK this year

“Even within a staffing group — if you look at nurses, for example — the financial rewards for moving up the ladder are lower than before,” Zaranko said. Figures from Ucas last week showed 1,560 fewer students enrolled in nursing courses this year, while the number of UK nurses leaving the NHS rose by more than a fifth between 2021 and 2020.

As Zaranko explained, salary is important for retaining and nurturing a workforce, but other things like work culture and lifestyle also matter. “I think there are fruits close at hand that we haven’t taken advantage of. For example, upgrading computer systems could save clinicians a lot of time spent on administration. »

He also suggested that efficiency improvements could be made to the mix of the workforce, such as introducing more “associate nurses” to help free up registered nurses to focus on nursing care. more complex clinics.

We don’t know exactly what levers to pull to alleviate labor shortages, but not achieving anything – and with the required imagination and scale – will really mean leaving people to their fate.

Now try this

I tried the Ken Ho (not to be confused with the chef Ken Hom) Cantonese restaurant in Birmingham last week. It reminded me a lot of the dim sum tea houses I had visited in Hong Kong, in that there is no reservation.

When you arrive, you collect a numbered ticket and then wait outside the restaurant for your number to be called. The staff speak Cantonese by default (don’t worry, the menus are translated into English), teapots are on the house, and you only have the table for an hour.

I would recommend the braised beef tripe with black pepper sauce, the turnip cake and a favorite classic dim sum: har gow or a steamed shrimp dumpling. They are well worth the wait.

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