Saturday, 21 February 2009

Short staffed and enslaved

The government's recent attempts at medical workforce planning are embarrassing. The reduction in doctor working hours as a result of EWTD has combined with government training reform (MMC) and draconian anti-IMG (international medical graduate) to produce a disastrous short and long term situation. A recent survey of surgeons in training found that over half (53%) were experiencing problems with rotas that were short staffed, this is not just a surgical problem, it is a systemic malaise present in most hospital specialties. If you visit a hospital this year, chances are that the doctors looking after you are working extra shifts and seeing their training reduced thanks to this very serious problem.

Not only has EWTD resulted in more doctors being needed to fill hospital rotas, it has also reduced the training gained in jobs as full shift rotas are brought in across the board. Meanwhile MMC has resulted in the disappearance of the service providing 'lost tribe' bulge, as thousands of doctors who missed out on the golden 'run through' ticket have either left the profession or fled abroad. The Department of Health has also forced thousands of IMGs away with their ridiculously unfair and stupid changes to the way in which IMGs are treated by our health system.

The end result is a disaster for both patients and training, in both the short and the long term. Not only is patient care being compromised as rotas are left at dangerously low levels of staffing, but the training of doctors is also being significantly compromised as doctors are spread too thin and the training element of jobs is spread even thinner. Patients are getting less thorough care and less continuity, while the doctors who are left to pick up the government's pieces are finding the quality of their training is going quickly down the pan.

This problem is not going away and it does not appear to be being solved, meaning that more trouble is only just around the corner. The government thought it could expand medical school places and force British grads into service level posts, however that was never going to work, the service level jobs are not attractive for our own grads, they will remain empty until something is done, while EWTD's further enforcement will only make things worse.

NHS Employers has recently announced a rather blatant u-turn in their policy making by trying to make it easier for non-EU doctors to work in the UK, a tacit admission that their previous attempts were gross bungles. Unfortunately this will not help the doctors who are currently doing lots of extra hours and shifts to cover the huge gaps that have arisen as a result of this calamitous government thinking. They are slaves to their NHS trusts, despite being treated like dirt they work on for their patients, it's just a great shame that the government has treated them so very shabbily.


David L. Cox said...

As foreseeable as night following day, Garth.

Notwithstanding the use (or rather abuse) of IMG's, the need to solve the training problems is really pressing. The lost tribes are still there (or overseas of course!). The expansion of training places to (a) solve the short term need to get the SHO's into sensible training positions and (b) to get the longer term goal of a consultant-led NHS (remember that?) by training more doctors remains to be seen to be done.

Using the juniors to fill in rather than training them is a further abuse, on a par with the misuse of the IMG's. Not using them at all, as with the missing lost tribes of SHO's was and remains a criminal squandering of taxpayers's money for which no-one is yet held accountable.

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