Barely a week goes by without some new initiative being announced to ‘solve the NHS workforce crisis’. It has become the cause celebre de nos jours and will probably be a major bone of contention at the next General Election.
This week saw the announcement of the ‘medical apprenticeship’ scheme – a new idea to increase the number of doctors and widen access into the medical profession. In traditional fashion, the media splash generated instant hostile pushback from horrified commentators choosing to interpret the plan as permission for school leavers to undertake appendicectomies. Equally predictable was the tedious condemnation from the medical establishment – ever eager to protect its intellectual hegemony and maintain barriers to entry onto the medical register.
I should state up front that I quite like traditions. For example, it is the tradition of the Daily Sceptic to look deeper than the mainstream media – to investigate and analyse the reality behind headlines. We think that’s what attracts our readership – so here goes.
My first observation is that this is not a new idea. Medical students have walked the wards as porters, healthcare assistants and general orderlies for generations. In my day it was a useful way of becoming acquainted with the junior nurses – a highly enjoyable way of broadening one’s education.
It’s not even a new idea in the near term. Health Education England (HEE) announced the plan on their website nearly a year ago.
From my perspective at the other end of a medical career, there are many advantages to aspiring young doctors getting early exposure to the sharp end of clinical practice (notwithstanding proximity to charming nurses). For a start, it enables students to decide early on whether the practice of medicine is really what they want to do. If it isn’t, much better to find out quickly and transfer to another career. The reality of medicine does not suit every smart teenager with good grades in science A levels and a starry-eyed belief in the priest-like virtue of the healer. That’s one reason why we have so many disgruntled juniors – the hype is not concordant with reality.
Using such a scheme to widen access to medicine for established healthcare workers in other fields also has potential. Over the last 34 years I have worked alongside some outstanding specialist nurses and allied trades. Within their narrow scope of practice those talented and dedicated individuals are every bit as effective as doctors. If some of them wanted to gain a medical degree via an apprenticeship route they would undoubtedly be a massive asset to the nation.
So, let’s put the hysterical pearl-clutching to bed. If we want more doctors, we need to train them, and an apprenticeship scheme is not a bad way to achieve that goal.
Now for the problematic part – the detail. The devil is always in the detail.
We can start by looking at the HEE website and their arguments in favour of the scheme:
The apprenticeship has been introduced to make the profession more accessible, more diverse, and more representative of local communities so patients are treated by a medical workforce that reflects the diversity of local communities. The aim is to recruit students from varying backgrounds, who may have struggled to pursue a traditional medical degree education, so that future generations of students, and health professionals, more closely mirror the population that they serve.
Frankly, this kind of bullshittery brings me out in a rash – it’s precisely the line of thought that devalues and degrades an otherwise worthy idea. The implication behind this type of nonsensical statement is that anyone can become a doctor if they have the correct demographic characteristics required to fill a diversity quota. Unfortunately learning the trade demands rather more than that. Whichever route one takes, there is a non-negotiable need to spend long hours sitting on a hard chair in a quiet room, committing vast amounts of information to memory – then demonstrating you’ve memorised it and can process it properly via a rigorous examination process. There’s no getting around it – not everyone is capable or inclined to manage the intellectual demands needed to get a medical degree. If, as HEE confidently assert, the apprentices will achieve a medical degree within the same five-year period as at university, then they are going to have to work a good deal harder than their equivalents on the traditional pathway.
My concern about the implementation of an apprenticeship scheme is that standards of examination will be ‘relaxed’ in the interests of diversity and of pushing more students/apprentices through the scheme. If that turned out to be the case, we would not be training more doctors – merely handing out badges in the interests of tokenism and political imperatives to get the numbers up. The only professionals benefitting from this scenario would be malpractice lawyers.
HEE and their fellow travellers are quick to state that standards for apprenticeships will be exactly the same as for a doctor trained in a medical school. That may be the aspiration, but past experience with ‘medical educators’ leads me to be suspicious about assurances of this nature. The usual argument deployed is that there are vast areas of the medical curriculum that students ‘do not need to know’ – that bypassing a granular study of anatomy, physiology, pathology and pharmacology can be done without degradation of a practitioner’s effectiveness in the workplace. I’m sceptical.
The argument about knowledge requirement really leads to the core question: What constitutes a doctor? What are the essential differences between doctors, nurses, and other health professionals?
In my view, the differences lie in the breadth and depth of knowledge which underpins the acceptance of responsibility for decision-making. It may well be the case that in everyday practice, an individual doctor will not use specific bits of knowledge. It will be rare for a practitioner to be called on to recall the branches of the trigeminal nerve, or to discourse on the modes of actions of different diuretic drugs or the clinical presentations of the four common types of malaria parasite. But here’s the point – medical problems do not present in isolation, wrapped up neatly in boxes with the diagnosis on a sticker. Medicine is complex. Diseases present with odd symptoms. Multiple problems overlap and transgress anatomical and physiological boundaries. Having a breadth of knowledge and experience makes errors less likely – if you don’t know what you don’t know, then you will be practicing in blissful ignorance – an accident waiting to happen.
But let’s give HEE the benefit of the doubt and accept their assurance that educational standards will not be lowered for the apprenticeship scheme. Who will train the apprentices? Hospitals and universities already struggle to provide adequate teaching for medical students, as experienced clinicians come under more strain to manage the NHS backlog. High quality medical education requires lots of ‘bedside teaching’ – small groups of students gaining regular intense tuition in history taking, clinical examination and the diagnostic process under the tutelage of senior doctors with decades of experience. Where is that coming from in the brave new world of medical education?
From my personal standpoint, as I approach retirement from clinical practice, I could be tempted to help out with a bit of teaching if the terms and conditions were similar to 30 years ago – but of course, they are not. Having one’s every remark scrutinised for ‘micro aggressions’, ‘unconscious bias’ or other contrived thought crimes, makes the idea of teaching modern day medical students extremely unattractive – indeed, those are the reasons why I withdrew from teaching some years ago. I can’t see many of my cohort volunteering to assist in training the next generation, as many outstanding retired clinicians did when I was at medical school.
Concerns have been raised by colleagues that an apprenticeship degree could be considered a second rate-qualification compared to a formal medical school education. I think this worry is exaggerated. In the crucible of clinical medicine, meritocracy usually prevails. If an apprentice doctor meets the standard, no one will even ask or care how they obtained their degree. I’ve worked alongside colleagues from all over the world, across the full spectrum of ethnicity and orientation. The good ones rapidly gain the respect, trust and affection of their peers – the idle or incompetent are equally rapidly exposed.
In summary, I have absolutely no objection to an apprenticeship style training in medicine. Indeed, done properly, it could be highly advantageous. However, I’m deeply suspicious of the motive and intention behind the implementation of this plan, based on my experience of the type of people pushing it and their track record of destroying much of what was good about British medical training and education over the past two decades. When medicine becomes politicised, standards slip and patients suffer. Feel free to call me sceptical, but my expectation is that last week’s fanfare was a performative piece of PR fluffery, carefully orchestrated to pretend that the clever people in the NHS had discovered a magic wheeze to fix an insoluble workforce problem at a stroke. It doesn’t matter which way you slice it – learning to be a doctor is hard work and takes a long time. There are no short cuts.
To join in with the discussion please make a donation to The Daily Sceptic.
Profanity and abuse will be removed and may lead to a permanent ban.
Thanks for that useful summary.
— Labour are also going to allow Vindictive Catholics to start harassing Northern Ireland Protestants and British Army veterans again, with endless legal actions over “The Troubles” tying up the courts for decades to come. That will please the Vatican.
— Labour are also going to allow (and fund?) the bizarre, creepy Holocaust Memorial to be built next to the UK Parliament, to show everyone who is really in charge, because no such memorials will be built there for the Holodomor, though no doubt Churchill’s statue will be replaced by George Floyd, and a Muslim memorial, and a Sikh memorial, and a Hindu memorial, and a Buddhist memorial, not to exclude an African Slavery (not White Slavery) memorial, a Pagan memorial, and a Maori Cannibal memorial.
Nationalise the Railways; that’s all a bit Benito. Good luck trying to bring that industry under control.
It is the stuff not mentioned I worry about. Stuff deep down in documentation that only the most eager nerd could uncover. They again, Agenda 2030 has just had a fresh boost of steroids.
“This is designed to avoid the mistakes of the disastrous Liz Truss “mini Budget”
Lol.
The Liz Truss budget that the Bank of England scuppered with their malign interference in the Bond markets?
Hmm.
Exactly, and which had zero economic effect.
Yup, that’s the one.
We’ll have 5 years of disastrous budgets now with tax increases of all kinds that will harm the economy.
Ah, but Kneel is introducing “safeguards” tof. The ‘Budget’ will be referred to the OBR for scrutiny which is marvellous – unelected faceless civil servants will give each budget a once over and if it does not suit (them) it will be altered / rejected. This offers the Chancellor the always sought after clause of
“Not me Guv.”
Ain’t life grand?
In my youthful naivety I thought that leaving such things to “experts” rather than irresponsible politicians was a good idea, but I have changed my mind now. The decisions must be made by people you can boot out of office if you think they’ve cocked it up.
Yes why would they want to avoid that, that is straight out of the Globalist playbook for anyone that undermines the agenda like wanting democracy.
Wasn’t allowed by the Banking Families/aka TRPTB.
Almost as bad as saying no more fractonal banking.
Consider –
Jackson
Lincoln
Garfield
Kennedy.
And
Gaddifi,
Kim Jon Um
Putin,
Putin – No more shall we enslaved by the Rothschilds of thsi world.
Complete smoking ban. “Health” fascism. Thanks to all who voted for parties that support that – Labour, Tories, probably most of the others.
In this respect, the sky is the limit once the practice has been established. Teetotalers, lactose intolerants, vegans, fructose intolerants (yes, they do exist) etc would all love to force others to live as they believe to be healthy by weaponizing criminal law. And that’s just food stuff. I bet there’s pretty much no aspect of human life some people don’t hold irrational but extremely strong “health opinions” about. Eg, so-called sedentary life style is widely believed to cause all kinds of serious health problems, so, why not outlaw sitting in public and demand that everyone must run a minium of … miles per week and be ready to demonstrate that to some public health surveillance authority?
Precisely. It won’t end with smoking.
I don’t think they’re interested in a healthy population. 2020 they closed the Gyms . I was lucky there, I had just moved house and moved my equipment the day before the Lockdowns, though at the time thought it would be three weeks. On the day of the Lockdown I still drove passed the Gym just by the off chance it was open, not taking things too seriously and not sure how seriously the Gym owner was taking it.
“I don’t think they’re interested in a healthy population.”
There’s an awful lot of culling to come.
The population has to be made poorly in order to reduce it.
The free breakfast club allows the government to try and influence the eating habits of the future adult population and/or give the children a poor diet so they have trouble learning.
“free breakfast club”
Exactly. And of course increase dependence on the state. For some parents this is literally manna from heaven.
Don’t give the barstewards ideas.
It’s not a smoking ban but a buying ban
Eventually there will be no one left alive who can legally buy cigarettes- how is that not a smoking ban?
Effectively: The immediate outcome will be a vibrant black market for smuggled cigarettes and without hiring a load of “community health police officers” who aggressively target smokers to force them to prove that they bought their tobacco legally, there’s nothing which can be done against that.
That’s obviously just the kind of measure the anti-smoker NGOs would love to implement. But these guys would also be love to be allowed to shoot smokers on sight because of the “health risks” they pose to them¹. It remains to be seen if they will also get it.
¹ That’s an actual quote from a conversation with such a guy I had in the past.
Exactly
First it was the smokers, then the car drivers – what’s next booze methinks.
The sky’s the limit!
Fake, lab-grown meat gets the go ahead. Now why would we need that I wonder?
Soylent green anybody?
Exactly.
Nonsense. That was real meat.
ulp!
https://www.conservativewoman.co.uk/uk-the-first-european-country-to-approve-lab-grown-meat-starting-with-pet-food/
https://youtu.be/yY3sNWK1_QU?si=MCOqcf0a_gJ0-NdO
This gives a clue to why we will need “lab-grown meat.”
Farmers need to wake up, I will be checking how many signs are up regarding ‘No Farmers, No Food, No future it the Royal Welsh Show. I remember arguing with one farmer and he said people don’t have a right to know why Bill Gates is buying up so much farmland in the US. FFS.
I ordered some stickers from ebay:
No Farmers
No Food
So these are appearing on local lampposts AND a baseball cap with the same message.
On the transport item, it may be worth clarifying the fact the infrastructure and physical operation of it is already state owned (Network Rail, Transport for London, Transport for Wales etc), and that some of the train operation organisations are also state owned, with the rest being franchised to private contractors, such as various train operators and rolling stock leasing companies. Even within the franchises, there is a lot of governmental management, via the Treasury. In the real world, we are looking at more reorganisation, which is normal; no such thing as stability in that trade, if you look back over the last century!
For quite a while recently, well before the election, there has been a lot of manipulation about the new “Great British Railways” (GBR) organisation, presumably being developed under the DfT. More work for the Civil Service, no doubt.
Over the years, my employers were British Rail, Adtranz, Bombardier, and a couple of contractors, one which took over the other.
So plenty of ruinously expensive activity and beggar all progress.
Plus ça change……..since 1990.
How is barring people born after 2009 from doing certain principally legal things not age-based discrimination? And how’s that going to work in practice in shops once the legal age for being allowed to buy cigarettes has risen to a point where it’s impossible to tell people who are and aren’t of age apart on sight? Lastly, considering that the war on drugs has been so horrendously effective that consumption of illegal drugs is virtually unheard of¹, what’s the likely effect of handing yet more profitable trade opportunities to the Mafia?
¹ If Cocaine consumption was as legal as it is ubiquitous, pubs etc could provide dedicated facilities for this. This would greatly reduce vandalism, violence and other unpleasantries the sometimes preciously few people using so-called restrooms for their nominal purpose would have to put up with.
When the Digital ID/Cashless Society/Social Credit system is up and running Big Brother will automatically be able to identify individuals by age ….. and stop them from buying products which aren’t approved.
I think you have that backwards: Enforcing this would require creation of such a system (plus a load of other totalitarian measures I mentioned in another comment).
Cheer up everyone. No blasphemy law…yet.
Annoying muslims is not goot for your health and hence, introducing one would save the NHS money!
On Labour’s new “Border Security Command”, here is a comment from the Daily Mail:
“Fact for you…On Labour’s Watch since Election nearly 2000 illegal migrants arrived in UK by rubber boats..& 1000s more in the back of Trucks ? A friend saw 9 men jump out of a Truck on M6 Services a week ago and run off across fields. .a member of staff told him …it happens every day & night, mate !”
If that is at least 20 illegals jumping out of lorries every 24 hours at just ONE motorway services stop, can you imagine the true, devastating extent of this invasion by land, coming on lorries through the Channel Tunnel, in addition to the thousands pouring in by sea?
And where do they go after “running across fields”? Years ago there were reports from rural people all over the country that groups of illegals were often seen and heard walking in single file through quiet villages in the dead of night.
Is this not a type of Guerrilla Warfare?
An Undeclared War on the West?
By our own elected politicians?
As you can see from this chart, immigration began to rise steadily and unstoppably from 1994, the year the Channel Tunnel opened.
Immigration: the numbers – UK in a changing Europe (ukandeu.ac.uk)
It was exactly what many British people had feared, as soon as Margaret Thatcher started pushing for the Tunnel to be built.
And long before that:
“So long as the ocean remains our friend, do not let us deliberately destroy its power to help us”: so argued the former Prime Minister, Foreign Secretary and First Lord of the Admiralty Arthur Balfour in 1920.”
“Balfour…echoing the views of a number of serving and retired soldiers plus a supporting chorus of politicians, civil servants and some sectors of public opinion, was arguing that the idea of constructing a Channel Tunnel linking Britain and France was a thoroughly bad one.”
https://www.jstor.org/stable/24430112
“Opposition to the Channel Tunnel, 1882-1975: Identity, Island Status and Security” by Duncan Redford, National Museum of the Royal Navy
What gets me is how they know where to go assuming they have just escaped from a vehicle. I suppose more who get here hitching on unsuspecting truck drivers still have their phones, but who do they phone.
Yes, yes, exactly so! How do they know where to go in a foreign country where they don’t even speak the language?
I’ve just been watching an astonishing explanation of this by US veteran and war correspondent Michael Yon, linked by The Expose website article here:
Michael Yon: The Invasion of Ireland – The Expose (expose-news.com)
and his video here, where he shows the actual map with the Foreign Forces deployed around Dublin: “(Allow approximately 1 minute and 20 seconds for the audio to kick in and the brief countdown to begin. The sound at first appears not to be working, but is actually fine.)”
Michael Yon: Callsign BIG HONEY 6 on X: “Michael Yon Live: Invasion of Ireland / June 19th https://t.co/UehvbR6cFa” / X
It’s a real shocker.
One shock from the video is realising that all the ring roads that were built around British towns and cities may be used as a convenient military barrier to encircle and imprison the inhabitants as in a siege, blocking all escape routes.
I remember reading years ago that some farming communities in the American Midwest were aghast when the military blocked off their access ramps overnight to stop them from driving their vehicles onto the state and interstate highways. They said it was just an “exercise”, and removed the blocks after a short time, but the locals were frightened at the speed with which their vehicular access had been totally blocked in the dead of night without warning, preventing them from getting their farm produce to market.
On the Radio I heard them mention in the King’s Speech that he said something along the lines of…..”Avoiding the snake oil salesmen of populism”. Yes Charles, I already know what team you bat for!
Chuckles and his mob are traitors.
His speech was entirely written by the Labour government for him to read out, as you must surely know.
Yes and he seems happy to read out stuff like that.
Who wouldn’t, considering the pay?
It’s worthwhile to remember that the actual family name of this guy is v. Gotha und Sachsen-Coburg and that the actual name of his father was v. Battenberg. The former was replaced with the synthetic name Windsor during the first world war, the latter anglicized into Mountbatten (literal translation) marking these people as the worst kind of Germans: Those who hide their heritage if it’s more profitable to do so.
I’m sure Nigel was very grateful for the PM making it so obvious where the real Opposition will be coming from.
What an absolute joke Lefties are. A Government Billy and His No Mates voted for intends to wreck the country, wreck the railways and wreck children’s lives. Nothing new under the sun essentially.
The rail bill is especially ludicrous. The railways were privatised for one precise reason: the country could not afford to maintain and replace the stock. The trains were a disgusting joke and I, for one, did not travel on them at all. Privatisation changed the entire ball game and trains are, today, modern and comfortable.
Where is the bit in the Bill about how the railways will be funded by the cash cow Sheeples? I see it not.
Climate Change – The Magic Energy Tree
This King’s speech also had some points on net-zero & climate change;
”The speech highlights the new Government’s recognition of the urgency of the global climate challenge and the new job opportunities that can come from leading the development of the technologies of the future.
It states the Government’s commitment to a clean energy transition which will lower energy bills for consumers over time, introducing the Great British Energy Bill. This entails a publicly owned clean power company headquartered in Scotland, which will help accelerate investment in renewable energy such as offshore wind.
Bringing forward legislation to help the country achieve energy independence and unlock investment in energy infrastructure, the Sustainable Aviation Fuel (Revenue Support Mechanism) Bill”
To my mind this is a lot of pie in the sky, wishful thinking, nonsense. ‘Lower energy bills’ ‘achieve energy independence’, they must still believe in the Tooth Fairy and Father Christmas. Gordon Brown gave us the quantitative easing magic money tree that has undermined the economy, this latest Labour gov is giving us eco energy fantasy land that will leave us all huddled round the wood-burner ( if you are still allowed to have one?) and reading fairy tales by candlelight.
No King of mine !!
The usual stuff: a few sops to the poor in order to keep the lid on things. All agreed beforehand by the banker class of course. The whole point of the Trilateral Commison (Starmer is a memebr) is to put their people into positions of power. In terms of quality of life it has degraded massively in the last few years and it will detriorate even more quickly now. They have great confidence in their ability to control things but events that are now occurring globally – no governing class will be able to help you. Accept it in your heart that you are truly alone and then start to build from that.
We have a dismal situation in this country where most of the working class get an educaton which is essentially a truncated utlitarian version of mainstream orthodoxy. Not to mention television and popular culture. They have engendered this situation. If you go back to the mid nineteenth century the working class wre highly literate and producing publications that showed high levels of sophistication. An academic,Jonathan Rose if I recall, wrote a book about it. And then you look at the pernicious influence of cinema and radio and television. You should see some of the anti-German propaganda in 1914. Apparently innocent daschunds got slaughtered. We are very blighted now in terms of popular consciousness but it is worthwhile putting it into perspective.
I have to say though, Charles is a contemptuous little prick. Apparently when he goes abroad with his entourage he is very unpleasant with them. But he and his concubine look particularly nasty in these photos. I remember in the 1990s a leaked text message where he said that he wanted to be her tampon. I doubt that there is much nobility in his mind.
The nannification of the population continues.
Meantime, Big Brother prepares to take over when Nanny is tired.
It would be useful to indicate which issues come under devolved legislation. Ie NHS is not Wales, Scotland or NI.A problem not covered in the recent election debates.