September 27, 2023

After I turned 40, my fast showers twice a day morphed into a protracted night tub. Maybe this was to assist me sleep and to appease my joints—or to flee the clamour of a busy, rising family. I quickly got here to understand that there’s an artwork to operating a superb tub.

Step one, and the obvious, is to place within the plug to cease the water operating out. The identical might be stated concerning 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 medical doctors leaving the workforce. As a substitute, what we would name the “operating faucet” part of the report has 18 pages devoted to coaching, with the phrase showing almost 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 prime. The phrases “retain” or “retention” seem solely 59 occasions.

In fact, 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 may nonetheless be significant and transferring: “On the market: child footwear, by no means worn.” Not like Hemingway’s story, nonetheless, the ten pages of the NHS workforce plan which can be 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 Approach,” which come throughout extra like a a reimbursement assure on a secondhand automobile or the title of the following Lord of the Rings movie.

In case you run a shower earlier than placing within the plug, you simply waste scorching water. And scorching water is efficacious. It has taken time to warmth, to retailer, and to run. To let it merely drain away is each wasteful and silly. You can also make the faucet run ever sooner, however and not using a plug you’ll battle to keep up a water degree excessive sufficient to loosen up below. Your head and shoulders will keep chilly, even for those who achieve warming up your toes.

Publishing a workforce plan with out adequate concentrate on retention is a waste of the NHS’s most treasured useful resource—its workers. Regardless of what number of concepts or plans the report accommodates to recruit new workers, it doesn’t masks the truth that simply operating the faucet more durable will make a variety of noise to muffle the truth that the new 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 scientific 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.