How to Tackle NHS Staff Shortages

On the front page of almost every major newspaper in the UK today is the story that the National Health Service (NHS) is facing its worst staffing crisis in its history.

A report produced by Commons health and social care select committee headed by the Former Health Secretary, Jeremy Hunt, highlighted the fact that the NHS is short of 12,000 hospital doctors and more than 50,000 nurses and midwives.

The proposed solutions include the re-examination of the NHS' pension arrangements that encourage early retirement of doctors, a change in the employment requirements for medical professionals from other developed countries, and increased pay for nurses.

While all of the proposed solutions are brilliant on paper, they do not tackle the root causes of the NHS' staff shortage. So, what are the root causes of the NHS staff shortage?

Root Causes of NHS Staff Shortage

There are two root causes of NHS staff shortage:

·?????Obsolete healthcare business model.

·?????Obsolete medical education.

Obsolete healthcare business model

In my soon-to-be-published healthcare reform book, I ask the question: why did Sarah Harding have to die?

Sarah Harding, the late 'Girls Aloud' band member, became the face of the recent pandemic's secondary death toll when it was revealed that her death was partly due to a delay in her cancer treatment.

Her breast cancer treatment scan was ordered just at the time when the country went into its first lockdown. Accordingly, there was a lengthy delay. When she finally got the scan, her cancer had already spread. In spite of the doctors' efforts to save her life, it was too late.

Sarah's story made the front pages because of her celebrity status. But there were literally thousands of people who lost their lives, either because their treatments were paused or because they could not visit the hospital during the pandemic.

The key question is: with our level of sophistication and technological advancement, why weren’t we able to treat Sarah and Covid patients simultaneously?

Why were medical doctors and hospital administrators forced to make the difficult decision of treating a Covid patient and leaving Sarah to die?

The answers to these questions lie in our current healthcare business model. Our current healthcare business model was developed in the 1900s when healthcare needs were different.

It was developed when there were myriads of infrastructural challenges. Today, those infrastructural challenges no longer exist, yet we maintain the old healthcare business model.

General hospitals were needed when it was a challenge to travel from one part of the UK to another. Today, people easily travel from one continent to the next for medical treatment. So, why do we need so many general hospitals? What we need are specialist hospitals that can treat specific diseases.

With these specialist hospitals in place, when faced with another coronavirus, the Sarahs of this world will continue to receive their cancer treatments from cancer hospitals while coronavirus patients will also receive treatment from hospitals dedicated to viral outbreaks.

Then we will not have the case where doctors will be forced to make the choice between saving Sarah or saving a Covid patient. We cannot achieve good outcomes with bad processes. To expect a 19th century healthcare business model to suffice in the 21st century is a fool’s dream.

Obsolete medical education

In 1910 a report on medical education in the United States known as 'The Flexner Report' was submitted to the American Medical

Association (AMA). 'The Flexner Report' was commissioned after the AMA concluded its own secret study of medical education in the United States.

The report cited, amongst other things, the fact that medical school graduates did not examine a single patient until after graduation. Graduates hoped to put their theory into practice when their first patient walked through their doors.

According to the 'The Flexner Report', many medical schools did not even require a high school diploma for student admission. Applicants were not required to even have a science background. The report highlighted the fact that it was more difficult to gain admission into a reputable college than a medical school. In fact, the study discovered that only a single medical school required applicants to have a prior degree.

You might be tempted to dismiss this report as something that happened more than a century ago. You might think it’s impossible for modern medical schools to be so terrible. After all, many of the things highlighted in 'The Flexner Report' no longer exist.

Are you willing to bet your house on that?

Are modern medical schools any different from the medical schools highlighted in 'The Flexner Report'?

Yes, students are currently required to master science in high secondary to be eligible to apply for medical school, and modern medical schools are tightly regulated.

But is modern medical education leading to improved patient outcomes?

Modern medical schools might not be owned by individual professors, as they were when 'The Flexner Report' was first published. But they are bankrolled by private money. Every medical school is bankrolled by big pharmaceutical companies. Medical professors are also paid by pharmaceutical companies to conduct specific research.

Medical school curricula are not developed with the aim of tackling menacing diseases but to trial specific pharmaceutical products. So, while it might appear as if it would be irresponsible to make a comparison between the situation of medical education when 'The Flexner Report' was published and modern medical education, this is not so. The basic architecture remains the same.

The advancement in medical science and technology should not be confused with advancement in medicine. With the advancement of medical science and diagnostic technology, it might appear that patient outcomes have improved dramatically from the early 1900s.

Regrettably, this is not the case.

Between twenty to fifty million people died of influenza in 1918. Over 15 million people have so far died of Covid up to the time of writing this article in 2022. Crunching the numbers with all things considered, more people have died of Covid compared with the numbers who died of the 1918 influenza.

How could that have happened with our level of sophistication and medical advancement? The answer is simple: the profession of medicine is not as advanced as we are made to believe.

Medical science and medical technology have advanced, but the profession of medicine together with medical professionals are still at the 1900s level.

Furthermore, as a result of the relationship between the pharmaceutical industry and medical schools, the architecture of medical education is still stuck in the 1900s. The core architecture of medical education was developed in the early 1900s after 'The Flexner Report', and it has not evolved since.

Medical school terms were structured around the farming season to enable medical students to complete certain modules and return home in time to help their parents on the farm. It was in consideration of medical students' need to return home to assist their parents during the farming season that the duration of years for medical education and all university education were instituted.

Because we live in different times, there is no need for the current structure for medical training to remain. There is no need for medical training to last for the duration it currently does. Medical degrees could be completed in two, maximum three years, and students would be as competent as they are at present. The additional years add nothing to the competency of the students. It only allows universities to charge exorbitant fees and preserve the myth of the complexity of medicine.

When medical school curricula were developed, most diseases were acute. Most, if not all of the patients in intensive care in many hospitals today, would have died when the current medical school curricula were created. Why? Because the technology available today to effectively operate ICUs did not then exist. That's the gulf between the outdated medical school curricula still being used and the available medical technology in existence today.

Diseases that were considered life-threatening at the time are no longer deemed to be so. Most of the diseases on the World Health Organisation's list of leading causes of death are chronic diseases, which would have killed many people decades ago. Those diseases are diseases of affluence, meaning they did not exist centuries ago when the current medical school curriculum was created. Teaching medical students using a curriculum that was developed when the diseases they are being trained to tackle were non-existent does not seem prudent; in fact it is without controversy, injudicious.

How to Tackle NHS Staff Shortage?

The first step to tackling NHS staff shortage is for policy makers to identify the correct root causes of the staff shortage.

The root causes are:

·?????Obsolete healthcare business model

·?????Obsolete medical education

Second, redesign the current healthcare business model, taking into account the changing infrastructural challenges and medical technological advancement.

Third, change medical school curriculum to reflect the changing demands for medical treatment. The idea that anyone needs to take seven years to become a medical doctor in the 21st century is absurd.

If the Commons health and social care select committee and the incoming British government are serious about addressing the NHS staff shortage crisis, those are the actions they need to take.

Poaching healthcare professionals from other countries is only a band-aid. No amount of money can solve what is fundamentally a structural problem.