Abstract
NHS productivity hasn’t recovered to pre-covid levels. The management consultants have been called in to dispense their wisdom. Some things are all in the timing, and this does not seem to be the time for a dialogue built around powerpoint presentations, spreadsheets, and global case studies. At some point the NHS crisis morphed into business as usual and we stopped calling it a crisis. The crisis still exists.
A workforce, unhappy with working conditions and pay, requires some hope that its longstanding complaints will be addressed. A humble proposal is that if the government mollifies the workforce, productivity will take care of itself. Some signs are positive, in that doctors and the government are negotiating. A new health secretary, at least, seems more willing to find agreement than her predecessor.
A workforce plan was also published recently with much fanfare and general relief. It came with targets and promises to increase numbers of doctors and allied health professionals to meet the growing demand. However, closer scrutiny has raised important questions about how the plans will be implemented, and whether it is realistic to increase numbers without adequate reform of career structures and solutions to training needs.1,2
One of the most controversial elements of the workforce plan is expansion in numbers of physician associates. The problems include how to clearly identify physician associates distinctly from doctors, how they should be trained, and how they should be regulated. The principle of a more diverse workforce to meet the population’s needs is a sound one, but, like the workforce plan itself, the conversation is being allowed to drift instead of being meaningfully resolved.
A sense of drift also accompanies political responses to the climate crisis even though demands for action continue to intensify. Medical journal editors have united to demand that the climate crisis and the nature crisis, namely biodiversity loss, must be considered together since they are interdependent. 3 The World Health Organization must recognise the threat to human health by declaring a global health emergency. The longer we drift, the more we are doomed.