This is how many of developed nations are plundering the poorer countries
Patrick Cockburn is the author of War in the Age of Trump (Verso)
Cross-posted from Counterpunch
Photograph Source: DFID – UK Department for International Development – CC BY 2.0
At the beginning of the first lockdown two years ago a friend told me about a relative of his who was a nurse in a London hospital who had caught Covid-19. She said that her manager had told her “to go home and tell nobody about it”.
His response to bad news was to hide it, which is in keeping with secretive traditions of the NHS, as it is with all large institutions protecting their own interests. In the case of the NHS, the secrecy may be less obvious because a sympathetic media has been giving wall-to-wall coverage to its heroic efforts to treat victims of the pandemic.
Reporting today focuses largely on the shortage of doctors and nurses, their numbers depleted by Covid-19. Much publicity is given to short-term fixes such as sending in the army and re-employing retired medical staff.
Unfortunately, what is lost in this tidal wave of information are fundamental questions about the state of the health service from which flow most of these short-term problems.
Most important of these is why Britain trains only half the number of doctors that it needs, which is far less than in other developed countries. England has 28 doctors for every 10,000 people compared with 37 in comparable EU countries according to a report by the British Medical Association.
The chair of the Commons Health Committee and former health secretary Jeremy Hunt cites figures from the royal colleges showing that the country is short of 2,500 GPs, 2,000 emergency care consultants, 2,000 midwives, 1,900 radiologists, 1,400 anaesthetists, and 500 obstetricians while the NHS has 100,000 vacancies.
Britain has never trained enough doctors, but the deficit has got a lot worse in recent years – and so too has the dubious means used to bridge the gap between demand and supply. The solution is to rely on foreign-trained doctors and nurses, often from poor countries with health systems already crippled by staff shortages.
“In 2019 more doctors joined the [NHS] workforce from outside the UK than were UK-trained, a ratio never before seen,” says Rachel Jenkins, professor emeritus of epidemiology and international mental health policy at King’s College London. She says that the number of medical student places in Britain needs to be double from the 10,403 currently available, so as not to rely on attracting scarce doctors and nurses from Africa and South Asia.
The number of foreign doctors joining the NHS doubled between 2017 and 2019 alone, according to data from the General Medical Council. They now number 112,024 as of last month or more than a third of the licensed doctors in the UK.
Jenkins says that politicians and the media seldom make the essential point that failure to train enough doctors in the UK is at the root of many other difficulties. “Senior NHS executives say that we should recruit more from the international pool, but there is no such pool – it is more like the Sahara out there.” There is a worldwide shortage of physicians which the World Health Organisation estimates to number 2.8 million.
Rich countries that boast about their international aid programmes are mute about the degree to which they are parasitic on the scarce healthcare resources of the recipients of that aid. This receives little publicity, though an article in The New York Times in 2012 had the title: “America is stealing the world’s doctors.” The consequences of the theft can be devastating: it seriously weakened Sierra Leone’s ability to cope with the Ebola epidemic in 2014-15 which killed 4,000 people.
OECD countries all syphon off scarce medical personnel from poor countries, but Britain is among the worst offenders, taking almost twice as many trained professionals as a proportion of its medical workforce as do other countries.
British government excuses for its reliance on doctors and nurses expensively trained in poor countries are often embarrassingly inadequate. They include the claim that immigrant doctors enhance their medical expertise in Britain and bring back such valuable knowledge – except the number who do return home is small, so this does not happen.
So why does Britain train far fewer doctors than it needs, as it has been doing for decades? The chief reason is expense, since it is cheaper to get somebody else to pay for training and medical schools. The Treasury has always been averse to paying more for more medical students which might mean more teaching hospitals. Government ministers do not want to spend very large sums on students since they only become fully trained doctors seven years later, long after the ministers have left their jobs.
During the Covid-19 crisis, resources are understandably devoted to producing quick fixes and not to long-term solutions.
Yet such solutions are needed rapidly because ministers are speaking resignedly of people having to learn “to live with coronavirus” as an endemic disease. In other words, there will be a permanently greater burden on the health service in future which will only be sustainable if there are many more doctors in Britain.
Dependence on luring doctors from Africa and South Asia looks even more short-sighted and hypocritical than it did pre-pandemic. The emergence of Omicron variant in southern Africa showed that weakening health services anywhere in the world by tapping them as a source of doctors can have an immediate impact on richer countries.
Not spending money on training medical students has proved to be a false economy in terms of human lives. But it is also ill-judged in terms of saving cash, since gaps in providing medical care are filled by expensive locums and agency staff. Imported doctors still have to be paid their salaries and pensions. More medical schools and teaching hospitals may be needed, but this will be unavoidable in a post-pandemic world.
What the pandemic has demonstrated is that forecasting and monitoring the future requirement for doctors and nurses is too important to be left solely to governments and the NHS. Jeremy Hunt says a remedy for this damaging blind spot on such a crucial issue could come through an amendment to the Health and Care Bill going through the House of Lords, providing for independent and public forecasts of the number of doctors Britain should be training.
This might seem a good moment for reforming the NHS since it now occupies a place in the British national pantheon akin to that held by the Royal Navy a century ago. Glorified by politicians and the media as one of the best health systems in the world, it has become difficult to criticise.
Yet this triumphalism obscures the inconvenient fact that by many medical metrics – such as cancer outcomes and the ratio of doctors and nurses to population and beds – the NHS has become one of the poorest-performing health services in western Europe. It also conceals the obvious cause of these inadequacies which is the failure to train enough doctors and nurses to meet the country’s needs.
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