Staffing is the issue most often keeping NHS leaders awake at night – and consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to both the daily pressures on staff, and the wider trends and policies shaping NHS staffing. Contact me in confidence

The Royal College of Paediatrics and Child Health has warned in no uncertain terms, as I report this week, that big child health workforce shortages could threaten the NHS’s ability to improve health outcomes for this group.

This is alarming, even more so considering the context - as has been highlighted in recent months, infant mortality in the UK is higher than some European peers and not moving in the right direction.

Among older children and young people, the UK has a higher rate of “medical” mortality than elsewhere, and high mortality for preventable causes such as common infections and asthma. 

Ensuring a robust workforce – including health visitors, paediatricians, paediatric nurses and others – to improve metrics like these (which are covered by ambitions of the NHS long-term plan), must be a priority.

In an exclusive interview with HSJ, college president Russell Viner said as part of workforce planning now under way, he wanted proposals designed specifically for children anad young people, “rather than just blend it in” to the whole. 

The long-term plan has aspirations to create an integrated service for 0-25 year-olds. It’s an interesting concept which, Professor Viner asserted, would account for 30 per cent of the total population.

In doing so, government, NHS England, NHS Improvement and others involved will have to recognise this is a complex workforce; but also try to accelerate short-term filling of posts.

The college has called for paediatric consultants, trainees and SAS doctors to be placed on the shortage occupation list but has also called for any new immigration system to look beyond pay as a proxy for skill - meaning the lower-paid staff groups services rely on can still come.

The backdrop is child poverty - which is the root of many risk factors for infant mortality and other poor outcomes and which, according to the United Nations special rapporteur on extreme poverty, is at risk in the UK from recent changes to social support. The child health workforce should be ready to respond to these challenges.

Opportunity or burnout?

The UK Foundation Programme has published its most recent data on the destination of foundation year two doctors and has revealed some interesting, if perhaps unsurprising trends.

Only 37.7 per cent of F2 doctors went straight into training in 2018, which is down from 42.6 per cent in 2017 and just over half the year before. In 2011, 71.3 per cent carried straight through the system.

More doctors reported that they planned to take a career break after foundation training at the beginning of F1 (9.6 per cent) and fewer indicated at the end of medical school they wanted to go straight through training, which suggests that many always planned to take a break.

However, General Medical Council and British Medical Journal surveys have found the never-ending examination and assessment cycle through foundation training and medical school has pushed doctors to take a break from training because of burn-out.

Although they may not be able to influence the medics planning a break – to travel or to complete an ‘F3’ year out – Health Education England, trusts and others need to act fast to keep doctors in the system.