This week saw the health secretary issue his “mandate” to Health Education England - the national quango charged with leading workforce planning for the NHS.
Said mandate − coalition Newspeak for “targets” − confirms the government intends to push on with its oft-stated plan to reform the £5bn system for funding clinical training and education by making money follow the student.
‘Over the next few years, those medical trainees will fully qualify and look to the NHS to keep them’
It admits such a shake-up − which would see piles of cash shifted from London to the provinces, as well as from big teaching hospitals to smaller generals - could be destabilising for the hospital sector. But the instruction to HEE is to press on, albeit with care, and “over a number of years”.
The document is almost completely silent, however, on the other source of significant instability in medical education: the 20,000 oversupply of hospital doctors that will hit the NHS workforce in the next seven years without radical change in either employment patterns or training pathways.
According to the Department of Health’s centre for workforce intelligence, the bulk of those 20,000 future unemployed hospital doctors are already part-way through their £250,000-plus training programme. The programme was substantially expanded during the relative boom in NHS spending under the second-term Labour government.
It is only over the next few years, however, that those medical trainees will fully qualify and look to the NHS to keep them in the manner in which they have been accustomed to expect.
But meeting those expectations with consultant-grade salaries would cost the NHS an extra £2.2bn a year in today’s money − at a time when the NHS is looking to make efficiency savings of more than twice that each year.
‘It is unlikely that hospital’s human resources directors are viewing the impending battles with relish’
The DH has so far skirted around this issue − “welcoming” the physical capacity to introduce consultant-delivered care in hospitals (something most patients would be appalled to discover is not the norm) but staying schtum on the question of funding it.
Meanwhile, hospital finance directors are rubbing their hands with expectant glee at the thought of the consultant workforce being exposed to the sort of market competition normally reserved for the rest of us lesser mortals. They reason: if there are too many qualified applicants for each consultant post, salary rates might be lowered, spearheaded by the introduction of a “sub-consultant” grade.
It is unlikely that hospital’s human resources directors are viewing the impending battles with quite the same relish.
Sally Gainsbury is a news reporter for the Financial Times, firstname.lastname@example.org