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A winter’s tale of promises

BMJ 2019; 367 doi: (Published 05 December 2019) Cite this as: BMJ 2019;367:l6808
  1. Rebecca Coombes, head of news and views
  1. The BMJ
  1. rcoombes{at}
    Follow Rebecca on Twitter @rebeccacoombes

The NHS is heading into winter with its performance against key targets the worst on record. These telling signs of pressure have had the consequence of putting the NHS, and not Brexit, centre stage of this unseasonably timed general election.

This week The BMJ tackles one significant pain point: the chronic workforce gap in nursing, where the vacancy rate is around 11% in England. The problem, says John Appleby (doi:10.1136/bmj.l6664), is not only the many unfilled nursing vacancies but a growing gap between the supply of labour and the demands on the NHS. We may have more nurses—their numbers have increased by 4% in England over the past decade—but they have ever more work to do. Elective admissions are up 26%, emergency department attendances are up 27%, and first outpatient attendances are up 33%, Appleby points out.

Does this election, with its clutch of freshly minted manifestos, bring any sensible solutions? Hugh Alderwick’s analysis of election promises (doi:10.1136/bmj.l6773) credits Labour for committing to spend the most in a future parliament. But what good is more money without more staff? “The manifestos recognise these problems but are light on detail about how they will be resolved,” he says. One welcome area of consensus across the parties is a promise to restore financial support to nurses in training.

For Alderwick, the chief failing of the manifestos is on social care, with delays in access risking even sharper deteriorations in NHS performance. It’s a theme developed by Saleyha Ahsan, an emergency care doctor and Liberal Democrat candidate in the election, who is one of more than 50 doctors hoping to enter parliament on 12 December (doi:10.1136/bmj.l6777). Ahsan was politicised by trying to get social care for her late mother. “I have been shocked and horrified trying to navigate a really complex system that has obstacles and hindrances in place—I think, to deter people from accessing what they’re entitled to.”

Doctors are good at speaking truth to power, as shown by junior doctor Julia Simons, who tackled Boris Johnson about climate change on a recent hospital visit ( But how do doctors cope when the shoe is on the other foot? Paul Williams, a GP standing for Labour in Stockton South, found that trustworthiness is more of an issue on the doorstep (doi:10.1136/bmj.l6777). “As a doctor, most people take everything I say at face value. In politics, even though I’m saying the same things, there is a suspicion that I might not be telling the truth,” he says.

On the theme of pledges, we ask readers to consider supporting our Christmas appeal for Water Aid (doi:10.1136/bmj.l6807). Worldwide, a quarter of healthcare facilities lack clean water, a situation that the charity wants to fix with your help. Please give generously.