England’s new workforce plan is a propaganda masterclass in glossing over the gaps

When the analysis is done on the new workforce plan for England’s NHS, the verdict might not be the rosy one that was presented to the world one week ago. The plan is full of ideas and solutions—more doctors, more nurses, more allied health professionals (doi:10.1136/bmj.p1510, doi:10.1136/bmj.p1535).12 The plan talks of retention, enablers of work, and flexibility (doi:10.1136/bmj.p1515).3 The plan promises money: £2.4bn over five years.

The plan is the gift that keeps on promising. It is good and important that the UK’s Conservative government is taking a long term view, much in line with the thinking of the Labour Party, the main opposition, but the delays to the plan’s release and complexities in the plan yet to be grappled with fully—such as how career progression will work for the influx of doctors—suggest that detailed delivery of this plan will become somebody else’s problem. There is a good reason why our commentators, in the words of Helen Salisbury, welcome the plan with half a cheer (doi:10.1136/bmj.p1519, doi:10.1136/bmj.p1513).45

The implications for education, training, service provision, and patient care are yet to be worked out. A plan is only as good as its implementation and its impact on outcomes. Which is why it is perplexing that the workforce plan was greeted with such enthusiasm by presidents of medical colleges, and other worthy people, before the full report was available.

The press release to announce the workforce plan amounted to under 900 words, but it was accompanied by effusive testimonies by 43 of the good and the great that reached over 5000 words.6 In Nineteen Eighty Four, George Orwell writes that, “If you want a picture of the future, imagine a boot stamping on a human face—forever.” That’s how it felt reading the press release—a stamping barrage of positive soundbites.

The Department of Health and Social Care has acquired quite a reputation for issuing major announcements by press release with little of consequence to back them up. It is a technique of propaganda that was perfected during the covid-19 pandemic. It avoids scrutiny and allows a free hit for government messaging. By the time the full information is available, public perception is already favourably set (doi:10.1136/bmj-2022-073720).7

These tactics echo the cynical industry practice of releasing and publishing positive study findings to support the launch of a new drug or intervention. Only later do the deeper analyses and the negative studies emerge. We call this publication bias, and journals are partly responsible because they are attracted to positive findings, but it is unethical (doi:10.1136/bmj.f5248, doi:10.1136/bmj.326.7400.1171, doi:10.1136/bmj.f3227).8910 In a similar way, the practice of issuing a press release without information to substantiate and scrutinise the claims is equally unprincipled.

The BMJ has taken a stand against this unethical practice because it is likely to lead to patient harm for the sake of political or corporate point scoring. A year ago we decided that we would no longer report on unsubstantiated press releases, and we will continue to take this stand (doi:10.1136/bmj.o1878).11 But it is time that governments, institutions, and industry placed the public good above their self-motivated agendas. The BMJ is unique among medical journals in its journalism, so the primary responsibility is on other major news outlets, national broadcasters, and newspapers, to join us in no longer being mindless pawns of authority. Otherwise, there is no reason for the boot of propaganda to stop stamping, for this masterclass in glossing over the gaps not to be repeated.

If you want a picture of the future, imagine a major press release or announcement including nothing more than hundreds of endorsements by famous people that is unquestioningly accepted as the truth. It’s a future that seems imminent and inevitable.