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Opinion Critical Thinking

Matt Morgan: How to run a bath without losing water

BMJ 2023; 382 doi: (Published 15 August 2023) Cite this as: BMJ 2023;382:p1856
  1. Matt Morgan, consultant in intensive care medicine
  1. Cardiff, UK
  1. mmorgan{at}
    Follow Matt on Twitter: @dr_mattmorgan

After I turned 40, my quick showers twice a day morphed into a long evening bath. Perhaps this was to help me sleep and to soothe my joints—or to escape the clamour of a busy, growing household. I soon came to realise that there’s an art to running a good bath.

The first step, and the most obvious, is to put in the plug to stop the water running out. The same could be said about the NHS’s Long Term Workforce Plan1: the first and most obvious step in any such plan must be to focus on retention, to stop doctors leaving the workforce. Instead, what we might call the “running tap” section of the report has 18 pages dedicated to training, with the word appearing nearly 400 times. In contrast, the “plug” section of the report—focusing on retention—has just 10 pages, the last of which has only 13 words printed at the top. The words “retain” or “retention” appear only 59 times.

Of course, word frequency and the number of pages don’t mean everything. The American writer Ernest Hemingway once showed us how a short story of just six words could still be meaningful and moving: “For sale: baby shoes, never worn.” Unlike Hemingway’s story, however, the 10 pages of the NHS workforce plan that are devoted to staff retention have little in the way of substance, narrative, or emotion. They simply rehash references to fantastical sounding programmes such as the “NHS People Promise” and “Our Leadership Way,” which come across more like a money back guarantee on a secondhand car or the title of the next Lord of the Rings film.

If you run a bath before putting in the plug, you just waste hot water. And hot water is valuable. It has taken time to heat, to store, and to run. To let it simply drain away is both wasteful and stupid. You can make the tap run ever faster, but without a plug you will struggle to maintain a water level high enough to relax under. Your head and shoulders will stay cold, even if you succeed in warming up your toes.

Publishing a workforce plan without sufficient focus on retention is a waste of the NHS’s most precious resource—its staff. No matter how many ideas or plans the report contains to recruit new staff, it doesn’t mask the fact that just running the tap harder will make a lot of noise to muffle the fact that the hot water is just draining away.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Matt Morgan is an adjunct clinical professor at Curtin University, Australia, an honorary senior research fellow at Cardiff University, UK, a consultant in intensive care medicine at the University Hospital of Wales, and an editor of BMJ OnExamination.