We constantly hear that the NHS is in crisis. Most recently on the news agenda has been the NHS staffing crisis with a chronic lack of doctors, nurses, technicians and many areas of the NHS workforce. The Conservative government’s latest response to this is to shorten the length of medical degrees from five to four years. If implemented this will most likely mean training will be more narrowly focused on the most “essential” or “important” elements of medical training. What might be lost in the process?
Several years ago, I taught some components of a medical degree including social research methods, medical history and what was referred to as “psychosocial” training. This involved a social scientist, such as me, being paired up with a GP to train groups of medical students on the interplay between psychological and social issues and health. In pairs students would visit volunteer patients, accessed via the GP, with long term, chronic health conditions and spend some time learning about their lives, how they managed work, family and social life, treatment, medication, etc. In workshops they would explore the social context of medical treatment and the understanding required to effectively treat patients and how to develop a “bedside manner” which is respectful and effective.
A few years later I taught a couple of units on a dietetics course covering sociology of health and some aspects of health promotion. This helped to introduce students to what was again called the “psychosocial” context of, influences on, or outcomes of dietary behaviours and interventions. By encouraging students to reflect on broader aspects of a discipline which is mostly focused on biological processes and behaviour change they are given the space to start to see the people they want to help as people in something like their real context.
The government’s proposed strategy of shortening the length of medical training will speed up the supply pipeline of new staff but it is likely to be at the expense of developing some important knowledge and skills. By focusing on the “essential” elements (typically identified as biology, chemistry, clinical practice) it could encourage a narrower view of health and make treatment less effective with service users less satisfied with their interactions with professionals. It is well established that dignity and being treated like a human being are essential for all kinds of medical encounters. Developing these capacities in future medics was precisely the intended outcomes of the kinds of teaching I and many other people delivered to medical students.
Similar changes to training in the probation service, to cut costs and fix staffing issues, have encouraged a more “pragmatic” culture built around risk management rather than developing relationships with offenders and applying a more “academically” grounded approach. A similar “vocational” understanding of higher education can be seen in the recurrent proposals over the last few years for accelerated two-year university degrees (in a range of subjects) to give “better value” to students who would rather get through their degree, and into the job market, more quickly. These would forego summer breaks and have more densely packed timetables (reading between classes can presumably be done instead of sleeping).
This approach is often presented as increasing access to higher education for those who can’t afford to wait three years to enter the job market. But many students need to work part-time (or even full-time) to support themselves (and in some cases family) while studying for three-year degrees on a more densely packed two-year course would probably be less viable for them (therefore further restricting access for already underrepresented groups). As with the proposed changes to medical training this approach leaves little room for the development of broader understanding and reflection and is really part of a broader attack on certain sections of higher education.
As Prime Minister Rishi Sunak told a group of Conservative supporters in August 2022:
“We’ve got to get far tougher on those university courses that are simply not paying their way, because we are spending your money to subsidise these courses, which are not producing the goods for people, right? So it’s great news for the universities largely full of, you know, people who don’t vote for us anyway.”
This is demonstrative of the long-standing attack on the arts, humanities and social sciences by many Conservative adminstrations. The government is not directly spending tax-payer money to subsidise these courses as the funding comes overwhelmingly from tuition fees. Rather, it is the “high cost” courses (eg. medicine, veterinary sciences, nursing and midwifery, dietetics) which are subsidised. However, long term spending on the courses targeted is greater as the majority of the government backed loans are not repaid so are ultimately written off.
The current government encourages a narrow view of all kinds of higher education and training and appears to have very little understanding of how the disciplines intertwine with skills and knowledge shared between them. Medical degrees would be worse off with less time dedicated to developed “person centred” approaches and reflection on the “psychosocial” issues as well as the history and ethics of their discipline. Framing degree subjects, and by proxy the students and staff affiliated with them, principally in relation to their risk to the government’s loan portfolio also devalues their role in the education of future medics (and many other professions).
The current staffing crisis in the NHS, and the industrial action by nurses, junior doctors and soon senior doctors, are all the long-term result of more than a decade of austerity policies initially introduced by the Con-Lib coalition government soon after they came to power in 2010. The proposed shortened degrees, along with other proposals to reduce NHS “pen pushers” and no doubt increase the administrative burden on medics, will only make caring for patients even harder.