How should one go about writing about “a £1 billion cash injection to try to fix the NHS staffing crisis” which the Treasury has refused to fully fund? It would surely be deceiving the reader to act as if it were entirely real.
Yesterday the Sunday Times reported that the Government is expected to announce a major push to solve the NHS staffing crisis:
“Under proposals still being discussed, the government is expected to announce a doubling of medical school places for doctors to 15,000 by 2028-29. The plan would also train 24,000 nurses and midwives by 2030, 2,000 more trainee GPs and thousands of dentists.”
Few voters will object to the idea of more medical staff. But the whole thing is lent a somewhat tractor-production-statistics quality by the news that:
“While Jeremy Hunt, the chancellor, has pushed for higher levels of spending, officials in his department raised concerns about committing billions to the plan beyond the next government spending review in 2025.”
Why? Unless someone at the Treasury is sitting on compelling analysis that the NHS workforce crisis is somehow going to solve itself, that money is going to need to be spent, at least if the problem is actually going to be addressed. The only reason not to do so is to leave room to not fund it.
And you can see why they might. Jeremy Hunt chose in the Budget to postpone some £30bn of spending cuts until the 2025 spending round – and it’s always less painful (politically, in the short term) to cancel planned spending than cut current spending. Oh, and:
“Sources suggest that Sunak and other senior ministers are concerned that the costs could eat into the government’s fiscal headroom and ability to cut taxes before the next election.”
Anyway.
We’ll have to wait for the full announcement before we can take an overall view on the plan. There are some positive indicators, especially the reported plans to increase apprenticeships and on-the-job learning; I wrote about the raging debate about nursing turning into a graduate profession back in October.
If the goal is to save money and increase capacity, it makes sense to have trainees working for the NHS, rather than spending years on expensive, government-funded academic courses whilst also employing extra staff to perform the duties which once fell to students.
But assuming that the press reports accurately reflect at least the broad outline of the plans, there are a few glaring omissions.
First, as the Sunday Times notes, is retention. At present, our system is basically that we train medical staff at huge expense, and then they take better-paying jobs overseas whilst the NHS imports medical staff to plug shortages – one reason the Conservatives have made no progress on their headline commitments to reduce net immigration.
As reported, there is little in the proposals to counteract this baleful process (although obviously trainees learning on the job will at least have to give a few years’ service to the NHS until they’re qualified). That in turn would significantly dampen the benefits of doubling the number of medical school places.
The number of medical school openings is set by the Government because they are funded by the state. In a world where the bulk of the graduates had little option but to go and work for our national healthcare monopsony, that might make sense. But high levels of medical emigration make a nonsense of it.
Why not completely redesign the system around retention instead? Lift the cap on numbers and let medical students pay fees like everyone else.
Then, use the money previously used to fund places to repay, over a number of years, the student loans of those who actually work for the NHS. That way, ministers could lift the training bottleneck and make sure that this significant public expense was directly tied to the provision of an actual public service.
As it stands, even if this plan went ahead it would to a great extent be an expensive commitment to train the next generation of Australia’s doctors, whilst the UK continues to meet its own needs by importing medical staff trained overseas.