“Individually, they’re great people,” he says. “I’m not criticising individuals, but the system was a catastrophic failure.” As editor of the Lancet, he’s particularly aggrieved that the series of five academic papers the journal published in late January first describing the novel coronavirus in disturbing detail went unheeded. 

 “In several of the papers they talked about the importance of personal protective equipment,” he reminds me. “And the importance of testing, the importance of avoiding mass gatherings, the importance of considering school closure, the importance of lockdowns. All of the things that have happened in the last three months here, they’re all in those five papers.”

He still can’t understand why the government’s scientific advisers didn’t consult their counterparts in China. The world of medicine is a small one, he says, and everyone knows the people responsible for coordinating the Chinese government’s response. “These are people they could have literally sent an email to, or picked the phone up to, and said, ‘Hey, we read your paper in the Lancet, can it really be as bad as that? What is going on in Wuhan?’ And if they’d done that they would have found out that this was indeed as bad as described.”

He doesn’t know if such conversations took place, but he can’t see why, if they did, the response was so sluggish that the UK is second in the world, trailing only the much larger nation of the US, in the league of Covid-19 deaths. What he does know, from the published reports of Sage meetings, is that scientists were “trying to be as sensitive to economic issues as they were to health issues”. That, he says, “is a dangerous place to be” because it compromises the ability of the advisory group to protect health.

While the arena of public health is no stranger to heated disputes, it’s common for the antagonists to maintain a diplomatic front in public. Horton, who appeared on Question Time back in March and declared the government’s delay in locking down a “national scandal”, has never been shy about speaking out, but even by his own forthright standards, he seems to have abandoned all instincts for restraint. 

The NHS could be short of almost 70,000 nurses within five years, according to a leaked copy of the government’s long-awaited plan to tackle the staffing crisis.

Blaming the government’s decision to abolish bursaries for nursing students, a draft of the NHS people plan says: “Our analysis shows a 40,000 (11%) shortfall [in the number of nurses needed in England] in 2018-19 which widens to 68,500 (16%) by 2023-24 without intervention, as demand for nurses grows faster than supply.”

That would mean that the NHS’s shortage of nurses increases from one in nine of the workforce to one in six, adding to the rising pressures on hospitals, GP surgeries and mental health care.

The report, seen by the Observer, makes clear that the shortage could be even higher than 68,500 because of “additional pressures” on GP surgeries, which are due to take on greater responsibilities for patient care over the next few years under the NHS long-term plan.

The document adds that even if its recommendations are implemented in full, the health service will still be short of 38,800 nurses by 2023-24, almost as many the current total of 40,000 vacancies. It says: “We believe we can reduce the gap between supply and demand to 38,800 (10%) in 2023-24, assuming that we are able to make progress on all of the interventions in this chapter.”

From next year, existing medical schools will be able to offer an extra 500 places to future doctors. Another 1,000 places will be allocated across the country, based on an open bidding process. The bidding process will be supervised by Health Education England and the Higher Education Funding Council for England.

The extra places will be targeted at under-represented social groups such as lower income students, as well as regions that usually struggle to attract trainee medics. The government has also pledged to ensure the places are allocated to medical schools who will work closely with their local communities to help talented students from disadvantaged backgrounds become doctors.

Alongside the plans to train 1,500 more medical students, the government will also fund 10,000 additional training places for nurses, midwives and allied health professionals. Some of these places will be available to students next month.

Alongside this, and of particular interest to RSN members, the Department has published the Government’s response to the consultation on expanding undergraduate medical education.

The response explicitly references rural in calling for the bidding criteria to ‘align expansion to local NHS workforce need with an emphasis on priority geographical areas, including rural and coastal areas’; (page 6); and highlights the challenges of recruiting to rural and coastal areas because of ‘distance to an urban centre’ (page 16).

This reflects a recent discussion I had with medical undergraduates – how can we increase the probability of newly qualified clinicians taking up and staying in a medical job in a rural area? Ivan and I are working on this now and have some ideas…