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Future Excess of Doctors?: Present Shortage of Nurses
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Commentary from Westminster Future Excess of Doctors?: Present Nurses
Shortage of
ONE of the Prime Minister’s most consistent boasts when
under fire in the Commons about the condition of the National Health Service is that we now have more doctors and more nurses than under any previous Government. But both claims are subject to doubt. We may, it is suggested, be
training more doctors than on projected plans for the NHS it will be able to employ. And we are quite clearly running
perilously short of nurses. Doubts about the destination of the present medical student intake were raised in The Lancet five months ago by Dr Nussey and colleagues1 at St George’s Hospital Medical School, London. Working from published figures, they suggested that graduate output might be running at as much as 1550 a year above likely demand. They challenged the DHSS to state where the graduates emerging were likely to find employment, whether the planned establishments for hospital medicine and general practice were big enough, and what planned establishment figures determined present graduate numbers. Autumn turned to winter and winter to spring, but the Department of Health remained silent. On March 28 an editorial comment in The Lancet,2 using rather more extensive figuring, arrived at much the same conclusion. Medical students were being trained in numbers which could well increase the number of doctors per 10 000 population in England and Wales from 13-6 now to 22 -4. Yet the official projections set the ration in ten years’ time at 110. "Good medicine", the editorial declared, "cannot be practised with this sort of staffing. How can there be plans to educate 70% more doctors when the NHS faces a staff cut of It is difficult to escape one of two conclusions: 16% either the Government has no knowledge or control over what is happening, or half the students are intended for a vastly expanded private sector." The Lancet repeated the demand of Dr Nussey and his colleagues that the Department should furnish a reply. But the stately procession of the seasons, from spring to summer and so back to autumn again, may well on present evidence proceed for a while without producing an official response. The Department of Health has a difficulty here. These matters are monitored by an advisory committee for medical manpower planning. In 1985, the committee checked the forecasts for likely supply and demand, recommended that there should be no change in the target medical school intake, but said the situation would need to be reviewed at regular intervals. Such a review is now being carried out by a successor committee, set up last year, on which the medical profession, the universities, and the health departments are represented. It hopes to complete its work later in the year. The Department is clearly reluctant to start confirming or denying other people’s estimates until this committee has arrived at its own. Should the committee arrive at conclusions similar to those of The Lancet and Dr Nussey, then engines may have to be thrown into reverse. Gleanings so far, however, suggest that this outcome is not expected. The gap which worries Dr Nussey and others, it is foreseen, will be eroded by both higher demand and lower supply than their figures suggest. Growth in medical manpower has run ahead of growth in NHS resources for fifteen years and may well ...
The increase in consultant posts and is thought likely to outpace critics’ calculations. Retirements and wastage of various kinds-the shift to private practice, certainly, but emigration, declining numbers of overseas recruits, and women taking time off to have babies also-could leave more room for replacement than outside arithmetic to
do
so.
general practice appointments
suggests. All this may sound dangerously complacent. Until the DHSS has digested the findings of its advisory committee and published the conclusions, there is frankly no way of telling. But no-one underestimates the pitfalls of the territory. One of the classic miscalculations of post-war planning occurred in precisely this area, when Harold Macmillan’s Government accepted a report from a committee under Sir Henry Willink that too many doctors were being trained, and ordered a cut in their numbers; only to find so many signs of strain appearing that within five years the calculations were repudiated and the policy reversed. The day may perhaps come when the leader of the Opposition will challenge the Prime Minister across the despatch box about this issue. Where numbers in nursing are concerned that day arrived last week. With the review body about to report, the air at Westminster was thick with prophecy and warning as the Commons broke for the Easter recess. DHSS evidence to the review body suggested that nothing above the rate of inflation was called for this year. But the accumulating signs of shortfall make it hard to see how a Government alert to the working of market forces could be happy with such a conclusion. For there is now overwhelming evidence that staff shortage in high-cost areas like London is reaching crisis proportions. According to one estimate, one job in four is now unfilled in the capital. In an adjournment debate on April 2, the new Alliance health spokesman, Mr Simon Hughes, catalogued the reasons. Not enough people of the right age group were coming into the profession. Pay was inadequate. The work made excessive demands, especially on students. Housing and travel cost too much, and growing violence in the streets made late shifts unenticing. And higher rewards in the private sector were
generating an ever more persuasive pull.
Given all these disincentives, one can hardly believe that Mrs Thatcher’s constant insistence that nurses have been far more generously treated by her Government than by the Labour Government before it can carry very much weight. To most young nurses, the Wilson-Callaghan era is already ancient history. The Health Minister, Mr Tony Newton, produced, as usual, a more sensitive response. In a long written answer to Mr Laurie Pavitt (Lab, Brent S) last week he listed a whole battery of internal and external investigations already under way, while in a second answer to the Liberal MP for Ceredigion, Mr Geraint Howells, he gave the first public indication of DHSS pressure on the private sector to take some part in the training of the nurses whom it employs in increasing profusion.3 But the pay review is the heart of the matter. With an election in the offmg, Conservative MPs went off at Easter as anxious as anybody that the Government would decide to do the decent, generous thing-at the very least, for the areas which are hardest pressed. DAVID MCKIE 1. Nussey
SS, Pilkington TRE, Saunders KB. Where will this month’s medical intake go? Lancet 1986; ii: 977. 2. Editorial. Medical student numbers and medical manpower. Lancet 1987; i: 723-24. 3. Written answers, HC Debates, April, 1987, col 188-89.
continue
Commentary from Westminster Future Excess of Doctors?: Present Nurses
Shortage of
ONE of the Prime Minister’s most consistent boasts when
under fire in the Commons about the condition of the National Health Service is that we now have more doctors and more nurses than under any previous Government. But both claims are subject to doubt. We may, it is suggested, be
training more doctors than on projected plans for the NHS it will be able to employ. And we are quite clearly running
perilously short of nurses. Doubts about the destination of the present medical student intake were raised in The Lancet five months ago by Dr Nussey and colleagues1 at St George’s Hospital Medical School, London. Working from published figures, they suggested that graduate output might be running at as much as 1550 a year above likely demand. They challenged the DHSS to state where the graduates emerging were likely to find employment, whether the planned establishments for hospital medicine and general practice were big enough, and what planned establishment figures determined present graduate numbers. Autumn turned to winter and winter to spring, but the Department of Health remained silent. On March 28 an editorial comment in The Lancet,2 using rather more extensive figuring, arrived at much the same conclusion. Medical students were being trained in numbers which could well increase the number of doctors per 10 000 population in England and Wales from 13-6 now to 22 -4. Yet the official projections set the ration in ten years’ time at 110. "Good medicine", the editorial declared, "cannot be practised with this sort of staffing. How can there be plans to educate 70% more doctors when the NHS faces a staff cut of It is difficult to escape one of two conclusions: 16% either the Government has no knowledge or control over what is happening, or half the students are intended for a vastly expanded private sector." The Lancet repeated the demand of Dr Nussey and his colleagues that the Department should furnish a reply. But the stately procession of the seasons, from spring to summer and so back to autumn again, may well on present evidence proceed for a while without producing an official response. The Department of Health has a difficulty here. These matters are monitored by an advisory committee for medical manpower planning. In 1985, the committee checked the forecasts for likely supply and demand, recommended that there should be no change in the target medical school intake, but said the situation would need to be reviewed at regular intervals. Such a review is now being carried out by a successor committee, set up last year, on which the medical profession, the universities, and the health departments are represented. It hopes to complete its work later in the year. The Department is clearly reluctant to start confirming or denying other people’s estimates until this committee has arrived at its own. Should the committee arrive at conclusions similar to those of The Lancet and Dr Nussey, then engines may have to be thrown into reverse. Gleanings so far, however, suggest that this outcome is not expected. The gap which worries Dr Nussey and others, it is foreseen, will be eroded by both higher demand and lower supply than their figures suggest. Growth in medical manpower has run ahead of growth in NHS resources for fifteen years and may well ...
The increase in consultant posts and is thought likely to outpace critics’ calculations. Retirements and wastage of various kinds-the shift to private practice, certainly, but emigration, declining numbers of overseas recruits, and women taking time off to have babies also-could leave more room for replacement than outside arithmetic to
do
so.
general practice appointments
suggests. All this may sound dangerously complacent. Until the DHSS has digested the findings of its advisory committee and published the conclusions, there is frankly no way of telling. But no-one underestimates the pitfalls of the territory. One of the classic miscalculations of post-war planning occurred in precisely this area, when Harold Macmillan’s Government accepted a report from a committee under Sir Henry Willink that too many doctors were being trained, and ordered a cut in their numbers; only to find so many signs of strain appearing that within five years the calculations were repudiated and the policy reversed. The day may perhaps come when the leader of the Opposition will challenge the Prime Minister across the despatch box about this issue. Where numbers in nursing are concerned that day arrived last week. With the review body about to report, the air at Westminster was thick with prophecy and warning as the Commons broke for the Easter recess. DHSS evidence to the review body suggested that nothing above the rate of inflation was called for this year. But the accumulating signs of shortfall make it hard to see how a Government alert to the working of market forces could be happy with such a conclusion. For there is now overwhelming evidence that staff shortage in high-cost areas like London is reaching crisis proportions. According to one estimate, one job in four is now unfilled in the capital. In an adjournment debate on April 2, the new Alliance health spokesman, Mr Simon Hughes, catalogued the reasons. Not enough people of the right age group were coming into the profession. Pay was inadequate. The work made excessive demands, especially on students. Housing and travel cost too much, and growing violence in the streets made late shifts unenticing. And higher rewards in the private sector were
generating an ever more persuasive pull.
Given all these disincentives, one can hardly believe that Mrs Thatcher’s constant insistence that nurses have been far more generously treated by her Government than by the Labour Government before it can carry very much weight. To most young nurses, the Wilson-Callaghan era is already ancient history. The Health Minister, Mr Tony Newton, produced, as usual, a more sensitive response. In a long written answer to Mr Laurie Pavitt (Lab, Brent S) last week he listed a whole battery of internal and external investigations already under way, while in a second answer to the Liberal MP for Ceredigion, Mr Geraint Howells, he gave the first public indication of DHSS pressure on the private sector to take some part in the training of the nurses whom it employs in increasing profusion.3 But the pay review is the heart of the matter. With an election in the offmg, Conservative MPs went off at Easter as anxious as anybody that the Government would decide to do the decent, generous thing-at the very least, for the areas which are hardest pressed. DAVID MCKIE 1. Nussey
SS, Pilkington TRE, Saunders KB. Where will this month’s medical intake go? Lancet 1986; ii: 977. 2. Editorial. Medical student numbers and medical manpower. Lancet 1987; i: 723-24. 3. Written answers, HC Debates, April, 1987, col 188-89.