The challenge of health education today

Staff shortages in the health professions becomes no greater than shortage of teachers, accountants, bankers and civil servants; but in the population there are probably not enough intelligent persons for the full staffing of all professions and of senior posts in commerce and industry.

Abstract

Introduction Britain's health services have been the envy of the world, and on death rates for 5-year age groups, only Sweden, Norway and Holland have better statistics. Yet our hospital waiting lists have lengthened so alarmingly that one person in every 20 has joined a private scheme. On all sides we hear of shortages of nurses, health visitors, radiographers and physiotherapists. Some hospitals have only three nurses for every four needed; and at integration some local authorities had less than half the health visitors required for their population. Also our health services, dangerously near collapse, are continuing by courtesy of the developing nations: a sixth of our doctors and over a third of our nurses are from overseas, and that source of recruitment is drying up as developing countries open their own medical and nursing schools. Two remedies have been proposed. First, treatment of the arthritic joints of the service by gold injection. Certainly we have run our services on the cheap, spending on all health and social services only 5.7 ~ of the gross national product, compared with 7.4 ~o in the U.S.A. and 8 . 4 ~ in West Germany. Certainly in a mechanized civilization where one machine can replace 100 workers, we can afford to spend more on health. Certainly we must go considerably beyond Hatsbury and raise the salaries of nurses, midwives, health visitors, and so on, to parity with other skilled professions. Yet, even if we raise health expenditure by 50 ~ (to the level of West Germany) or to the higher level recently mentioned by Robert Maxwell (1974), staff shortages will remain. By all means ensure that shortage in the health professions becomes no greater than shortage of teachers, accountants, bankers and civil servants; but in the population there are probably not enough intelligent persons for the full staffing of all professions and of senior posts in commerce and industry. The second remedy offered is to improve co-ordination and remove duplication. Slight staff saving might result from rationalization of general practice territory (saving travelling time of doctor, health visitor and home nurse) if we are prepared to accept reduction both of clinical freedom and of patients' freedom of choice; and Babson (1973) has shown that we could raise the efficiency of maternity services by abolishing home confinements and G.P. maternity units and concentrating on 48-hr hospital confinements and subsequent home care. Such changes, even if acceptable, would produce only small staff savings. More money and better management will prevent immediate collapse but still leave dangerous and increasing scarcity of health personnel.