The vote against proportional representation, led by the media, has ensured that we will have continual swings from left to right in the philosophy of the English NHS. PR of any form would have been a good move towards de-politisizing the Regional Health Services (RHS). (Wales of course does not have this problem as we have been tattooed with left-wing philosophy since birth.)
We need to plan for longer term than 5 years. We need to attract doctors to more remote areas The vast majority aim to work in cities. The best schools are in cities. Thus more applicants and success come from city students.
As a revolutionary idea, I suggest that each school is allocated at least 5 places for medical school entry, preferably after a first degree, and with equal numbers of men and women to correct the current imbalance. The outcome would be grossly unfair, and post coded against the cities: just as today’s RHS services are post-coded favourably for services in cities… It would however be progressive (as opposed to regressive) and it would reduce inequalities. If students were based in rural areas during their formative years, with tutorials and major learning on the internet and through recorded lectures and on-line tutorials, they would be more likely to settle in the area they were attached to in training, as they would form relationships and get involved in their community.
The barrier to such radical and bottom up thinking is the Deaneries, and the Politicians (budgets). The power is in the centre, and is enhanced by undercapacity,. It will be reduced by overcapacity…..
Sir, The report commissioned by the Medical Schools Council which concluded that half of schools in Britain failed to send a single pupil to study medicine is well analysed by your education editor (Dec 10). The only sensible conclusion one can form is that there seems to be a complete lack of understanding of the nature of the problem or of its very serious nature.
There are more than 88,000 applicants each year for only 8,000 places. These students are all high quality and well motivated. What would be the point of more schools taking part, perhaps doubling the number of applicants who would later be rejected? More importantly, when will we see the end of there being too few places in our medical schools, given that it is perpetuating a situation in which we have a chronic shortage of doctors at the same time as a large number of people reaching retirement age.
Sir, The Sutton Trust welcomes the Medical Schools Council’s recognition that more must be done to improve access to a career in medicine for students from low and middle-income backgrounds. This year we launched a pilot programme with Imperial College London that will take practical steps to increase the numbers of students from low and middle-income families applying to study medicine. It will reach 180 students over three years, offering them the support and information they need to compete with those from affluent backgrounds. The Pathways to Medicine programme includes help with interviews and applications, work experience and a one-week summer school where students get the chance to take part in hands-on experiments and medical seminars.
We hope this kind of practical support for low and middle-income students, together with a contextual approach to admissions, will radically alter the composition of our medical schools, making the profession accessible to all based on merit rather than money.
Sir Peter Lampl
Chairman, The Sutton Trust
Sir, The shortage of doctors and nurses in this country does no credit to any recent government. It has been official policy to rely upon imported doctors for some years now — imported from countries that can ill-afford to see them go. That, and the cutback in training places, has meant that we are now finding it difficult to find doctors to fill consultant posts and to become GPs.
In nursing the position is as bad. There is no shortage of people wanting to do nursing — simply a lack of training places, with the consequence that we rely on agency nurses from the Philippines and Portugal to staff our wards.
Our excellent school of nursing has been closed, the internationally renowned Nightingale School of Nursing is a shadow of its former self, amalgamated in the name of “efficiency savings”, as have been so many medical schools.
Nursing is an advanced life skill and communities need trained nurses to function properly — to help to look after people at the extremes of age, or who have left hospital, or to provide advice over smaller medical problems (so that people don’t need to go to A&E).
It costs society far more not to have doctors and nurses than it does to train them.
Dr JA Lack
Coombe Bissett, Wilts
Sir, It is not just a question of broadening intake for medicine, but of creating more training places for doctors, midwives, nurses and other health personnel. It is a false economy to attempt to shore up the NHS with imported staff, which plays into the hands of Ukip.
Successive governments and health leaders have constantly lamented staff shortages in the NHS, but it has been nobody’s fault but their own. If there were more places then the entry conditions need not be quite so harsh, (and also less arbitrary). Urgent steps should be taken by the coalition so that we become self sufficient in this precious commodity.
Winchelsea, E Sussex
From the correspondence on line:
Don’t worry – regarding doctors, the devaluing of medical professionals’ jobs will gradually reduce the calibre of applicants in any event (and is already doing so from my experience). 6 years of pay freezes or miniscule rises, with many more years promised; an attack on pension values and an increase in contributions (from 6% up to 15% or more); a pervasive blame culture; a tick box mentality enforced by the ever increasing number of too-powerful and underskilled managers; defensive medicine practiced to avoid complaints and lawyers’ interventions (which is counter-productive to good health and to rational use of resources, but done to cover doctors’ backs); demoralisation from a fragmented service being eaten up by a short-sighted private sector taking the low lying fruit and leaving the difficult, unprofitable bits behind; an attack on professional autonomy by the introduction of assembly line, volume medicine designed to follow rigidly imposed protocols; and a futile attempt to meet the insatiable and unrealistic consumerist demand for healthcare and for convenience without being prepared to pick up the costs of that (e.g. moving to 7 day working but with no extra money to pay doctors for working (even more) unsociable hours). Fewer and fewer of the brightest are going to want to do it. And those that do choose it will increasingly drop out. Sure, there will be enough who will do it – and there are so many more “A-grade students” now with the grade inflation of the last couple of decades to fill the places. And sure, they will probably do a “good enough” job – but don’t expect as many of the brilliant minds of the past that I have seen dedicate themselves to medicine and the NHS (and don’t just mean brilliant academically, I mean in all of the skills needed to succeed as a doctor). They will go (and are going) elsewhere.