September 29, 2023

After I turned 40, my fast showers twice a day morphed into an extended night bathtub. Maybe this was to assist me sleep and to assuage my joints—or to flee the clamour of a busy, rising family. I quickly got here to grasp that there’s an artwork to working bathtub.

Step one, and the obvious, is to place within the plug to cease the water working out. The identical might be mentioned in regards to the NHS’s Lengthy Time period Workforce Plan1: the primary and most evident step in any such plan should be to concentrate on retention, to cease docs leaving the workforce. As a substitute, what we would name the “working faucet” part of the report has 18 pages devoted to coaching, with the phrase showing practically 400 occasions. In distinction, the “plug” part of the report—specializing in retention—has simply 10 pages, the final of which has solely 13 phrases printed on the high. The phrases “retain” or “retention” seem solely 59 occasions.

After all, phrase frequency and the variety of pages don’t imply every part. The American author Ernest Hemingway as soon as confirmed us how a brief story of simply six phrases might nonetheless be significant and transferring: “On the market: child footwear, by no means worn.” In contrast to Hemingway’s story, nonetheless, the ten pages of the NHS workforce plan which are dedicated to workers retention have little in the way in which of substance, narrative, or emotion. They merely rehash references to fantastical sounding programmes such because the “NHS Folks Promise” and “Our Management Means,” which come throughout extra like a a refund assure on a secondhand automobile or the title of the subsequent Lord of the Rings movie.

For those who run a shower earlier than placing within the plug, you simply waste scorching water. And scorching water is effective. It has taken time to warmth, to retailer, and to run. To let it merely drain away is each wasteful and silly. You may make the faucet run ever sooner, however with out a plug you’ll battle to keep up a water degree excessive sufficient to loosen up beneath. Your head and shoulders will keep chilly, even in case you reach warming up your toes.

Publishing a workforce plan with out adequate concentrate on retention is a waste of the NHS’s most valuable useful resource—its workers. Regardless of what number of concepts or plans the report incorporates to recruit new workers, it doesn’t masks the truth that simply working the faucet more durable will make lots of noise to muffle the truth that the recent water is simply draining away.


  • Competing pursuits: I’ve learn and understood BMJ coverage on declaration of pursuits and declare that I’ve no competing pursuits.

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

  • Matt Morgan is an adjunct medical professor at Curtin College, Australia, an honorary senior analysis fellow at Cardiff College, UK, a advisor in intensive care drugs on the College Hospital of Wales, and an editor of BMJ OnExamination.