More funding, training, and recruitment? Or just more Verschlimmbesserung ?

[摘要] There is growing darkness at the (imagined) light at the end of the COVID-19 tunnel.As the earlier massive tide-surge of the pandemic seems — for now — to be receding we have many reports of its legacy of damage and cost to our health care: not just delays and interruptions of sometimes vital treatments, but also of increasing staff burn-out, drop-out, and opt-out. And many of those who remain seem like heroically motivated runners staggering towards the end of a gruelling marathon — painfully determined to continue, yet collapsing into the arms of supportive and restorative care in order to recover.Thankfully, the effects of this as well as the vicious criticism of GPs has been recognised.1,2 These are serious problems to be neglected at our peril. Part of the remedy? Adequate funding for greater training and recruitment of staff. In a post-COVID-19, post-austerity era this may sound encouraging, but it raises many other questions, some very quotidian, others more fundamental yet obscure. How much funding is ‘adequate’? How will this be raised, distributed, and secured? If we recruit medical and nursing staff from other (often much poorer) countries — what are the ethical and practical (elsewhere) consequences of this?COMPUTERISATION AND THE NEW ECONOMICS But there are much greater and deeper rooted problems that threaten our NHS workforce than this COVID-19-induced concussion: the insidious and cumulative demoralisation and depersonalisation of healthcarers who have lost a sense of vocational pride and satisfaction, and collegial trust and belonging in their work. This deep and widespread dissatisfaction among so many nurses and doctors far precedes the super-added — albeit far more dramatic — COVID-19-crisis. Perhaps because this erosion of spirit and morale has been more gradual and incremental, its substantial damage has received little sustained attention from governing and managing authorities. Despite many years of growing evidence — for example, falling recruitment, failing health, increased early retirement, and career abandonment among primary and mental healthcare workers — little attention has been paid to the human meaning of this. This inattention is highly selective and thus tells us much about the nature of our problems.For the last 30 years there have been successive NHS reforms that may be seen as shifting attention, with increasing resources and precision, to money and metrics. The pioneering neoliberal agenda of the Thatcher era converged with the excited early development of digital technology: this enabled the mass-management and commodification of health care, and thence to marketised commissioning, monitored performance, and regulated compliance — together these are most compatible with corporate tendering and contractual negotiation. All this was much less possible in a previous world informed by mere ledger-books and managed by variable human good faith and judgement. The combination of computerisation and the new economics could then reform health care to become more and more like competitive commercialised manufacturing industries — like a giant web of siloed factories.

[学科分类] 卫生学