The Economist - UK (2022-04-30)

Shortagesofdoctors

When the applause

fades

M

anydiagnoseshavebeenofferedfor

the  malaise  racking  the  National

Health  Service  (nhs).  Like  lots  of  74­year­

olds, its vital signs are poor. It has a backlog

of 6.2m people on waiting lists. There were

110,000 unfilled hospital and community­

care  posts  in  December—a  figure  that  in­

cluded  8,000  doctors  and  almost  40,000

nurses.The number of people waiting over

12 hours for admission in a&eis around ten

times higher than it was pre­pandemic. As

Kevin O’Kane, a consultant in acute medi­

cine,  says:  “The  situation  is  bad  and  it’s

about to get worse.”

The national mood towards the nhs is

souring. “Our nhs” has long had a tender—

perhaps  too  tender—place  in  British

hearts.  Britons  danced  for  it  in  the  Olym­

pics; clapped for it in the pandemic; paint­

ed rainbows for it everywhere. 

An almost religious reluctance to criti­

cise the nhsis now giving way to more au­

dible  grumbles.  Data  from  the  National

Centre  for  Social  Research  show  that  be­

tween  2020  and  2021  overall  satisfaction

with the nhs fell by 17 percentage points, to

36%—an  unprecedented  drop.  Two  recent

scandals—one over woeful maternity care,

another over an epilepsy drug that caused

birth defects—have not helped. 

There are both immediate and underly­

ing  causes  for  the  nhs’s  condition.  Of  the

immediate  ones,  covid­19  continues  to

complicate the treatment of patients while

also depleting numbers of staff. Burnout is

a big issue: a survey conducted last year for

the  British  Medical  Association  (bma),

which  represents  doctors, found  that  a

fifth of health­care workers were consider­

ing another career. The situation for those

who are still left is “intolerable”, says David

Wrigley, deputy chair of the bma council. 

A pandemic is bound to put bodies un­

der stress. But it causes a lot more stress to

bodies that are already weak and unfit. And

the  nhs has  been  unfit  for  years,  in  large

part  because  of  poor  workforce  planning.

Even  before  the  pandemic,  Britain  was

light on medics (see chart). In oecd coun­

tries in the eu, the average number of doc­

tors  per  1,000  patients  is  3.7.  Austria  has

5.4.  England  has  2.9.  As  Jeremy  Hunt,  a

Conservative  mpwho  is  a  former  health

secretary  and  current  head  of  the  health

and  social  care  committee,  sees  it,  doctor

shortages are “the biggest single challenge

facing the nhs now”. 

To  understand  how  bad  the  govern­

ment’s  control  of  the  nhs workforce  is,

consider its reservoir of doctors. The gov­

ernment  more  or  less  knows  the  current

level of this reservoir but neither monitors

the  pressure  in  the  pipelines  that  feed  it

nor the volume needed in future. It has lit­

tle idea how many doctors it will need next

year,  let  alone  in  ten.  Its  workforce  plan­

ning is, says Dr Wrigley, “non­existent”.

Meanwhile, older and experienced doc­

tors are seeping out of the system with par­

ticularly  alarming  rapidity.  One  in  ten  se­

nior  doctors  are  expected  to  retire  in  the

next  18  months.  This  is  partly  due  to  the

difficulty of working as a doctor when old­

er. It is a physically and mentally demand­

ing  job.  Some  things—such  as  going  back

to  sleep  after  a  2am  phone  call—become

harder with age. 

Yet the nhs operates a one­size­fits­no­

one approach to planning medical careers,

so a doctor who is 60 is expected to do the

same work as one who is 40. Many cannot,

or  will  not.  Older  doctors  are  also  leaving

for  financial  reasons:  a  kink  in  the  pen­

sionssystemmeansthatdoctorscanlose

thousandsofpoundsinbenefitsbycon­

tinuingtoworkbeyond60.Manymaysim­

plyhanguptheirstethoscopes.

A hostoffactorsledthenhstothis

mess,butoneofthebiggestispolitical.

Thetimescalesofdoctorsandpoliticians

donotmeshwellwhenitcomestowork­

force planning. “Becauseit takes seven

yearstotraina doctorandtenyearstotrain

agp,”saysMrHunt,“itisnevera priority

for health secretaries or chancellors in

spendingreviews.”Bythetimenewdoc­

torscomeonstream“neitherofthemare

expectedtobeintheircurrentpost.”

Theslowprocessoftrainingnewdoc­

torsmeansitistoolatetofillthereservoir

upnow.Butthegovernmentcouldtryto

stopexistingdoctorsfromleakingaway.

Changing pension rulesso they do not

punish  people  who  keep  working  would

help.  So  would  a  cleverer  approach  to  ca­

reer planning: greybeards could be used to

train new recruits, for example.

The  opacity  of  the  pipeline  of  future

doctors must also be tackled. A coalition of

over 100 organisations, including the bma,

has written to the government asking it to

require independent estimates of how ma­

ny  health­care  workers  are  being  trained

and  how  many  are  needed.  Officials,  says

Dr  Wrigley,  “are  just  ignoringit”.  Mean­

while, the patience of patientswears thin.

The sound of applause fades.n

Britons are starting to criticise an

organisation they used to clap for

Doc shock

Doctors per 1,000 people

Selected countries, 2020

Source: OECD *2019 †201

England

France*

Ireland

Italy

Denmark†

Sweden†

Spain*

Germany

Norway

Austria

6543210

And then three come along at once

22 Britain The Economist April 30th 2022

TalkTV

All mouth.

Any trousers?

I

t was asomewhat trying night for fans of

understatement. On his first prime­time

show on Talktv, a broadcast and streaming

channel that launched on April 25th, Piers

Morgan  declared:  “As  Nelson  Mandela

might  have  said,  it’s  been  a  long  walk  to

freedom of speech!” His opening­night in­

terviewee, Donald Trump, may be the only

person in the world who can make Mr Mor­

gan look bashful. But the presenter has not

been  hired  for  his  command  of  euphe­

misms. His job is to sock it to Britain’s ex­

isting news broadcasters.  

Talktvis  the  latest  addition  to  Rupert

Murdoch’s media empire. In 2018 his bid to

take full control of Sky, a European pay­tv

giant,  failed,  leaving  the  tycoon  with  no

stake  in  a  British  broadcaster  for  the  first

time  in  decades.  He  considered  investing

in  gbNews,  a  right­wing  news  channel

which began broadcasting in June 2021. gb

News has avoided clashes with Ofcom, the

Will Rupert Murdoch’s latest

broadcasting venture succeed?