We need a health service that reflects the whole of society

A typical doctor in the UK grew up in a family earning two-thirds more than the average
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The Independent Online

It was little more than two decades ago that both women and people from ethnic minority backgrounds struggled to break into the closed shop that was the admissions process to Britain's medical schools. In recent years we can be proud that we have taken great strides towards a more meritocratically selected medical workforce. Today, more than half of medical students are women and the profession has become much more ethnically diverse. But there is still more to do to ensure that the world of medicine truly represents modern Britain.

It is still the case that a typical doctor working in the UK today grew up in a family earning two-thirds more than the average. There are several reasons for this. For a start, aspiration matters – parents and schools make a huge difference here. If you don't start with the belief that you can be a doctor, then the chances are you won't become a doctor. And if you don't have anyone supporting you in that belief, then it's even harder.

Many medical schools today rightly look for evidence of a long-held desire to enter medicine and for suitably "caring" work experience. But, ironically, recruiting people based on their ability to show a track record of caring on their UCAS form could exclude those from poorer backgrounds.

Demonstrating work experience or time spent volunteering in the health and care sector is far more difficult for those where a medical career was never encouraged as a realistic option by school or parents from a young age. So if you are from a deprived background you are unlikely to have undertaken work experience in a clinical setting to get you an interview at medical school, even though you might make a fabulous doctor.

There is hope for making social mobility in medicine a reality. On Tuesday, a new report from the UK Medical Schools Council will outline some of the answers, such as work experience programmes with GPs, hospitals and care homes, targeting children who receive free school meals. Some medical schools are also piloting the use of aptitude tests for prospective students. Testing raw ability in additional to A-levels may well help to level the playing field. And through part-time medical degrees, we can open up the system to encourage people from a wide range of backgrounds, including both working and full-time students, to apply.

There's also evidence that the Government's successful academy schools programme is raising the aspirations of less well-off children – over the past year, the GCSE results of our poorest pupils increased faster in sponsored academies than in all state-funded schools, and faster than in comparable local authority-run schools by motivating children to think ahead about their career choices, what subjects to take or where to do work experience.

Following such high-profile recent events as the Mid Staffordshire inquiry and the Care Quality Commission's report on Morecambe Bay, the full glare of the spotlight has been thrown on the culture of the NHS. In light of these events, creating a more transparent, open culture has to be the priority.

The need to support students from more deprived backgrounds into medical careers on the basis of ability and merit is, of course, completely unrelated to the failures of care at Morecambe Bay and Mid Staffordshire. However, these terrible events allow us to reflect on the fact that there are further cultural problems that must be tackled in the NHS. The need to change the culture of medical recruitment and improve social mobility has been a problem for decades, and we need to act now.

Last month, we announced that Health Education England, a new independent body, will have until the autumn to come up with a way to measure and improve social mobility in medicine. This is not only about being fair, it is about better care. The NHS has the largest workforce in the country, employing more than a million people. A medical profession that more accurately reflects the society it serves will be better and stronger for it.

Dr Dan Poulter is a Health minister