Written evidence submitted by Dr. Michael Brendan O’Reilly (RTR0007)



Submission to the Health Select Committee inquiry into Workforce: recruitment, training and retention in health and social care.


I am a private GP.  I qualified in 1981 and have experience in hospital medicine and general practice.  I also have 20 years experience assisting doctors with employment and regulatory difficulties which led me to study law and I was called to the Bar of England and Wales in 2017. 


This submission is over the 3,000 word limit because of the fact that the inquiry raises so many issues it is impossible to address them meaningfully in under 3,000 words.  With this in mind I have not exhausted the myriad of issues that could have been raised.


In summary:  The various numerous and incessant political changes to the medical professions and to the NHS has resulted in fragmented professions and NHS.  Tens of thousands of people are dying as a result:  chronic kidney injury;  Liverpool Care Pathway;  sepsis;  long waiting lists etc.


Patients are not safe in hospital because they are not properly nursed; nurses do not nurse anymore due to the changes made to their training and role.  Those on wards are technicians and others are practitioners depriving wards of nurses.


Medical training is severely damaged.  More men need to enter university and enter the workforce.


All of this needs to be reversed before reversal is impossible for UK authorities without outside assistance.


The new integrated care systems cannot and won’t work.


The number of organisations within healthcare is staggering and is likely to be untenable cost wise at some point.


The medical and nursing professions and the NHS urgently need independent traditionalist  individuals to lead a shake up from the current situation and to bring the professions in particular backwards to what they were. 


Political support is what is needed and not political interference.  It is immoral that professions and institutions can change on the whim of political parties but it is even more immoral that this continues despite politicians being aware of the harm that has been done.  The need for this inquiry is directly as a result of that harm.  



What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium and long-term?


The problems leading to staff shortages must be the first thing to be addressed.


This question is non-specific and encompasses all staff.  It is not possible to address this in simple terms.


If one considers doctors:  they will not be attracted in the current climate: regulatory; clinical work overload and; the NHS as an institution.


I am aware that in one EU country that has close ties to the UK that the NHS has an exceptionally bad reputation amongst doctors.  They will not be attracted in the current climate.


It is also relevant to note that healthcare staff everywhere talk to each other and relay their experiences.


The main steps to increase recruitment are to address why there is an issue with staff leaving in the first place;  properly address bullying and oppressive systems;  make the NHS a proper place to work – this will need system and attitude change and to address regulation.


Until the causative issues for low morale and individuals leaving are honestly addressed it will be impossible to recruit extra staff and retain them; recruitment will be a perennial problem.


Another essential issue is excellent training.  If training is “dumbed down” in an attempt to increase staff numbers these new staff will not be as competent and they will leave.  There will also be more scandals and litigation.  Therefore a major part of keeping staff is excellent training.


This question is answered further below.



What is the best way to ensure that current plans for recruitment, training and retention are able to adapt as models for providing future care change?


I am unable to answer this question as put.


However the term “future care change” is very important.  One of the major problems in the professions and in the NHS has been the huge number of changes.  Designing a system now that is intended to be adapted for yet further future change is a system that is doomed before it starts.


Also there are 3 elements here: recruitment,  training and retention.  These are very different things and each requires its own distinct system.


The aim should be to develop systems that fundamentally work.  Once they fundamentally work and work well there should be no need for “future care change”. 


The reason there are major issues now is because of past change upon change.




What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?


International recruitment should be kept to a minimum.  These workers are not cannon fodder and should not be introduced into a dysfunctional institution (the NHS) or dysfunctional professions (medicine, nursing etc).  There is a major moral issue in this.


There is a further moral issue with regard to the harm and damage caused by removing staff from their home countries, especially developing countries.


In the wider context there is much discontent in the UK about the high level of immigration and increasing such immigration into the NHS and care organisations will add to this.


At an individual level I am aware of dissatisfaction of patients being cared for or nursed by staff who they do not understand and cannot relate to.  This too must be considered.



What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?


As above this is not a panacea or easy solution to the existing problems in the UK.  The UK Government should not be relying on non-UK doctors, nurses and healthcare staff.  There is an adequate supply in the UK.  Retention and working patterns are the key to this.


There are issues with healthcare throughout the world and it is therefore not ethically acceptable to recruit from any developing and many developed countries. 


The reason there is a shortage of nurses is not because there is a shortage of individuals capable of nursing; it is because nurses do not nurse.  They are a form of technician on the wards and off the wards they are nurse practitioners etc. This is the fault of previous change and it is an essential issue to address.



What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors? In particular:


There have been major changes to medical training over the past 25 years.  This has led to the current broken system and it is one alongside other changes that I believe has led to huge numbers of deaths to the extent that the UK has crossed the criminal threshold of democide.


With regard to medicine (doctors) first:

UK medical school training is unrecognizable to the traditional training that still happens in many other countries.


Medical students do not study the basic and clinical sciences as was done previously.  Many medical schools do not have anatomy, physiology, pharmacology, microbiology, pathology etc etc as individual subjects.  No doctor should practice without a detailed knowledge of these subjects.


Clinical examinations are not now clinical examinations;  actors are used instead of patients and various made-up communication and other fuzzy skills are assessed.


Medical students are not being trained to be proficient doctors.  They are being trained to be able to provide a basic ‘hands-on’ service as Foundation Year 1 and 2 doctors. 


Medical student and doctor training needs a huge overhaul.  Traditional methods that took centuries to evolve need to be reinstated.  In other words there needs to be a reversal in many aspects of training and work.


Many UK graduates leave the NHS and there is a high attrition rate of young doctors.  If this were curbed there would be no need for international recruitment and the service would be superior.  Failing to act on this aggravates the democide issue.


The incessant change has led to verschlimmbesserung.


With regard to nursing:

The changes to nursing since 2000 I believe is largely responsible for the crime of democide in the UK.


Nursing has a specific meaning which is to look after and nurse patients;  this consists of clinical, personal and non-personal duties.  There is evidence of patients being afraid in hospital;  patients not getting analgesia;  patients not being given oral fluids and food.  This is a national and human rights scandal.  Patients in hospitals are not safe.


Christina Patterson on the BBC Four Thought programme “Care to be a Nurse” in 2011 describes the state of nursing.  This is a hugely important 15 minute description of a patients journey in a UK hospital:  https://www.bbc.co.uk/sounds/play/b010mrzt


Nurses on the wards spend an inordinate amount of time on administrative tasks which are oft repeated over and over and are of no value whatsoever.  They do technical tasks as opposed to those of a nurse noted above.


Probably the majority of so-called nurses do no nursing at all and become nurse practitionersWe now also have physicians associates etc.  The intention behind these roles is to do doctor work in order to make the system more efficient.


By definition this cannot make the system more efficient.  The skills these grades have are not comparable to those of doctors and never will be. 


This is a sub-standard clinical service.  I would provide examples if I could do so without breaching patient confidentiality. 


The direct answer to this question is that nursing needs to revert back to pre-2000 days.  If it is deemed that nursing should continue to be attached to a university then it should be done in a way that the traditional style of nurse training is reinstituted.  Nothing else will improve the nursing service.  It was a grave error to change it.


A further reason nursing training should revert is because in the traditional training model only nurses who had a vocation would apply for and finish this training thus ensuring a very high standard of nurse.  This is also an important patient safety issue.


Nurses without a vocation should not be allowed to become nurses.


With regard to pharmacy:

Pharmacy training is in the process of being changed.  I am aware that 1st year pharmacy students must now buy a stethoscope and they are being introduced to clinical (doctor like) training as they will be expected to provide clinical services in their pharmacies.

This is madness.  Not only will pharmacists be exposed to potential clinical disasters but if pharmacists are spending time doing unsupervised clinical duties their pharmacy service must by definition decline and there is danger here too.


Pharmacy training was defined decades ago.  It should not be changed nor should the service pharmacists provide be changed.



To what extent is there an adequate system for determining how many doctors, nurses and allied health professionals should be trained to meet long-term need?


It is an impossible task to have an adequate system for determining staff needs to meet long-term needs when so many are leaving;  the roles of staff change;  etc.


With worker levels there should be a natural cycle.  This has been obliterated by the changes to the professions and the NHS.  Regulation has added to this. 


I’m afraid it is not possible in the current climate to have a workforce planThis is one of the unintended consequences of change after change. 



Do the curriculums for training doctors, nurses, and allied health professionals need updating to ensure that staff have the right mix of skills?


This and the following question show a huge lack of understanding and insight into medicine (doctoring) in particular.  This lack of understanding and insight amounts to wilful blindness.


Medicine is not a simple profession that just anyone can do or just anyone can determine what training or skills are required.  Medicine is hugely complex.  This fact is being routinely overlooked and this has contributed to the harm done in the UK to medicine and to patients. 


However the fact this question is asked is a good start to putting things right.


The curriculums for training are grossly inadequate as noted in my other answers.  As noted above medical and nursing training needs to go back to what it was several decades ago. 


Medicine is a profession that needs proper study and clinical training.  Patients are complex as are many medical conditions.  Some medical conditions are relatively straight forward but hidden within may be something serious (eg. Cf. the level of sepsis).  It takes years for doctors to build up excellent clinical and intellectual skills. 


Nurse practitioners (NP’s) will never come up to this standard.  NP’s specialising in a niche area may provide a service of sorts and if they see patients clinically they will never be able to provide anything like the service a doctor provides.  This is a huge waste of resources and is a scandal.  The public are being massively misled on the role of NP’s.  Even their titles are misleading “Consultant Nurse Practitioner” etc etc. 


Nurse training has been raised above.


The training curriculums do not need “updating”;  they need to go back to the traditional training that evolved for very good reason, patient safety. 


Further, postgraduate medical training needs to include medical generalists https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190283/ authored by the Chief Medical Officer and other senior medical figures.  This needs to be in future planning.

Could the training period for doctors be reduced?


In one word: NO


Contemplating reducing the period of training for doctors shows a clear lack of insight into what medicine is and what doctors do.  This demonstrates clear ignorance.  This would be frankly dangerous.


Medical school training has taken centuries to evolve and it has been deemed to take at least 5 years for very good reason – medicine as a science is hugely complex; medicine as an art is also hugely complex. Medicine is a mixture of science and art.


The duration of post-graduate medical training is very much specialty dependent and rightly so.  To even consider reducing the time to train a specialist (eg neurosurgeon) for a short-term increase in doctor numbers is bordering on criminal.


If you reduce the length of medical training you are committing a crime and will make the crime of democide worse. 


Having said that it is very important to raise this issue in some depth.  In a current Scottish Government consultation on Assisted Dying the following comment is made:


“We recognise that over the past decades custom and practice in healthcare has

seen nurse practitioners take on increasing responsibilities and that the divide between doctors and nurse practitioners has narrowed.”

https://www.parliament.scot/-/media/files/legislation/proposed-members-bills/assisted-dying-for-terminally-ill-adults-scotland-consultation-2021-final.pdf Note 89 Page 20


This is clearly the attitude in the rest of the UK as well.  This is absolutely shocking and a clear indication that the standards in medicine and nursing are declining.  In fact “nursing” has been forgotten about entirely.  This is a hugely significant and serious issue.  This is criminal.


This is a sign of a very broken healthcare system. 



Should the cap on the number of medical places offered to international and domestic students be removed?


Does this question relate to medical students?  It appears to.  The answer is NO.


Medical school training is sophisticated and complex.  Universities and hospitals can only accommodate a limited number of students in order to train them properly.  It is simply not possible to have unlimited numbers of medical students.


There is already an adequate number of very able UK students.  These UK students must be prioritized.  Clearly this would have a positive effect on recruitment.


In view of the current shortages there is also a strong argument for halting international students into UK medical schools altogether.  If universities are making money out of higher fees from international students this should be stopped.  UK students are disadvantaged unfairly by this which is clearly wrong.


On this issue there are some elephants in the room that have to be raised at some point.  


In the past 30 years the healthcare professions have become markedly majority female. Traditional female professions such as nursing have remained marked majority female.  There has been a huge increase in female recruitment to medicine.  Therefore the NHS is staffed predominately by women.


A stark example of this is a 2018 study by the Liverpool Women’s NHS Trust in which 89% of staff were female and 11% male. https://www.liverpoolwomens.nhs.uk/media/2113/workforce-profile-report.pdf


Overall 77% of NHS staff are female.


Medical Schools:

More females enter medical schools.  Boys are disadvantaged as they develop slower.  This needs to be addressed.  If it is addressed there will be clear implications with recruitment and retention.


Are there too many female medical graduates? Yes” - BMJ


These figures will increase as older doctors are predominately male and they are retiring, some early. There are already more female GP’s than male GP’s and this will increase too.  


It is essential that the number of males entering medical schools is increased and more males should be encouraged to train as GP’s. 



What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?


  1. Another elephant in the room never discussed is human behaviour.

Women and men are fundamentally different psychologically.  This is confirmed in all manner of ways an excellent example being the different behaviours of boys and girls at school.  This difference is maintained for life and is simply a fact of life that cannot be changed.  But if should be recognised openly.


  1. As noted above if the majority of NHS staff are female irrespective of grade or role within the NHS it follows that the environment, behaviours and ethos will be  predominately female with all that this entails.  It is an emotionally charged environment making working relationships more difficult.  The effects of this are evident and it effects patient care and workplace relationships.  The number of complaints and disputes attest to this.


The NHS is largely a toxic environment made worse by the following points.


  1. Whistleblowing:  The toxic nature of the current NHS is blatantly displayed in how whistle-blowers are treated.  Eg: https://thephilosophyfridge.co.uk/


Dr. Ahmed’s book confirms major problems in dentistry and dentistry training.


An important example is that of Dr Chris Day:


Here is a debate in Parliament on this issue: https://twitter.com/drcmday/status/1478696387818795011/video/1

In this case it was argued that junior doctors did not have a contract of employment.  This kind of behaviour is abominable and must be totally wiped out.  It is the kind of behaviour that has serious negative effects on the whole workforce.

  1. Regulationthere is not a proper continuous professional development (CPD) system in medicine in the UK.  The events surrounding Shipman have been abused by politicians to gain greater control of the medical profession.  This resulted in Appraisal and Revalidation


This has caused huge harm resulting in doctors leaving early, emigrating and being demoralised.  It is not a CPD system; it is a policing system

Appraisal and Revalidation is more onerous in general practice.  It takes several weeks to complete and it is very costly.  It is also a bully’s charter.  Doctors in training are very vulnerable – ARCP [Annual Review of Competency Progression).


The very first thing that should be done to improve UK Medicine is to immediately abolish Appraisal and Revalidation. It is a simple matter to introduce a proper CPD system such as that in other countries eg. Ireland.


Thousands of doctors have left the NHS because of this degrading and appalling regulatory policing system.  Those recruited in the future will face exactly the same degradation and frustration and many will leave on this ground also.  


  1. Performers Lists for GP’s – this is a local regulatory body and in reality a complete waste of time and resources.


Another important point is that the regulation of doctors has become so overbearing because it is deemed necessary to patient safety but non-doctor individuals can provide doctor services without such overbearing regulation.  This is a hypocrisy and an oxymoron.


  1. Working conditions generally:

Targets:  targets were introduced for anything and everything and once introduced the focus is on the target and not patient care.  While intended to monitor work and to improve patient care this does not happen.


In general practice for example Quality and Outcomes Framework (QOF) is a system for performance management and payment forcing practices to do work that is not relevant to acute or on-going care.  It is akin to being at a university and a huge waste of resources. 


Clinical Commissioning Groups (CCG’s) which commission services and decide on services in a particular area is yet another huge quango and a waste of resources. 

Referrals:  it is required to use various electronic forms which are time consuming and often ask for information that is not relevant to the referral.  Referrals can be refused by non-clinical individuals and / or anonymous individuals.  Often doctors in hospitals cannot refer to another doctor in the same hospital and the patient must be directed back to the GP for re-referral.  This is more madness in a fake economy which is costly and damaging.  Administration of CCG’s is huge.


Teams:  in the past there were clear demarcated teams.  Every patient had a named consultant.  Doctors knew their patients and vice versa.  This has all but vanished and doctors do not know their patients and patients do not know their doctors.  This is a danger to everyone. 


Uniforms:  This may not appear important but it is fundamental.  White coats have been removed citing infection control as the reason.  When this happened it took an authority and professional symbol that is critically important away from doctors.  It is also difficult for patients as it added to professional standing which is important to patients.

Most staff now wear surgical scrubs of varying colours.  They look shabby and unprofessional.  They are not a uniform.  When nurses wore proper clean white uniforms they looked professional, had standing and respect from patients and were identifiable as nurses.


The uniform issue is important because if you have shabby dress you generally have shabby work practices. 


Specific Specialities: Public Health; psychiatry, radiology, dermatology and pathology have been decimated. 


There are now very few post-mortems performed when it is well known that misdiagnosis or missed diagnosis in hospital is not uncommon.  This is a critical issue.  https://www.newscientist.com/article/dn27733-death-of-the-autopsy-leaves-us-in-the-dark-about-misdiagnosis/


  1. Pensions: there have been changes made to pensions and tax with negative effects on many consultants in particular.  This is without doubt exceptionally bad behaviour on the part of the authorities.  It is also responsible for the loss of many doctors.



Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?


I am unable to answer this question.



What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff?


The NHS People Plan and the people plan for the social care sector are different and should be dealt with separately.


This raises yet another elephant in the room. As noted above the professions of medicine and nursing have been virtually destroyed.  These need to be rescued as a central part of an NHS People Plan because if they are not the People Plan will fail and things will deteriorate yet further in the NHS.  This is also relevant to the issues above surrounding democide.


The single most important thing for patient safety and wellbeing is the presence of proper and properly functioning medical and nursing services.  This is not the case now.


To get back to this point a lot of change will be needed to the professions in the NHS.  This will involve strife and job change.  Because of the developments over the past 30 years this is going to be a nightmare requiring real political courage.


Politicians have been aware for many years that many thousands of people are dying needlessly in the NHS every year and their failure to address this makes them complicit in democide.  These deaths are largely due to political initiatives over the years.


Because a clear emergency has existed for many years in the NHS the NHS People Plan must deal with this emergency head on.  This requires major fundamental changes to doctor and nurse training and work practices many of which require reverting to practices before the radical and disastrous changes were made to the professions.   This must be done irrespective of the upset it will cause.



To what extent are the contractual and employment models used in the health and social care sectors fit for the purpose of attracting, training, and retaining the right numbers of staff with the right skills?


In the past doctors worked a lot of “on call” meaning they worked well over 40 hours a week.  With the introduction of the European Time Working Directive this was drastically reduced and doctors, like nurses, went on to shift working.  Doctors shift work patters are irregular in many instances and there are fewer working at any one time resulting is a huge workload meaning they are prone to burnout.  Training too is adversely affected.


Sometimes conditions are described as dangerous which is clearly a patient safety issue with clear legal implications for the NHS and individual doctors.  An example of this is Dr. Bawa-Garba who was found guilty of gross negligence manslaughter. https://www.pulsetoday.co.uk/analysis/regulation/bawa-garba-timeline-of-a-case-that-has-rocked-medicine/


Doctors afraid to go to work: https://www.theguardian.com/society/2021/oct/20/doctors-in-south-wales-scared-to-come-to-work-over-safety-fears


The working patterns and working conditions of doctors need to be looked at.  No contract will retain them when they are forced to work extra shifts, often unpaid or an attempt made not to pay.  This is unacceptable and urgent.


Junior doctor contracts need to be fair and proper as noted above in the Dr Chris Day case.



What is the role of integrated care systems in ensuring that local health and care organisations attract and retain staff with the right mix of skills?


Integrated care is about giving people the support they need, joined up across local councils, the NHS, and other partners. It removes traditional divisions between hospitals and family doctors, between physical and mental health, and between NHS and council services. In the past, these divisions have meant that too many people experienced disjointed care.

From the NHS Website: https://www.england.nhs.uk/integratedcare/what-is-integrated-care/


This is another example of reactive planning and it means that there will be yet more administration and confusion.  Each service is distinct and must work as such.  Removing traditional divisions is a grave error.


County Councils have nothing to do with healthcare.  Social services and non-medical care of the elderly have nothing to do with healthcare. 


Public Health:

There have been major changes recently such as the creation of the new UK Health Security Agency and the Office for Health Improvement and Disparities.  Where will these fit in with the Integrated Care proposals?


Changes made in the past have shown how damaging they are or can be.  An example of this is the closure of community and step-down facilities.  If these still existed it is clear that there would be less stress on the acute NHS service. 


Instead of using systems that worked we are making new change upon change in an already unstable and unsustainable system which has resulted in on-going service deterioration.


What is needed is perfectly clear.  It is to reverse many of the past changes.  This is going to be very difficult in some areas like the professions (nursing in particular) and replacing step-down facilities will also be very difficult.  Irrespective of the difficulties this is the right course of action. 


Just reading the paragraph above on integrated care from the NHS website demonstrates that what is proposed is 1) inefficient  2) impossible to achieve (it is a naïve proposal) and 3) unworkable likely to lead to more patient safety issues.


The fact that legislation is proposed to support integrated care indicates a decision that is already made.  In circumstances where training and the professions are in decline and retention is a major problem and legislation is going through to support a new system change that cannot by definition work is nothing short of negligence and wilful blindness. 


Changes made over the years to the professions and the structural NHS have led to an institution that is severely damaged and effectively not fit for purpose and crucially one in which patients are not safe (they are not properly nursed;  the basics).  This has led to thousands of deaths.


The proposed changes are wrong and will cause harm.  There needs to be a major U-Turn on many issues.  It is essential that ‘committee types’ and anyone already involved in any of the past and current changes are excluded from fixing the NHS and the professions.


In conclusion:  unless most of the changes made to the professions of nursing and medicine and those made to the NHS itself are reversed nothing you do will improve training, recruitment and retention.  The current system is broken. 



January 2022