To meet the widening healthcare workforce gap, Dr Nadeem Moghal suggests a new bold and ethical model of education that seeks to build local capability in the low and middle income countries from where the UK sources healthcare workers


There is a solution; not from our current leaders with their current thinking

The assumption must be that the more is said and written about healthcare workforce deficits, someone somewhere is listening and quietly beavering away doing something useful, at scale. So quietly, no one knows.

Baroness Dido Harding is talking about the Soviet tractor factory model no longer being the solution but still advocating complex planning, despite the world constantly changing. The analogy was further unnecessarily complicated.

‘We give up and push the problem to local providers’ was a moment of many moments of NHS leadership stuck in their thinking.

An admission if ever there was one, that workforce planning strategies have all failed – so we might as well kick the can further down to the local systems that can’t agree on one system of anything. The can, kicked further down the generations.

The solution is in fact factories. Build the factories, here, there and everywhere, to invest in people, here, there and everywhere. Factories, at scale.

Who can lead us out of this self-inflicted wound? It isn’t the managers. It isn’t the leaders of today.

The same thinkers are leading us to the same outcomes. There is an embarrassing silence from the senior leadership of the one profession that should have the greatest influence to affect action.

It’s simple – over produce, here there and everywhere

There is only one way out of this workforce gap. Simply produce more. More than we need, every year, forever.

If at any point a manager at Health Education England says it’s an unaffordable cost then remind them of the costs incurred now on agency and locum fees and eye watering hourly and day rates determined by the supplier.

The quality of care doesn’t ignite action because quality outcomes are still too crudely measured and don’t land as a line in the balance sheet; locums working unregulated hours, rotas filled with gaps, dedicated staff exhausted, seemingly energised by “chin up” tweets – who is living this – the clinical staff. Who is paying the price – the staff and patients.

Training people is not a cost. It is an investment. In people. In the health of people

A college president will suggest that we can’t over produce because we have a duty to employ expensively trained adults. Remind them that the trainees are indeed adults who made career choices, like every other adult in every other profession where there is no guarantee of anything, not even a salary free internship.

And another reminder. Training people is not a cost. It is an investment. In people. In the health of people.

If we over produce and they can’t find a job matched to their expertise in the left toe, then they failed to read the local market, and they can go deal with the left toes in Liberia. They need all the help they can get.

If we ever did over produce, and Liberia is not attractive, they could apparently move their training sideways, carrying generic skills into what the market wants – they said that was possible to improve on the 2005 training reforms.

That “lost tribe of SHOs” has morphed back as F3s, F4s, and even up to F6s, all locuming, holding the employer hostage.

They will come, and some will want to stay

It will take decades to produce enough for our own needs. In the mean time, draining from the colonies will continue.

HEE will tell you that it really is cheaper to recruit and recycle from our former colonies, but we will do it ethically by luring them to come and learn for three years and make sure they return, frustrated.

Remind them that that’s unethical and also inefficient – it takes a year to get used to new cultures, people, country and health systems.

A colleague originally from North Africa, locally studied medicine in English, passed all his exams in English, now admits that for the first year in the NHS, he understood virtually nothing, whilst looking after patients.

Even if they don’t unintentionally harm patients for want of effective communication, a huge chunk of the three years will be dedicated to the “come to learn” bit of the strategy, if the offer to learn is serious.

A surgeon from a low/middle income former colony comes to Wales for higher training. She is very good and with every intention of returning to serve her national population. The pressure to have her stay in Wales is considerable. All the resources. A new standard of living.

She will probably stay. The source nation loses a person and already scarce skills.

So what are we to do to deal with what is a complex ethical dilemma.

The genuinely ethical trade

If we want to keep the surgeon in Wales, then invest back into her source nation – pay for the education of say, 10 doctors for every one we take from the source nation as way of a trade. We pay for their education.

Pay for the education of say, 10 doctors for every one we take from the source nation as way of a trade

It’s one meaningful way to shift the numbers and make tangible our global responsibility. Some will come. Some may want to stay, contribute and make a life here. Even if they stay, they always find ways to give back to what will always be their homes.

We can be even more ambitious

Dublin has an internationally renowned organisation that is an extraordinary factory for healthcare workers. It produces high-quality globally focused doctors, pharmacists, physiotherapists, physician associates and postgraduate nursing graduates.

It undertakes internationally invested and recognised medical research. One organisation, one factory, one hub, deep in its national healthcare system, with a unique international reach.

I am one of its products. As is Lord Darzi.

We have universities investing in Malta, Malaysia, Bahrain… to grow their reach and value. We have the know how, when there is mammon. Profit can be measured in other ways with global social responsibility taken out of the hands of politicians to serve people directly.

Here’s an idea. Call it ethical. Call it giving back. Call it reparations. Call it The Health and Social Care Knowledge Road.

Politicians decry healthcare inefficiencies conveniently forgetting the billions in political inefficiencies. This model needs new leaders, new thinking, new action

We should establish the factories in all the low and middle income countries we have been draining healthcare workers from. Unlike China’s Belt and Road Initiative, we build the local infrastructure using local labour and resources without the debt traps.

We build the local capability to establish local faculties. We provide faculty. We train to standards we think are the best in the world. We contribute to local tuition costs.

We establish rotation links to UK healthcare provider organisations, accepting a proportion of the graduates into UK postgraduate programmes – service and education. If they want to, they can stay, build lives and contribute. Those that remain local, continue through local postgraduate programmes we also support.

We have the money. We have the reach. We have the know how. Politicians decry healthcare inefficiencies conveniently forgetting the billions in political inefficiencies. This model needs new leaders, new thinking, new action.

This is bold ethical workforce planning. Build the factories here, there and everywhere. So, we can produce more, here, there and everywhere. Let our institutions, built on the toil of others, invest in the future of people, here, there and everywhere.

The workforce failures are the failures of our senior medical leaders. It is unfashionable to use the word failure because it is not a supportive word, it is not collegiate and it is not constructive. But failure it is.

Until that is recognised, the medical profession will keep sitting in the audience, shroud-waving and blaming the managers. Why are our medical leaders mute?