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| Thousands of children’s operations are being cancelled. It doesn’t have to be that way | Thousands of children’s operations are being cancelled. It doesn’t have to be that way |
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| This week, figures published in the Guardian provided another sorry illustration of how NHS services have been pushed to the brink. More than 46,000 children’s operations were cancelled during the period 2013-14 to 2017-18, and that was just in the 53% of eligible NHS trusts that reported their figures. The numbers are shocking, all the more so as they clearly reflect only the tip of the iceberg. Children’s operations are not conducted without good clinical reason: delays are harmful, and for some children the damage may be long-term. | This week, figures published in the Guardian provided another sorry illustration of how NHS services have been pushed to the brink. More than 46,000 children’s operations were cancelled during the period 2013-14 to 2017-18, and that was just in the 53% of eligible NHS trusts that reported their figures. The numbers are shocking, all the more so as they clearly reflect only the tip of the iceberg. Children’s operations are not conducted without good clinical reason: delays are harmful, and for some children the damage may be long-term. |
| The reasons cited by the NHS trusts are predominantly related to workforce. As a frontline clinician I witness first-hand the human cost of staff shortages, and last month the Royal College of Paediatrics and Child Health (RCPCH), of which I am president, also published a workforce report identifying serious staffing shortages nationwide, which has forced several children’s services to close temporarily. There are currently about 240 paediatric consultant-level posts empty and children’s services have an average junior doctor vacancy rate of 14%. | The reasons cited by the NHS trusts are predominantly related to workforce. As a frontline clinician I witness first-hand the human cost of staff shortages, and last month the Royal College of Paediatrics and Child Health (RCPCH), of which I am president, also published a workforce report identifying serious staffing shortages nationwide, which has forced several children’s services to close temporarily. There are currently about 240 paediatric consultant-level posts empty and children’s services have an average junior doctor vacancy rate of 14%. |
| Paediatrics is one of the most rewarding specialities and has always been popular but junior doctors are now voting with their feet after last year’s damaging contract dispute in England. Applicants for speciality training in paediatrics fell from 800 in 2015 to 743 in 2016 and 580 in 2017, and for the first time paediatric training places are vacant in England (though not in Scotland, Wales and Northern Ireland). Simultaneously, over the period between 2013-14 and 2015-16 the number of hospital admissions for children in England rose by 25%, from 1.2 million to 1.5 million. Other areas of medicine report similar problems. | Paediatrics is one of the most rewarding specialities and has always been popular but junior doctors are now voting with their feet after last year’s damaging contract dispute in England. Applicants for speciality training in paediatrics fell from 800 in 2015 to 743 in 2016 and 580 in 2017, and for the first time paediatric training places are vacant in England (though not in Scotland, Wales and Northern Ireland). Simultaneously, over the period between 2013-14 and 2015-16 the number of hospital admissions for children in England rose by 25%, from 1.2 million to 1.5 million. Other areas of medicine report similar problems. |
| The upshot is that it is only through the dedication of doctors and the wider child-health workforce, with many doing the work of two people or working extra hours and days, that children continue to be cared for safely. But we are running to stand still: there is insufficient time to teach and train, to introduce improvements or research new treatments, to talk with children and their families – in other words, to advance the care provided. If this weren’t bad enough, the extraordinary failure to provide post-Brexit assurances to the 55,000 NHS workers who are EU citizens is worsening staff shortages. | The upshot is that it is only through the dedication of doctors and the wider child-health workforce, with many doing the work of two people or working extra hours and days, that children continue to be cared for safely. But we are running to stand still: there is insufficient time to teach and train, to introduce improvements or research new treatments, to talk with children and their families – in other words, to advance the care provided. If this weren’t bad enough, the extraordinary failure to provide post-Brexit assurances to the 55,000 NHS workers who are EU citizens is worsening staff shortages. |
| Operations were also cancelled because of bed shortages, equipment failures and lack of theatre time. There is no longer any doubt that UK healthcare is under-resourced. It must be asked why, in 2015-16, the public funds diverted into for-profit and other non-NHS healthcare providers rose by 18%, almost double the 10% average annual rise during the coalition government; why £901m, almost half the extra money made available, was spent on buying private sector care; and why, according to figures from the Department of Health, in 2013-14 £6.6bn was taken from the public purse last year to pay private health providers. | Operations were also cancelled because of bed shortages, equipment failures and lack of theatre time. There is no longer any doubt that UK healthcare is under-resourced. It must be asked why, in 2015-16, the public funds diverted into for-profit and other non-NHS healthcare providers rose by 18%, almost double the 10% average annual rise during the coalition government; why £901m, almost half the extra money made available, was spent on buying private sector care; and why, according to figures from the Department of Health, in 2013-14 £6.6bn was taken from the public purse last year to pay private health providers. |
| The public – and the vulnerable children among them – are being let down. Influential reports such as those prepared for the World Economic Forum by McKinsey & Company analyse the problems besetting health systems predominantly in market-driven terms. But market values in healthcare distort decision making, widen health inequalities and waste money, all of which is occurring in the UK today. The supremacy of market forces in healthcare has been successfully challenged by the NHS since its inception, yet instead of modernising and strengthening a model that has been unique, innovative, efficient and effective, recent years have seen chronic under-investment and the increasing alienation of the service’s bedrock: a once stable workforce proud to work in the public sector. | The public – and the vulnerable children among them – are being let down. Influential reports such as those prepared for the World Economic Forum by McKinsey & Company analyse the problems besetting health systems predominantly in market-driven terms. But market values in healthcare distort decision making, widen health inequalities and waste money, all of which is occurring in the UK today. The supremacy of market forces in healthcare has been successfully challenged by the NHS since its inception, yet instead of modernising and strengthening a model that has been unique, innovative, efficient and effective, recent years have seen chronic under-investment and the increasing alienation of the service’s bedrock: a once stable workforce proud to work in the public sector. |
| Solutions exist, but are being ignored. With respect to workforce issues, we have suggested identifying a responsible body for integrated national and regional workforce planning, including short-stay career development opportunities for non-training grade healthcare professionals from abroad; integrated child-health training programmes for both general practice and paediatricians; placing paediatrics on the shortage occupation list with exemption from the resident labour market test; providing reassurance to EU nationals in the NHS on maintenance of employment terms and conditions and migrant status; restoring UK-wide medical workforce terms and conditions; and ensuring immigration rules allow entry of healthcare professionals whose skills will benefit the NHS. | Solutions exist, but are being ignored. With respect to workforce issues, we have suggested identifying a responsible body for integrated national and regional workforce planning, including short-stay career development opportunities for non-training grade healthcare professionals from abroad; integrated child-health training programmes for both general practice and paediatricians; placing paediatrics on the shortage occupation list with exemption from the resident labour market test; providing reassurance to EU nationals in the NHS on maintenance of employment terms and conditions and migrant status; restoring UK-wide medical workforce terms and conditions; and ensuring immigration rules allow entry of healthcare professionals whose skills will benefit the NHS. |
| The NHS is too important to fall victim to political short-termism. The latest polls show that more than 60% of the public see the NHS as one of the most important issues facing Britain. We fear for children’s health and wellbeing, which is why we have also called for cross-party agreement to stop the fragmentation of our health system, ensure it remains publicly funded, provided and managed, and commit to raising the UK health budget incrementally to enable stable forward-planning. | The NHS is too important to fall victim to political short-termism. The latest polls show that more than 60% of the public see the NHS as one of the most important issues facing Britain. We fear for children’s health and wellbeing, which is why we have also called for cross-party agreement to stop the fragmentation of our health system, ensure it remains publicly funded, provided and managed, and commit to raising the UK health budget incrementally to enable stable forward-planning. |
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