What’s the best birthday gift the NHS could get? More capacity

As it celebrates its birthday, I like to think the NHS will look back with pride at how it made it through its 72nd year; probably the hardest it has ever faced. This pride at a challenge well met (though by no means over) should, of course, be shared by so many - doctors and nurses, public health and social care professionals, and many others too numerous to mention.

There will be warm words of appreciation for these staff, I am sure, but what I and many other colleagues are hoping to hear is how we will learn the lessons of the pandemic. I am buoyed by the perseverance and tenacity of my colleagues and everyone working in the NHS who expertly saw us through such challenging times. But having worked on Covid-19 wards myself, I know how hard a hit the NHS has taken. The Royal College of Physicians found that more than one in four doctors had sought mental health support during the pandemic – an astounding figure that reflects the intensity that so many had to face.

With a new secretary of state for health and social care, the best gift we could give NHS staff for the 73rd birthday of the health service is more capacity.

The key part of the solution is more staff. Even before the pandemic, almost half of advertised consultant posts in England and Wales went unfilled. The NHS cannot provide optimum care for patients without the right number of people to staff it – which is why the Nightingale hospitals went largely unused. The UK has far fewer doctors and nurses per head compared to our international counterparts, with just under three doctors for every 1,000 people. This is fewer than New Zealand (3.35), France (3.37), Germany (4.3), Norway (4.93) and Austria (5.24). The UK falls significantly below the average of 3.7 across all 37 Organisation for Economic Co-operation and Development (OECD) nations.

It’s worse for nursing: we have just 7.78 per 1,000 people, compared to 9.95 in Canada, 10.1 in Denmark, 11.89 in the USA, 13.22 in Germany and 17.97 in Norway.

The challenge of too few staff is going to get harder if we do not act now. The population is ageing and clinical demand is increasing, as experienced senior doctors are retiring and a growing number of those entering the NHS are working part-time.

A new survey by the RCP reveals that 27 per cent of consultant physicians expect to retire within three years, with 42 per cent of that group expecting to retire within the next 18 months. The same survey showed that over half (56 per cent) of trainees would be interested in working less than full-time.

A fifth of doctors currently work less than full-time and it is expected that this will continue to grow as expectations of work-life balance change. This squeeze on capacity at either end of the system requires a long-term recruitment and retention workforce strategy, alongside proper workforce planning to assess how many healthcare professionals we need in the system to meet patient demand. It takes around five years to train a doctor, so we need to start planning for this now.

The RCP has long called for the doubling of medical school places to train more doctors in the UK. Students entering medical school in 2028 won’t be experienced consultants until around 2040. And by that time, the Office for National Statistics (ONS) predicts the number of people aged 85 and over will have doubled and that over 65s will make up a quarter of the population. The patient population is going to look significantly different in 20 years’ time – but this is a challenge that we know is coming and can prepare for by acting now.

Training doctors costs money, but not training doctors isn’t free. The RCP has calculated that doubling the number of medical school places would have an annual cost of around £1.85bn – less than a third of the £6.2bn hospitals spent in 2019/20 on agency and bank staff (the RCP’s 2019 census found that on average locums account for around 10 per cent of consultants in UK hospitals, with 4 per cent having 30-40 per cent locums).

More staff, and better workforce planning, would also reduce the pressure the workforce is under – so they would be less likely to leave because of burnout and stress and improve access to care for patients.

More capacity in the system means more staff – but it also should mean less demand. A sustainable funding settlement for social care would help more people to live as independently as possible in the community. Currently, the funding gap leads to people who cannot access social care services turning to the NHS for help or, even worse, unmet social care needs leading to their health deteriorating so badly that they need urgent NHS care.

But when contemplating ways to decrease the demand on NHS services, we need to look beyond the Department of Health and Social Care to focus on the wider inequalities in our society that so often lead to poorer health. The avoidable differences between different parts of society and between (or even within) different parts of the country have existed for a long time, but have been severely exacerbated by the pandemic.

We know, for example, that obesity is twice as prevalent among adults living in the most deprived parts of the country compared to those in the least deprived areas. With 30 per cent of Covid-19 hospital admissions in the UK directly attributed to overweight and obesity, it is indisputable that lives could have been saved had the most deprived in our society not been overlooked for so long.

We need a cross-government strategy to address health inequalities, with a strategic review of housing, jobs, education and more, to give people the best chance possible to live longer, healthier lives.

It’s natural for birthdays to be a time for looking back but let’s make the last year a turning point and look forward to a new future for the NHS.

Andrew Goddard is president of the Royal College of Physicians