The ADgenda: this week's most offensive advert

Fifty years of Flash.

Flash is waving a red rag to a bull, gleefully taunting the British female population with its 50th birthday celebrations. Not content with enraging Londoners with its Underground advertising campaign during the Olympics ("Imagine London is your flat and the world's your mum. Don't you want to clean your flat ready for your mum's visit?"), which resulted in otherwise dead-eyed commuters spluttering with indignation at the idea that their city is a shithole the rest of the time (and that's just fine by the corporate fat cats) but once the global eye was momentarily resting on this little backwater, it was time metaphorically to shove your dirty dinner plates under the sofa.

The saccharine theme song jauntily bounces over the top of a montage of housewives with fixed smiles concentrating very hard on wiping a bin lid with a cloth. Years pass but the dedication to their womanly duty remains – all that alters is the height of the hairdos.

Fifty years down the line, it's worth taking a look back at the world Flash was born into. It's 1962 and a large proportion of the female population has managed to shake off the stifling 1950s pristine housewife tag. These women are about to embark on an adventure of discovery – exploring their bodies, experimenting with drugs and pushing the limitations of gender boundaries. 

Meanwhile, amid all this societal flux, a new cleaning product is being launched, the makers of which take one look around at the newly bohemian landscape and promptly set to work putting women back in their place. Know your limits. So this is what Flash is celebrating and they have a lot to celebrate. Fifty years later, millions of bottles are still being sold despite no attempt whatsoever to give a voice to the thousands of families who don't conform to mummy cooking in the kitchen, daddy smoking in the lounge. The first female prime minister, the contraceptive pill and the slow crawl towards equal pay in the workplace have all come to pass and the Flash ad execs have staunchly dug their heads deeper into the sand. Progress? Pah. Gender liberation? Bloody hippies. Fifty years of Flash, 50 years of tired old stereotypes.

A woman's work: a 1960s housewife. Chaloner Woods/Hulton Archive/Getty Images
Photo: Getty
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The NHS's sustainability is under threat if more isn't done to look after its staff

More work is needed to develop the health service's most precious resource.

As the NHS nears its 70th anniversary, the time is ripe for a workforce rescue plan. Staffing worries, even more than funding pressures, are the biggest cause of concern for NHS trust leaders. There are not enough trained health workers in the UK to meet today’s needs, let alone those of the future.

Demands on hospitals, mental health and community trusts, and ambulance services are growing. More patients need treatment. Increasingly, they require complex care, with specialist expertise. This is not just about numbers. We need a clinical workforce that is skilled and equipped to work in new ways to deal with the changing needs of the population it serves. 

That means improving the supply of people coming to work for the NHS, and doing more to develop and motivate them so they want to stay. These problems are not new but the scale of the challenge has reached a tipping point which threatens the future sustainability of the NHS.

Ministers rightly point out that the NHS in England has more clinical staff than ever before, but numbers have not kept pace with rising demand. The official "shortfall rate" for nurses and midwives across England is close to 10 per cent, and in some places significantly higher. Part of this is down to the recognition, after the events at troubled health trust Mid Staffordshire, of the importance of safe staffing levels. Yet for successive years during the coalition government, the number of nurse training recruits fell.

Far from being a problem just for hospitals, there are major nursing shortages in mental health and community trusts. Between 2009 and 2016 the number of district nurses employed by the NHS in England fell by more than 40 per cent. Just as the health service tries to accelerate plans for more treatment closer to home, in key parts of the workforce the necessary resources are shrinking.

There are also worrying gaps in the supply of doctors. Even as the NHS gears up for what may prove to be its toughest winter yet, we see worrying shortfalls in A&E consultants. The health service is rightly committed to putting mental health on an equal footing with physical health. But many trusts are struggling to fill psychiatry posts. And we do not have enough GPs.

A key part of the problem is retention. Since 2010/11 there has been a worrying rise in “leaver rates” among nurses, midwives, ambulance staff and scientific technical staff. Many blame the pressures of workload, low staffing levels and disillusionment with the quality of care. Seventy per cent of NHS staff stay on for extra hours. Well over a third say they have felt unwell in the past year because of work-related stress.

Add in cuts to real basic pay, year after year, and it is hardly surprising that some are looking to other opportunities and careers outside the public sector. We need a strategy to end pay restraint in the NHS.

There is also a worrying demographic challenge. Almost one in three qualified nurses, midwives and health visitors is aged 50 or older. One in five GPs is at least 55. We have to give them reasons to stay.

NHS trusts have made important strides in engaging with their workforce. Staff ratings on being able to report concerns, feeling trusted to do their jobs, and being able to suggest improvements are encouraging. But there are still cultural problems – for example around discrimination and bullying – which must be addressed locally and nationally.

The NHS can no longer be sure that overseas recruits will step in to fill workforce gaps. In the early 2000s many trusts looked beyond Europe to meet nursing shortages. More recently, as tougher immigration and language rules took hold, a growing proportion came from the EU – though not enough to plug the gap.

Now we have all the uncertainty surrounding Brexit. We need urgent clarity on the status of current EU nationals working in the health and care systems. And we must recognise that for the foreseeable future, NHS trusts will need support to recruit and retain staff from overseas. The government says it will improve the home-grown supply, but that will clearly take time.

These problems have developed in plain sight. But leadership on this has been muddled or trumped by worries over funding. Responsibility for NHS workforce strategy is disjointed. We need a co-ordinated, realistic, long-term strategy to ensure that frontline organisations have the right number of staff with the right skills in the right place to deliver high quality care.

We must act now. This year's long-delayed workforce plan – to be published soon by Health Education England – could be a good place to start. But what we need is a more fundamental approach – with a clear vision of how the NHS must develop its workforce to meet these challenges, and a commitment to make it happen. 

Saffron Cordery is the director of policy and strategy at NHS Providers