As the NHS grapples with systemic strain, the president of the Royal College of Physicians explains that the College is providing the blueprint to fix cracks in the system.
From the “Groundhog Day” of year-round corridor care to a medical training system she describes as no longer fit for purpose, the perspective of Mumtaz Patel, president of the Royal College of Physicians, is rooted in her daily reality as a consultant in Manchester. Here, she talks to Healthcare Today about the urgent need for transparent data, the integration of social care to unlock patient flow, and why the NHS must move away from blaming individuals for burnout and instead address the systemic failures in workforce wellbeing.
Corridor care has become a visible symbol of system strain. You have called for figures to be made public. What is taking so long?
It feels like Groundhog Day; we have been calling for this for such a long time now. Corridor care and emergency pressures were once primarily a winter phenomenon. Unfortunately, this issue has now become a year-round crisis.
We are seeing the result of chronic, structural problems and systemic issues – specifically a lack of investment and a mismatch between capacity and demand. We need to consider the entire patient pathway. The fundamental issue is the flow of patients.
It is both a front-end and a back-end problem. While seasonal illnesses in the winter certainly exacerbate the situation, the lack of capacity means these issues sadly continue all year round.
We have been pushing for better data since this time last year. When you see the loss of privacy and dignity you cannot help but think that it could be your own mother or father, or even yourself one day. It simply is not right.
What would materially reduce the need for corridor care? What can the government really do?
We have campaigned heavily on the data aspect because it remains vital to quantify the scale and location of the crisis. Occasionally, we hear that certain hospitals have successfully eliminated corridor care but we need to understand how they achieved that. Learning from and sharing best practice is essential.
In terms of the day-to-day reality, we produced guidance in October for both staff and patient care, focusing on measures to keep patients safe. While we must never normalise corridor care, we are currently immersed in it, so we have to make it as safe as possible while pursuing long-term solutions. A part of me feels a profound sadness that this is what we are now accommodating.
In the medium to long term, we must address ward capacity and reconsider the entire patient flow. We are huge advocates for the government’s proposed shifts towards community care and prevention, but we need to see these happen in practice. Crucially, social care must be integrated.
“It can sometimes feel as though the colleges are simply ‘moaning’ without offering a way forward.”
The RCP’s latest guidance provides standards for treating patients in corridors. How do we prevent best practice standards for temporary spaces from becoming the new norm?
It is a really difficult balance to strike. Our members are telling us clearly that these are critical issues; they are worried and they are asking for our support.
That is why we issued the guidance – to provide immediate, short-term support for those working in these spaces. Having official guidance gives them leverage with managers and other key stakeholders.
However, our campaign remains very active. We still want the data and we want this fixed. While I appreciate that the government cannot solve everything overnight, we need a firm commitment to the solution phase of this crisis. The data will remain a powerful tool in that process.
Some of our members have pointed out that it feels like a “no-win” situation – if we talk about safety, people ask about the data; if we talk about solutions, they ask if we have forgotten the data. My response is that we are pushing on all fronts. We cannot ignore the short term because, sadly, the problem isn’t going away. We must make current practice as safe as possible while simultaneously working on those vital medium– and long-term solutions.
Do you think the RCP has been sufficiently vocal about system risk? When the College speaks, do politicians listen?
I realise that, from the government’s perspective, it can sometimes feel as though the colleges are simply “moaning” without offering a way forward. To counter that, I – and many of my colleagues – make a point of pairing every issue with a proposed solution.
For a long time, I have argued that medical training is no longer fit for purpose and requires a radical shift. Following campaigns by our next generation group and the wider membership, a medical training review was announced. Similarly, with corridor care, our persistent campaigning has finally gained real traction.
Finally, there is the workforce plan. We were consistently asking where the engagement was, and in September, 80 organisations wrote to the government. Remarkably, about five days later, I received a phone call inviting us to a meeting. That led to focus groups and the use of our evidence base to inform the Ten Year Workforce Plan. I would never be one to shout about these things, but it shows the value of an evidence-based approach: providing support, offering challenge, and maintaining a constant, vital dialogue.
We hear a lot about doctor shortages, yet many trainees report bottlenecks in speciality training posts. Where is the problem? Is it supply, funding or workforce planning?
The challenges we face exist at every level. There is a massive demand for staff, yet we struggle with supply, recruitment, retention, and, crucially, staff wellbeing.
People are leaving the NHS in significant numbers, and prospective doctors are also being deterred. Young people are put off by the challenges within training and the difficulties of career progression.
Regarding recruitment and supply, we successfully campaigned to double medical school places back in 2020. However, we failed to see a commensurate increase in postgraduate, foundation and core speciality training posts. You cannot simply expand one end of the pipeline without addressing the other.
This has created a massive bottleneck. Since 2019, we have seen a significant rise in the recruitment of International Medical Graduates (IMGs). Our healthcare system simply could not function without them, but the ratios have become completely lopsided. To give you a sense of the numbers, pre-2020, we had roughly 12,000 applicants for 9,000 posts. Now, for those same 9,000 jobs, we have nearly 40,000 applicants.
Furthermore, we’ve seen an exponential increase – three to fivefold – in locally employed doctor posts. These are non-traditional pathways that lack the same quality assurance and progression as formal training. When people talk about doctor shortages, it is often a matter of where those doctors are in the system. There is also a major geographical imbalance. I work in Manchester, but if you go up the road to Blackpool or other coastal and deprived regions, they are struggling to find doctors.
We must get the quality of training and supervision right and ensure posts are distributed where they are needed most. We need to ensure that there is a healthy balance between service delivery and actual training; at the moment, that balance is off. Morale is incredibly low across the profession, which is why we are seeing so much unrest.
Finally, we need to address the total lack of flexibility. I had my two children while working as a consultant, but as a resident doctor, I moved 14 times in six years. That is simply not conducive to a healthy working life and is an upheaval that doesn’t happen in other professions.
“Retention fundamentally comes down to ensuring that staff feel valued.”
Is retention now a bigger concern than recruitment?
Retention fundamentally comes down to ensuring that staff feel valued. In any role, people work incredibly hard, and while the European Working Time Directive exists, the level of hours and commitment in medicine is on a different level.
A sense of belonging is essential, yet training has become so fragmented that staff are rarely in one place long enough to feel part of a team. I grew up in the firm structure, where a medical student, resident doctors and the consultant all worked together on the same patients daily. We were in it together. Now, the system is so disjointed that you might not see the same resident doctor from one day to the next.
While there is still no shortage of people wanting to enter medical school, we are seeing a worrying drop-off later on. Many are choosing to leave not just the NHS, but medicine entirely.
What is the uncomfortable truth about the NHS that politicians avoid saying?
My message to politicians is that the honest truth remains: the NHS is a magnificent asset to this country, and I am a firm believer in its value. However, they must listen to those of us on the ground to enable the necessary solutions. As a College, that is exactly what we strive to do – we are part of the solution. Whether as individual clinicians or as a national organisation, we want to provide clinical leadership.
I would urge the government to continue engaging with us. We represent countless voices on the front line and so many people who are deeply committed to this wonderful healthcare system. We want to make it work. We may not always say what people want to hear, but we offer that challenge in the spirit of making things better.
