Leader: NHS plan hangs on attracting and training staff

April 26, 2002

Everyone in British education is drawing encouragement from the mention of schools, colleges and universities in last week’s budget. A word from chancellor Gordon Brown - when railways and other key spending areas got not a syllable - has raised hopes for the summer’s spending review.

In the meantime, university managers are wondering how much of the budget’s extra £40 billion a year by 2007-08 for the National Health Service is headed their way. It seems that the improved NHS will need 80,000 new professionals. But the system for producing medical staff is under the same stress as the NHS itself. As our report shows, low pay in the NHS means that some of the subjects involved, especially nursing, are prone to student under-recruitment. For new universities, where they tend to be taught, expanding provision would be high-risk. There are fines for under-recruitment, and these are not subjects that bring in big research money.

Nor are matters easier at the other end of the medical food chain, the supply of doctors. There is no plan to expand medical schools further. Better retention, overseas recruitment and the already announced expansion of medical student numbers are being relied on to fill the gap. This is a relief to the medical schools, which are finding it complicated enough to cope with the expansion already in the pipeline. There is also a problem finding people to teach new medical professionals - doctors, nurses, scientists and many others - even if aspiring students can be found. Medical schools have a recruitment crisis of their own, which has left many posts vacant at all levels up to professor. And there is a new relationship to be worked out between the Workforce Development Confederations, which sign the contracts for medical education, and universities as expansion takes place in nursing and other health professions.

A better NHS is a priority. And success will depend on people emerging from universities. But there is a risk in the constrictions being placed on the system that imaginative response in universities will be stifled. New NHS money will arrive with strings attached. The new Commission for Healthcare Audit and Inspection will mean a new layer of inspection and assessment for universities. School-leavers will not provide all the people the NHS needs. Lifelong learning will be enormously important, offering opportunities for upgrading to existing staff, and the chance to return for qualified but inactive staff. How successful this is will depend on the new NHS University, about which little is yet known. The NHSU was intended to be about in-service training but it might become more ambitious given the changes sweeping the system. There is room for manoeuvre in its terms of reference as the training and education needs of the new NHS become apparent. But if it becomes a provider as well as a purchaser of education, it could further increase pressure on the inadequate pool of personnel available to teach a new generation of health professionals.

Britain’s health needs are indeed great, magnified by an ageing population. The temptation is great to try to solve staff shortfalls by recruiting overseas, especially with many qualified people eager to migrate to less turbulent countries than their own. While there is always a good case for offering a safe haven to refugees, asset stripping the third world, when its needs are greater than ours is hardly ethical. We should instead use the massive expansion of health services on which we are embarked to pull through participation rates for our own population. Here are huge areas of labour-intensive employment opening up. If we can use them to involve our own population more creatively and actively in providing our citizens with better care, it will be gain all round.

Everyone in British education is drawing encouragement from the mention of schools, colleges and universities in last week’s budget. A word from chancellor Gordon Brown - when railways and other key spending areas got not a syllable - has raised hopes for the summer’s spending review.

In the meantime, university managers are wondering how much of the budget’s extra £40 billion a year by 2007-08 for the National Health Service is headed their way. It seems that the improved NHS will need 80,000 new professionals. But the system for producing medical staff is under the same stress as the NHS itself. As our report shows, low pay in the NHS means that some of the subjects involved, especially nursing, are prone to student under-recruitment. For new universities, where they tend to be taught, expanding provision would be high-risk. There are fines for under-recruitment, and these are not subjects that bring in big research money.

Nor are matters easier at the other end of the medical food chain, the supply of doctors. There is no plan to expand medical schools further. Better retention, overseas recruitment and the already announced expansion of medical student numbers are being relied on to fill the gap. This is a relief to the medical schools, which are finding it complicated enough to cope with the expansion already in the pipeline. There is also a problem finding people to teach new medical professionals - doctors, nurses, scientists and many others - even if aspiring students can be found. Medical schools have a recruitment crisis of their own, which has left many posts vacant at all levels up to professor. And there is a new relationship to be worked out between the Workforce Development Confederations, which sign the contracts for medical education, and universities as expansion takes place in nursing and other health professions.

A better NHS is a priority. And success will depend on people emerging from universities. But there is a risk in the constrictions being placed on the system that imaginative response in universities will be stifled. New NHS money will arrive with strings attached. The new Commission for Healthcare Audit and Inspection will mean a new layer of inspection and assessment for universities. School-leavers will not provide all the people the NHS needs. Lifelong learning will be enormously important, offering opportunities for upgrading to existing staff, and the chance to return for qualified but inactive staff. How successful this is will depend on the new NHS University, about which little is yet known. The NHSU was intended to be about in-service training but it might become more ambitious given the changes sweeping the system. There is room for manoeuvre in its terms of reference as the training and education needs of the new NHS become apparent. But if it becomes a provider as well as a purchaser of education, it could further increase pressure on the inadequate pool of personnel available to teach a new generation of health professionals.

Britain’s health needs are indeed great, magnified by an ageing population. The temptation is great to try to solve staff shortfalls by recruiting overseas, especially with many qualified people eager to migrate to less turbulent countries than their own. While there is always a good case for offering a safe haven to refugees, asset stripping the third world, when its needs are greater than ours is hardly ethical. We should instead use the massive expansion of health services on which we are embarked to pull through participation rates for our own population. Here are huge areas of labour-intensive employment opening up. If we can use them to involve our own population more creatively and actively in providing our citizens with better care, it will be gain all round.   

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