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Under-funded, under-doctored, and overstretched NHS threatening patient safety

The choice is stark: increase the budget to meet demand or cut care, say physicians

Caroline White

Wednesday, 21 September 2016

The triple whammy of an under-funded, under-doctored, and overstretched NHS is threatening patient safety, concludes a report* on the challenges facing the NHS, published today by the Royal College of Physicians.

The choice is stark: either increase the budget to meet demand or cut care, says the report.

The report, which draws on the experiences, views, and concerns of consultant and trainee doctors, paints a picture of an NHS struggling to cope, and adds to the accumulating body of national evidence illustrating the gravity of the situation the health service faces.

The NHS budget has not kept pace with rising demand for services, which increase by 4% every year. However, in real terms, NHS funding is set to increase by only 0.2% a year to 2020, while cuts to social care are piling the pressure on NHS services. With hospital deficits hitting £2.45 billion, money to transform services risks being sucked into a financial black hole, says the report.

The UK does not train enough doctors. The number of medical students has fallen and there is a shortage of specialist trainees. This has left seven out of 10 trainees working on rotas with permanent gaps and hospitals failing to fill two in five of the consultant physician posts they advertise. Nurse shortages have increased the pressure, with 96% of trainee physicians reporting gaps in nursing rotas, says the report.

Four in five physicians-in-training report that their job is extremely stressful; three out of four don’t even manage to drink enough water on at least one shift a month. And 95% of them say that poor staff morale is adversely affecting patient safety in their hospital.

The number of patients stuck in hospital because of discharge delays has increased by 80% in the past five years. And reports of hospitals temporarily closing their doors that are usually associated with winter pressures, are now common throughout the year, says the report.

Patients and the public deserve to know the stark choice that has to be made: increase funding or cut care, says the report. But the College believes they deserve an NHS funded and staffed to meet their needs, now and in the future.

It recommends that a new NHS budget be created that can meet demand, set realistic targets for saving money, protect funds for transformation, and invest in the long-term sustainability of the NHS.

The number of medical students and trainee specialists must be increased, says the report: sufficient numbers of doctors for all parts of the medical workforce are needed it says, adding that there should be incentives to attract doctors to work in the most challenging and high demand areas of medicine.

Nurse shortages have to be tackled and new models of staffing, such as physician associates, must be pursued, while action across all government departments is needed to relieve immediate pressures on the NHS workforce, says the report.

Later this year, the College will launch a new campaign aimed at valuing and supporting doctors working in the NHS, on the grounds that a cared for workforce provides better care for patients.

The campaign will work with members to find innovative solutions to workforce pressure, while pushing for action from across government and the health service.

“As a doctor, I realise that this is a tough diagnosis for the NHS,” commented RCP President, Jane Dacre. “However, a diagnosis is the first step towards working with colleagues to find solutions. We are keen to find the best treatment for the NHS over the coming weeks, months and years,” she said.

RCP registrar Andrew Goddard added: “It is clear to all of us working in the NHS that we are at a point of no-return and the NHS in its current form is unsustainable without a significant increase in funding. We can’t continue to provide ever-more expensive treatments to an ever-increasing group of patients and not expect the system to collapse.

“There are some big decisions that society has to make, and the political parties have to stop blaming each other for where we are and work together to build a health and social care system that is fit for the UK in the 21st Century.”

Dr Johnny Marshall, Director of Policy at the NHS Confederation, said the report represented an important contribution to the debate on the future of the NHS.

But he said: “Further growth in the numbers of doctors is currently necessary but it will become unaffordable if allowed to continue indefinitely – putting healthcare at risk. It must go hand in glove with developing new roles, such as that of Physician Associates and developing new models of care that are more in tune with patients’ needs, such as moving services from hospital settings to community settings.”


* Underfunded, Underdoctored, Overstretched - the NHS in 2016. Royal College of Physicians, September 2016.

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