- Increase in medical training is a significant move and investment
- It is a break from the government’s approach in recent years
- There will be a big lag and the numbers may not be sufficient
- Policy does not address nursing numbers crisis
Jeremy Hunt’s commitment of around £100m to increase annual medical training numbers by 25 per cent is a keenly political move. He is fresh from the battlefield with the British Medical Association, and needs to make an impact in a post-Brexit referendum world.
It should be seen as a significant commitment – a quarter is a substantial increase, and a decision to make such an investment at this time of austerity cannot be underestimated.
And the NHS does need more doctors: evidence from medical royal colleges has shown rota gaps are a real and present problem facing many wards and specialties, while demand for healthcare continues to grow rapidly.
However, under closer scrutiny it is clear that this NHS workforce intervention, like many before it, is defined more by magical thinking and guesswork than by exact science - and it ignores the more pressing crisis in nursing.
The health secretary says increasing doctors in training by 1,500 is aimed at making the NHS self-sufficient. Even if these numbers turn out to be sufficient, which is questionable, it will not be until 2023-4 when these additional students would start graduating – and even then it will take a further eight to 10 years for them to complete full training and fill gaps at every level. Be sure to mark your calendar for 2030 so you remember to celebrate.
There is the question of what impact Mr Hunt’s announcement will have on the NHS’s much-needed workforce from overseas in the short term, while it is still required and there are concerns about staff deciding to leave the UK, or changing their mind about coming.
The new investment will also be received as a puzzling back-track on past policy. It follows a government decision in 2012, with the support of the British Medical Association, to reduce medical training places by 2 per cent because of fears there were to many doctors in the pipeline.
It will also, presumably, mean a reversal of the cuts to Health Education England’s budget which were decided as recently as the government spending review in November last year.
Finally – Mr Hunt faces an important question about why he has chosen to invest in doctors rather than nursing.
What evidence we have suggests the NHS’s need for registered nurses is more chronic, so would be a better starting point.
Between January and March this year the NHS advertised almost 30,000 vacancies for nurses, compared with only 9,000 medical jobs. The number of consultants in the NHS increased 54 per cent between 2002 and 2012, while nurses grew by just 13 per cent.
And under Health Education England current investment plans to 2020, nursing is due to see the smallest growth of any workforce group, at just 9 per cent, compared to an increase of 14 per cent in medical consultants.
In March the government’s own Migration Advisory Committee revealed that previous budget cuts had constrained nurse training by 3,000 in 2016-17, and recommended listing nursing as a shortage occupation to allow more overseas nurse recruitment.
Although the government hopes nursing will be expanded as a consequence of it removing the cap on places, central controls on placements in hospitals mean there is unlikely to be a large jump of the size which is announced today for medics.
Today’s intervention by Mr Hunt, while significant and welcome, leaves him open to the accusation of ignoring these more substantial and urgent problems in the nursing workforce.
Hunt pledges £100m to make NHS 'self-sufficient' in doctors
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Analysis: The magical thinking of Hunt's medical training move