RCP Report – Underfunded, Underdoctored, Overstretched

The NHS in 2016

RCP have released a pretty stark report highlighting, amongst other things, the significantly increase gulf between provision and demand. This in itself is not news to anyone working on the front line (and I believe not news to anyone in Whitehall either). However, if they ‘know’ but choose not act, you do have to ask two questions; why? and how should I react to that?

The report highlights a growth in demand of 4% per annum versus funding growth of just 0.2%. The gulf between this is stark enough but we must remember that the issue is compounded. So the gulf widens in a more exponential fashion (same reason why pensions at an early age are such a good idea). Moreover, I wonder if that 4% increase in demand takes into account other additive counfounders such as:

  • An ageing propulation brings an added component of complexity i.e. average acuity is increased, so the demand increase in actual care terms is greater than the increase in number of episodes – the traditional measures
  • Reductions in social care availability mean some elderly are less physically fit and present in worse condition, in part due to inactivity, a problem added to by things like staffing costs in care homes reducing available staff to the bare minimum for compliance and not enough to ensure residents have active lives

How to React?

The Government/DH is effectively declaring a policy attitude with their approach to funding, training numbers etc. They are saying “we recognise we aren’t keeping track and thus that heavier and heavier workload will fall on the shoulders of those that are already there”. That’s hardly consistent with the mantra that we are all in it together and need to pull together, collectively. It’s either an abandonment or an abuse of vocation.

As the RCP Report rightly points out, this impacts staff at a very personal level, with effects anywhere from morale to mental & physical health. Despite knowing this, the DH attitude is “well… tough. Just get on with it” Our view is slightly different because we see the effects of this compounded problem every day on two of our programmes:

(Click on them for links to them)

Those attending are often there because they are at the end of their tether. More accurately, they are highlighting that there are limits to human endurance and that compounding ‘overwork’ pushes people to the point of breaking, which manifests itself in all manner of ways, from home-stress and marital problems to real physical health problems such as MI. This is not a wooly ‘might be’ because there are countless studies looking at the effect of continual overwork, especially in stressful environments. The effect is itself is enhanced by feelings of being unfairly treated, something that the Whitehall Study (yes, I know… they know) demonstrated beyond reasonable doubt and statistical anomaly.

Link to Whitehall Study

So, our thought-provoking question is this; if you worked for an employer that didn’t care how much they over-worked you, knowing full well that it was bringing about the early death of some and having an adverse effect on many, if not the majority now, would you ‘kill’ yourself for them? The harsh question; so why are you?

There are of course many reasons but the main ones are:

  • It’s not for them, it’s for the patients
  • It just keeps on creeping up
  • We just don’t know how to address it, safely, without fall out personally
  • It has to change… soon

The issue with ‘for the patients’ is tough. However, I suspect it is best rationalised by thinking about the difference between Mrs Jones sat in front of you versus ‘patients’ the generic public who need to rely on the service for years and years to come. Whereas you will always find it impossible to turn away Mrs Jones because you have ‘finished’, you have to ask what effect you are having by ‘coping’ with the increases in demand with an increase in resource. If you cope, then the Government doesn’t address the problem, because you let them off. They don’t need to. You keep shouldering it. But… there comes a point when human endurance is overwhelmed and the system crashes in a way that leaves dead bodies everywhere – patients and workforce. Literally. Letting the Government off the hook is contributing to that point in time one day, probably in our lifetime and almost certainly by the timeĀ  we need to rely on the system for our own health needs. Is that what you want?

I know I am being harsh and probably touching quite a few raw nerves but what does it take to create a change in behaviour?

Well, there’s a second part answer to that question and it relates to the other bullet points above. You have to know how to approach that to ensure you are personally safe, act ethically, work in collaboration (even when it presents an inconvenient problem for those genuinely responsible) and minimise the effects on patients. As we are seeing with the juniors, if you don’t address it early, you end up in situations where patients are being put at risk. Regardless of the validity of their case, nobody comes out reputationally intact. It is this that we tackle on the two courses mentioned above, both dealing with work-life balance, workload control and returning your life to your own locus of control but in very different ways and to some degree from different starting levels of stress. We haven’t had anyone attend both who has complained about overlap – they are complementary.

The article is NOT a sales pitch. The article is to ensure you picked up the RCP Report, reflected on what it means, to you and to patients, whilst stimulating a way of thinking about this that perhaps helps you take action.That action can be so many things and so far beyond attending a programme (it’s a start…). The important thing is to take action when there are consquences to not doing so and if this stimulates a bit of that then it was worth the effort and harsh words. It’s up to the individual to work out what action is appropriate and if they want some help and support in that then of course we are here too.

Ironically, we go to the ends of the other to prevent one unnecessary death in the NHS and then we all too frequently forget that not addressing overwhelming workload and personal stress kills 1,000s for every single unnecessary death in the medical error sense of the word. It’s just not such an acute and visibily obvious death.


We made reference to two related courses. If you want more information you can find it by clicking either title below:

Time Management for Consultants Course

Stress Management & Resilience Course


2 responses to “RCP Report – Underfunded, Underdoctored, Overstretched

  1. Hi, my reaction to the report is to resign!! I have already decided, age 57, to retire in march 2017. however, to confirm this decision, I did two things, firstly, I went to Andrew Langsleys talk at the TUC last week, and also I read the RCP report. AL’s talk was intriguing, wonderfully unimpressive, in short total, rubbish. Poorly constructed, no intellectual rigor, no logic, no data, no reaction to failed policies, difficult questions from the audience just unanswered. He has no idea at all of health care, and how organisations and people work. He furiously attacked the BMA, and also junior doctors, he had no realistic vision. And this man held the highest health office in the country, and his friends still do. So, those running the show have no clue. And this is just as true of labour as tory, And the RCP report tells us the consequences. Which are just plain awful. I know that nothing will change for the better. So I must leave. Like half my colleagues aged 55-60. If people think there is a crisis now, wait for next year, when the whole sewage farm will hit the fan!! (Please do not publish my name!)

    1. I cannot disagree with any of your comments. However, I do debate with a very learned colleague whether the current policy direction of crashing the health system is by delusion or intention. These are intelligent people. My rather challenged frontal lobe rationalises that they must ‘know’ and thus are deliberate in their intentions. My friend argues that they are deluded and clueless on a massive scale. We both admit that it could be both… a really scary thought.

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