Strange days indeed. On the one hand, medical illustrators should remain enthusiastic about state registration and the positive benefits it promises for careers. In the same vein of progress, Staffordshire University has recently announced two important new qualifications – work‐based Graduate and Postgraduate Certificates in Clinical Photography and Graphic Design for Health‐Care. On the other hand, however, departments of medical illustration across the United Kingdom are facing job‐losses and redundancies on a scale that ought to make any of us feel less secure in our jobs. These job‐losses have not been brought about by a lack of skills nor by the excessive cost of medical illustration to the National Health Service, but as a result of the controversial NHS overspend, which is apparently in the region of £512 million (excluding Foundation Trusts). Politicians quibble about whether the figure for total job‐losses across the NHS runs into the hundreds or as high as 20,000; meanwhile demonstrators representing nearly every aspect of the NHS descend on Westminster to protest at the Government's policies. Whatever the rights and wrongs, something has to give and, compared to doctors and nurses, medical illustration and its allied professions will always be seen as soft targets in a politically heated climate.
During the last ten years, we have witnessed the decline or closure of many university‐based departments of medical illustration as the universities struggled to reconfigure their financial structures within a new political climate. In the United States, many large departments have not survived the last decade because most of that country's universities and health‐care institutions exist within a private‐finance environment and the consequent competitive market simply overwhelmed them. The extension of Private‐Finance Initiatives is, of course, something that both recent Labour and Conservative governments have championed for the NHS. Hence we must not underestimate the seriousness of the ongoing threat of job‐losses facing medical illustration staff within the NHS. As the Chairman of IMI recently reported to the Institute:
‘The only way to survive in the modern NHS is to demonstrate that the service you provide not only is good value for money but also contributes to the current political agenda. It is vital, therefore, to get to grips with the forces at play, from government level down to the management of each individual trust.’
This is an especially problematic challenge for those in charge of services, who may be obliged to make difficult decisions about the careers of others, ranging from education to professional development to, perhaps, redundancy. Increasingly they have to be informed, not only by local circumstances and considerations (although these must always be paramount), but also by the statutory requirements of state registration, by employment law, by transmuting NHS policies, etc. In other words, they must demonstrate the foresight and ability to comprehend a ‘bigger picture’ than their own departments. There will always be managers who are more or less capable, of course, but in the end we, all of us, have to remember why we are here. Without patients, we would be pointless; without clinicians and other healthcare professions, we would be worthless. Of course, we must be brave enough to assess the services we provide; be honest about the associated costs; review spending continually; reduce costs whenever possible; generate income. Ultimately, however, this must not be to the detriment of the quality of service we provide – first and foremost – to the NHS, or else what future do we have as a profession?