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From extract 1: Extract 1: Ministers set out plan to train and keep more NHS staff
By Nick Triggle and Philippa Roxby, BBC News, 30 June 2023 (Adapted)
More doctors and nurses will be trained and thousands of new roles will be created to work alongside them, as part of a major NHS England workforce plan. University places for medical students will double, a new apprenticeship scheme for doctors is planned and medical degrees could be shortened. Prime Minister Rishi Sunak said the delayed workforce plan, external was “historic” and had taken time to get right. Critics say poor working conditions in the NHS could undermine the plan.There are more than 110,000 vacancies in the workforce at present, with one out of every 10 posts unfilled, which creates huge pressure on staff and affects the care patients receive.
The NHS has been beset by strikes this year, and the dispute with doctors is still continuing. Pay for staff does not feature in the plan – instead, it focuses on increasing training places for medical and nursing students and a new scheme that allows trainee doctors to earn while they learn. A consultation on whether five-year medical degrees could be shortened by a year will also be launched. Unveiling full details of the 15-year plan on Friday at Downing Street, Mr Sunak said it would “deliver the biggest ever expansion in the number of doctors and nurses that we train, and a plan to reform the NHS so we deliver better care in a changing world”. But he said overcoming the challenges of an overstretched workforce “won’t be quick or easy”.
“We’re making the tough calls, and doing things differently, to protect the long-term future of the NHS and this country,” Mr Sunak said. NHS England chief executive Amanda Pritchard said the plan gave “a once-in-a-generation opportunity to put staffing on a sustainable footing for years to come”. Shadow health secretary Wes Streeting said ministers had “nicked” the opposition’s plan and he criticised the delay in publishing it. “There is a reason why the NHS is understaffed, and it’s the lack of a workforce plan for the last 13 years,” he said. The Liberal Democrats said the plan had come “too late” for the millions of people who had suffered in pain or died in hospital corridors waiting for treatment. And the Nuffield Trust think tank warned that the “dismal reality” of working in the NHS at the moment could undermine the push to tackle staff shortages in the long term. “There is a risk that we will feed more and more people into training, only to burn them out ever faster,” Dr Billy Palmer said.
Currently, half of new doctors and nurses have to be recruited from abroad as the UK supply route has struggled to keep up with demand. Without action, NHS vacancies could rise to 360,000 by 2037, modelling for the plan suggests. To help achieve the goals, the government has promised £2.4bn over the next five years. Mr Sunak called it “one of the most significant commitments” he would make as prime minister.
The targets for 2031 include:
• doubling medical school places for student doctors to 15,000 a year
• a 50% increase in GP trainee places for junior doctors from 4,000 to 6,000
• 24,000 more nurse and midwife student places a year – close to double the number now
• doubling training places for nursing associates to more than 10,000 by 2031
• increasing training places for physician associates to 10,000 by 2036
The role of nursing associate bridges the gap between healthcare assistant and nurse, while physician associates help doctors to diagnose and manage patients. They can work in GP surgeries or hospitals. The new roles will mean more qualified staff can focus on spending time with their patients. There is also a boost in training places for other roles, including pharmacists, psychologists and dental therapists. In the next five years, the proportion of NHS staff, including physios, podiatrists and maternity staff, trained through apprenticeships – combining paid work with study and no tuition fees – will double, to one out of every six.
Gemma Peffers is one of thousands of people to have already started a nursing apprenticeship – in 2016, aged 30, at Royal Derby Hospital. “I left school not knowing what to do,” she says. “I had lots of different jobs.” Ms Peffers has now qualified as a nursing associate and her next step will be to start two years of training to become a nurse.
Learning on the job has been really beneficial, Ms Peffers says. “We are learning the ethos of the NHS and getting to know how our patients want to be looked after,” she says. There will also be a major drive on retention – including more flexible-working options and career development to provide clear routes to senior jobs. Last year, more than 40,000 nurses left the NHS.
The plan is being welcomed by many in the health service. Matthew Taylor, of the NHS Confederation, which represents health trusts, called it “bold and ambitious”. But he said the same commitment was now needed for the social care workforce. Others have pointed out the drive to increase training places could be undermined by the lack of placements on the front line – half of a student nurse’s degree is spent working in the NHS. It will also take years before this expansion starts to have an impact on current shortages – it takes five years to complete a medical degree and three a nursing degree. There are challenges making sure the expansion of training places is successful. The first one is making sure there are enough people interested in pursuing a career in healthcare. The number of applications for nursing degrees is falling, with universities saying the cost of living crisis is putting people off. However, perhaps the biggest challenge of all is ensuring existing staff are retained – nurses are leaving the NHS almost as quickly as new ones are joining. Pay awards going forwards will be determined by two things – the size of the NHS budget and what is happening with inflation.
Answer the 5 questions related to extract
Extract 2:
Extract 2: THE WORKHOUSE POET John Withers Reynolds
Reynolds wrote the following poem to his sister in 1846.
WRITTEN FROM NEWMARKET UNION
Since I cannot, dear sister, with you hold communion,
I’ll give you a sketch of our life in the union.
But how to begin I don’t know, I declare:
Let me see: well, the first is our grand bill of fare.
We’ve skilly for breakfast; at night bread and cheese,
And we eat it and then go to bed if you please.
Two days in the week we have puddings for dinner,
And two, we have broth, so like water but thinner;
Two, meat and potatoes, of this none to spare;
One day, bread & cheese – and this is our fare.
And now then my clothes I will try to portray;
They’re made of coarse cloth and the colour is grey,
My jacket and waistcoat don’t fit me at all;
My shirt is too short, or I am too tall;
My shoes are not pairs, though of course I have two,
They are down at heel and my stockings are blue …
A sort of Scotch bonnet we wear on our heads,
And I sleep in a room where there are fourteen beds.
Some are sleeping, some are snoring, some talking, some playing,
Some fighting, some swearing, but very few praying.
Here are nine at a time who work on the mill;
We take it in turns so it never stands still:
A half hour each gang, so ’tis not very hard,
And when we are off we can walk in the yard …
I sometimes look up at the bit of blue sky
High over my head, with a tear in my eye.
Surrounded by walls that are too high to climb,
Confined like a felon without any crime,
Not a field nor a house nor a hedge I can see –
Not a plant, not a flower, nor a bush nor a tree …
But I’m getting, I find, too pathetic by half,
And my object was only to cause you to laugh;
So my love to yourself, your husband and daughter,
I’ll drink to your health with a tin of cold water:
Of course, we’ve no wine, not porter, nor beer,
So you see that we all are teetotallers here.
Do the relevant 5 questions (100 for all 5 questions 500 total)
Extract 3:
Extract 3 from Angela’s Ashes: A Memoir, Frank McCourt, 1999
“When I look back on my childhood I wonder how I managed to survive at all. It was, of course, a miserable childhood: the happy childhood is hardly worth your while. Worse than the ordinary miserable childhood is the miserable Irish childhood, and worse yet is the miserable Irish Catholic childhood.”
So begins the Pulitzer Prize winning memoir of Frank McCourt, born in Depression-era Brooklyn to recent Irish immigrants and raised in the slums of Limerick, Ireland. Frank’s mother, Angela, has no money to feed the children since Frank’s father, Malachy, rarely works, and when he does he drinks his wages. Yet Malachy– exasperating, irresponsible and beguiling– does nurture in Frank an appetite for the one thing he can provide: a story. Frank lives for his father’s tales of Cuchulain, who saved Ireland, and of the Angel on the Seventh Step, who brings his mother babies.
Come here till I comb your hair, said Grandma. Look at that mop, it won’t lie down. You didn’t get that hair from my side of the family. That’s that North of Ireland hair you got from your father. That’s the kind of hair you see on Presbyterians. If your mother had married a proper decent Limerick man you wouldn’t have this standing up, North of Ireland, Presbyterian hair.
She spat twice on my head.
Grandma, will you please stop spitting on my head.
If you have anything to say, shut up. A little spit won’t kill you. Come on, we’ll be late for the Mass.
We ran to the church. My mother panted along behind with Michael in her arms. We arrived at the church just in time to see the last of the boys leaving the altar rail where the priest stood with the chalice and the host, glaring at me. Then he placed on my tongue the wafer, the body and blood of Jesus. At last, at last.
It’s on my tongue. I draw it back.
It stuck.
I had God glued to the roof of my mouth. I could hear the master’s voice, Don’t let that host touch your teeth for if you bite God in two you’ll roast in hell for eternity. I tried to get God down with my tongue but the priest hissed at me, Stop that clucking and get back to your seat. God was good. He melted and I swallowed Him and now, at last, I was a member of the True Church, an official sinner.
When the Mass ended there they were at the door of the church, my mother with Michael in her arms, my grandmother. They each hugged me to their bosoms. They each told me it was the happiest day of my life. They each cried all over my head and after my grandmother’s contribution that morning my head was a swamp.
Mam, can I go now and make The Collection?
She said, After you have a little breakfast.
No, said Grandma. You’re not making no collection till you have a proper First Communion breakfast at my house. Come on.
We followed her. She banged pots and rattled pans and complained that the whole world expected her to be at their beck and call. I ate the egg, I ate the sausage, and when I reached for more sugar for my tea she slapped my hand away.
Go easy with that sugar. Is it a millionaire you think I am? An American? Is it bedecked in glitterin’ jewelry you think I am? Smothered in fancy furs?
The food churned in my stomach. I gagged. I ran to her backyard and threw it all up. Out she came.
Look at what he did. Thrun up his First Communion breakfast. Thrun up the body and blood of Jesus. I have God in me backyard. What am I goin’ to do? I’ll take him to the Jesuits for they know the sins of the Pope himself.
She dragged me through the streets of Limerick. She told the neighbors and passing strangers about God in her backyard. She pushed me into the confession box.
Answer all 5 questions 100 for each
No introduction, conclusion or references
