Nadeem Moghal on why he is against Health Education England’s “earn, learn and return” strategy
The long-term plan is strikingly silent on the workforce strategy needed to deliver the wish list. Presumably the man from Leeds will sort that by March. Health Education England’s Global Engagement Strategy is supposed to help. The strategy boils down to – You are welcome to come, earn more than you ever will, learn from us, but then leave after three years – “earn, learn and return”.
The ethics of draining clinicians from resource poor nations is not a new debate. I am on the side of the liberal economic theory on the free movement of labour which is counter to our current Brexit narrative, general protectionist policies and the HEE Global Engagement strategy. I would rather people came, stayed, and contributed.
The HEE strategy is clear. We are short of labour and we need workers from the rest of the world. HEE will entice them with the ethically attractive ”earn, learn and return” strategy, whilst trying to make the NHS self sufficient. The word ethical features 26 times, albeit drowned out in the word cloud. The global shortage is about 18 million. Our share is about 1 per cent. Every nation is short, but we will take them from anywhere, ethically. Anywhere is of course limited by English language fluency, meeting professional regulatory standards and paying the border tariffs to enter. That narrows it largely to when the globe was once splashed with colonial pink.
The HEE strategy is positioned on mutual development but fundamentally about our needs. If they come, they will only just begin to understand the NHS, just begin to meaningfully contribute, hopefully survive the cultural buffeting, only to return to their largely resource poor nations deeply frustrated, unable to fully apply their new learning to benefit most in need.
If we don’t want to welcome international graduates to come and make a life here, then we have to train and pay for a surplus. Training a workforce is not a cost. It is an investment in the nation’s people and health
This strategy is a signal of desperation. Our colleagues from the European Union are making real and present plans to eventually leave. Coming from the European continent to invest lives and careers in the UK has now become less financially, politically and culturally motivating. I know this from constant conversations with all my EU colleagues working in research, clincial care, teachers, engineers… The colonial past is now a potential saviour for our post Brexit economic and NHS future. The Brexit trade narrative now includes global trade in workforce taking advantage of clinical staff motivated to move from their resource poor nations. Karl Marx would have raised a knowing eye brow.
Anyone working in the NHS will know the lived experience of today’s workforce shortages and not just in the tougher, less attractive generalist areas including nursing. The rare generalist acute physician demanding £300,000 is the peak of unaffordable hourly locum shift costs. Shift by shift, teams are disparate, not functioning as teams because of the nature of locums, working alongside rota team gaps (and unevidenced training reforms). The desperately negative NHS narratives aren’t helping.
The elimination of the nurse bursary replaced with the opportunity of debt has damaged the ambition to grow our own. Physiotherapy meanwhile attracts increased applications with the same debt model, because private practice is possible, next to a public sector with waiting lists. Even allowing for tuition fees, the tax payer contributes to education and training, but unlike other nations, there is no bond to anchor tax payer funded trained staff to the NHS.
Workforce bodies have come, gone, and exist somehow somewhere, but now mostly as HEE. They have all proved the basic premise about workforce regulation and control – interesting, fantastical, and job creating for those that believe they can predict, plan and match clinical demand with training outputs. It has never worked; they assume retirements, predict consultant growth, and come to a number, typically under filling training centres. This illustrates the unique nature of our medical workforce planning intent – every hospital based trainee with an HEE training number gets a guarantee, albeit unsaid, of a consultant post. Every year the number will be wrong. Multiply that to scale. The only workforce planning needed is constant over supply.
If we don’t want to welcome international graduates to come and make a life here, then we have to train and pay for a surplus. Training a workforce is not a cost. It is an investment in the nation’s people and health. Even if the Treasury can’t get past the budget thing to pay for the surplus, right now the providers are paying a premium for poor workforce planning deficits, adding to their financial deficits.
We have to scrap the assumption of a guaranteed job at the end of training. The over supply remember are adults who made adult choices who can travel the globe for gainful employment where shortages abound. If we are not keen on importing, we better be ready to export. Perhaps the post Brexit industrial strategy could include national income from tariffs imposed on countries receiving our workforce exports.
Dr Moghal is writing in a personsal capacity