NHS at 70: ‘The founders would be proud of what exists today, but the NHS must solve workforce challenges to survive’

Professor Jane Dacre, President of the Royal College of Physicians (RCP), says the NHS must face up to the challenges of long-term conditions, funding constraints and staffing shortages to survive another 70 years.


25 June 2018, by Sarah Brealey

Professor Jane Dacre, President of the Royal College of Physicians

How do you think the founders of the NHS would view it today?

I think the founders of the NHS would be very proud of what they created and what exists today.

When the NHS first started, people were dying quickly of a single disease: now they are living longer with multiple diseases. I think they [the founders] thought that after a while we would have cured the major health problems, but it has just changed them. We need to support people to have a good quality of life.

The NHS needs to adapt to survive the next 70 years. The number of patients who are treated has gone up, and the complexity of their problems has gone up, year on year. We have more illnesses. We haven’t yet adapted the processes to be able to deal with that.

We also haven’t made the right decisions as a country about the level of investment and the staffing to keep the service going.

What is best about the NHS is universal healthcare, free at the point of delivery. We need to think about how we do what we do and make it affordable.

Do you have concerns about staff shortages in the NHS?

NHS Improvement has produced statistics that showed the NHS is 100,000 staff short from a total of 1.1 million. We [the Royal College of Physicians] agree with that.

I visit trusts frequently and there isn’t one trust where there haven’t been unfilled posts. That is having an impact on staff morale.

So when the service is overstretched you get winter pressures – either normal winter pressures or unexpected ones like the flu outbreak – that can have an impact on patient care.

We published a survey in March 2018 showing that nearly two-thirds of doctors think patient safety has deteriorated over the last year.

But the government tells us that there are more doctors in the NHS than ever before – isn’t this the case?

It is true that there are more doctors than ever before, but there are more patients being seen than ever before. It is not keeping up with demand.

There are 1,500 new doctor training places which will help the issue, but that’s only a start.

So what’s the solution?

We think there needs to be a careful look at a workforce strategy. We know that is happening, and we welcome that.

We need to train and protect workforce requirements for the next 20 to 30 years. It’s difficult, because for many years we have underestimated the number of clinicians that are needed in the NHS. There aren’t enough at the moment.

We can do things more efficiently. But it is very difficult to do this if we don’t have a full quota of clinicians.

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We need to recruit more from overseas. We have called on the government to give priority to healthcare workers from Europe to work here. It is difficult at the moment because of the Brexit negotiations.

We should be working with our sister colleges in the Commonwealth countries, but do that so we are not stripping them of healthcare workers, but working with them in areas where they have a surplus or we can help them with training placements. Other medical colleges in the Commonwealth would welcome the opportunity for their doctors to have a period of training in this country.

How is the RCP contributing to the debate on the future of the NHS?

The RCP this year is producing Our Future Health – a series of podcasts, surveys, video debates and social media activity. This is intended as a policy contribution to mark our 500th anniversary.

It will show doctors what physicians can contribute to the content of the future health service. We are looking at doctors’ dilemmas in the workplace: things like where patients should be treated, how to provide high-quality end-of-life care, when not to treat, whether we are over-medicalising certain conditions.

There has been a lot of discussion on structure of the health service: we want to focus on the doctor-patient relationship and making that better. We should be treating where we should treat, rather than where we could treat.

For example, there is evidence that patients are not necessarily given appropriate treatment at the end of life. Also, sometimes patients are on all sorts of medications for different illnesses, but they are not reviewed to see if they still need to be taking them.

Any final thoughts?

I would like to emphasise what unsung heroes the people working in the NHS are. They work in healthcare because they care about other people and want to do the best by them.

It breaks my heart to see the pressure some of my colleagues are under. It places enormous pressure on them as individuals. We should recognise what they do, and support them.

Interview by Sarah Brealey


More on the NHS at 70

Our patient magazine, Heart Matters, has published a suite of articles in time for the 70th anniversary of the NHS.