Underfunded. Underdoctored. Overstretched.

Dr Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. In this blog she discusses the recent RCP report ‘Underfunded. Underdoctored. Overstretched. The NHS in 2016‘. She tweets @geri_baby

underfunded-underdoctored_0The Royal College of Physicians have published a report Underfunded. Underdoctored. Overstretched. The NHS in 2016. It clearly lays out that honest debate is needed, and choices are going to have to be made – increases in funding or cuts in care. It states that a new plan is needed, not yet another  quick fix or temporary solution, rather one that is designed to meet the UK’s health and care needs in the long term, and that values, supports and motivates NHS staff.

For those of us involved in the care of older people it is helpful to see stark numbers clearly stated, with the acknowledgment that our patients have complex support needs, multiple health conditions and often frailty. Those aged over 85 spend five days longer in hospital than average, on a background of a growth in new admissions to hospital of 30% over the past decade. On the other hand, ambulatory services for acute care have also grown over this time period, so those who are admitted are sicker and more complex which means more intensive levels of care and higher workloads. The report acknowledges the intricate relationship between health and social care, and that cuts in local government funding have already had a direct impact on hospital services with no scope for improvement as the financial gap is set to continue to grow.

Recruitment to ST3 posts in Geriatric Medicine is the best it has ever been, but the demand for consultant Geriatricians remains unprecedented, with only around one third of posts filled when advertised. Providers have realised the value we add to services, and our roles in specialist liaison continue to grow. Despite this, reference is made in the report to the decision made by HEE to cut our higher training numbers in 2015. Despite ever increasing numbers of patients, there are fewer medical students now than at the start of the decade and even if all core medical trainees chose to progress to a medical registrar job, they would only fill three quarters of posts across all medical specialities. Falling morale, leading to disengagement and workplace stress affect all grades, from newly qualified doctors through to experienced consultants, and can impact directly on patient care and safety. It also acts as a deterrent to pursuing a career in medicine, with life in general practice acknowledged as being equally pressured and challenging.

The RCP is calling for action in three areas – an NHS budget that meets demand for health services, sets realistic targets for efficiency savings but most importantly invests in long-term NHS sustainability. More doctors need to be trained, and nurse shortages must be addressed. Finally the working lives of NHS staff need to be improved as this will deliver better outcomes for patients.

I welcome such direct statements from our representatives, and hope they are able to produce genuine action.

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