Dr Phil Hammond debates today's NHS workforce

Pre-Brexit opinion piece: join the discussion

The NHS’s workforce is often cited as ‘the primary driver of future health costs’ which must be responsive to the needs of our changing population. But is it realistic to expect the NHS to define what its workforce should look like? Having chaired our debate in January, Phil Hammond shares his personal view on the challenges now and post-Brexit with Respiratory Futures.

Help us build a debate around this crucial topic by leaving your comments at the end of this piece.

Phil Hammond: "The potential threat of Brexit to health and social care is well known, which is why not one prominent national medical, research, or health organisations sided with the leave camp.

Our biggest immediate hurdle is workforce planning which remains an unresolved challenge for the NHS, making us heavily reliant on overseas help. Migration clearly puts strain on some public services but I’d argue migrants are far more likely to be running the NHS than ruining it. Equally, as potential NHS ‘customers’, in reality EU migrants tend to be of working age, use the NHS less and pay taxes to fund it. Some even return home for healthcare because they can get quicker access to specialists than in the UK.

At the time of the 2016 Brexit vote there were around 135,000 non-British European citizens working in the NHS and social care at all levels of the service, from consultants to carers – that’s about 10 per cent of the total. But they are now returning home in record numbers, largely because of the uncertainty of not having their work valued and residency rights guaranteed in a post-Brexit future.

Jeremy Hunt’s needless war with junior doctors has meant over half of those who complete their foundation years’ training are taking a break before going into higher specialist training, or abandoning the NHS altogether.
Dr Phil Hammond

Surely using its dedicated staff as political pawns has been a hideous error, especially given the current shortage of 50,000 staff in the NHS?  

Add in the removal of nursing bursaries and the freezing of pay at all levels, meaning many vital ancillary and nursing staff can’t afford to live near their work, and the future is far from rosy. By the nature of their specialty, those healthcare professionals supporting patients with long-term conditions such as COPD and asthma are in it for the long haul. There is no 'quick fix' yet we expect them to provide consistent levels of good, appropriate care over time.

Theresa May recently argued the use of food banks by some nurses is ‘complex’ but I would suggest it’s simply because we don’t pay them enough. And – perhaps most shocking of all – Jeremy Hunt’s needless war with junior doctors has meant over half of those who complete their foundation years’ training are taking a break before going into higher specialist training, or abandoning the NHS altogether.

NHS England can invent all the ‘branded strategy’ it likes – Five Year Forward Views, Sustainability and Transformation Plans, Accountable Care Services – but until health and social care work together to attract, train, retain, inspire and pay sufficient staff – which seems even less possible post-Brexit – isn’t our healthcare system doomed to perpetual crisis whoever’s in charge?

The UK has been the most successful country at winning competitively awarded EU funding for research and development in life sciences. After Brexit, we would have to pay to keep access to funding yet have no influence in setting priorities.
Dr Phil Hammond

As for its impact on research, current thinking suggests Brexit would sacrifice our right to participate in the European Medicines Agency, which is already planning to relocate 900 jobs and families away from London (a significant economic loss in itself). The UK would then have to pay to keep access to the centralised authorisation system yet have no influence on policy.

It’s also been suggested that NICE could lose its vital European health technology assessments – if so, where would that leave us? To date, the UK has been the most successful country at winning competitively awarded EU funding for research and development in life sciences. After Brexit, we would have to pay to keep access to funding yet have no influence in setting priorities in research and development.

This year's General Election may have been about Brexit originally, but the government’s ineffectual social care U-turn switched the debate onto our ever-increasing elderly population. Caring for someone with severe dementia can cost £100,000 a year. Isn’t it time we had an honest debate about how this level of care is going to be paid for, and how we are going to value, train and support the carers who do the hardest job in the world? It’s time for a bidet revolution – from the bottom up! Surely engaging and involving patients and carers in improving their own, and each other’s, health is where some of our focus needs to be right now?

Surely using its dedicated staff as political pawns has been a hideous error, especially given the current shortage of 50,000 staff in the NHS?
Dr Phil Hammond

As for the wider implications of Brexit, a sense of belonging and connection must be fundamental to everyone’s mental health and therefore the country’s collective well-being? In troubled times, I think many NHS staff want to feel part of a Europe where compassionate collaboration triumphs over profiteering and virulent nationalism. To believe that the UK can be a gated community, immune to consequences of millions of displaced citizens and a resurgence in right wing nationalism in parts of Europe and beyond, is fantasy. 

Yes, the EU can be nightmarishly wasteful and bureaucratic, and needs continuous improvement. But denial and refusal to engage in finding Europe-wide solutions to such urgent and unifying problems will not keep the UK healthy for long. I’m an optimist by nature, but I still think Brexit is a grave error.

There are never any ‘quick wins’ in an area as complex as health and social care, but genuinely valuing, praising front line staff, and listening to their innovations and concerns – rather than dismissing them – seems a good place to start and would cost us very little?" 

 

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Dr Phil Hammond has been an NHS doctor for 30 years, a comedian for 27 years, Private Eye’s medical correspondent for 25 years and a BBC presenter for 21 years. He was a GP for 20 years and currently works in an NHS service for young people with chronic fatigue. www.drphilhammond.com, @drphilhammond​