London's Vaudeville act must cease

Ken Livingstone and Boris Johnson have been a great double-act. London now needs the act to take its

Neither Boris Johnson nor Ken Livingstone are fit to lead London.

It's a shame, because their double act has been engaging. They developed a nice chemistry; each taking it in turns to be the straight man to the others clown.

But now we have no room for clowns. The world's greatest city needs serious leadership, not a vaudeville routine.

Ken Livingstone has lived his dream. He will always be London's first mayor. He may also prove to be its most iconic. "Red Ken" will forever be as a much a part of the capital as red telephone boxes and red double deckers.

But his time has gone. To look at him is to stare into the past. He is physically old, and slightly frail. But not as old and frail as his statements. A measured response to the riots could have been the making of his mayoral candidacy. Instead, he sullied it.

It wasn't just the cheapness and transparency of his politicking; the Conservatives, the cuts, Cameron. Nor the tasteless way he used the London bombings to frame his suitability for tackling the London riots. It wasn't even the crass stupidity and simplicity of his analysis; blame the bankers, EMA, the fact that 14 and 15 year old rioters are enraged at their inability to provide for their wives and children.

London needs unity. And Ken Livingstone is divisive. He cannot help himself; divide and conquer, opponents and supporters. It is his way. Try as he might he cannot embrace, only attack. He cannot bind, only drive apart. Ken looks for factions to nurture and manipulate, when what we need is someone who can bring London together.

But crass though Ken Livingstone's comments were, at least he was in a position to make them. Cometh the hour, cometh the man? That man was not Boris Johnson.

Hindsight is a great gift. But it does not require hindsight to understand that the mayor of a major western capital city needs to be at his post, and seen to be at his post, when major public disorder strikes.

Those asking what operational impact could Boris have had miss the point. While Londoners sat imprisoned in our homes, with that strange awareness that a call to 999 would go unanswered, what we were looking for was leadership -- a sense that someone was in control.

There was none. We had a void. It wasn't that the Mayor was asleep at his post. It's that he wasn't at his post at all.

Kit Malthouse is an eloquent mayoral spokesman. But no one voted for him -- they voted for Boris Johnson. And where was our mayor when his city needed him most? Absent without leave. He picked up his broom too late.

A crisis reveals the true metal of our leaders, and when the moment came, both prospective leaders of London were found wanting.

But in truth, that shouldn't really surprise us. Neither Ken Livingstone, nor Boris Johnson are leaders. Nor are they really politicians. They are characters, political entertainers, colorful personalities who leap out from the parade of the bland.

But leading London is not a game. Nor is it the prize awarded to the winner of a game of Celebrity Political Big Brother.

There are serious people in our country, and outside it, who have run things -- big things, like corporations, institutions and even cities. They know how to manage. To procure. To plan. To lead.

London needs that now. We need serious leadership, not symbolic or colorful leadership. The world's greatest city now needs great statesmanship.

I've loved the unkempt blond locks. And the newts. I laughed at the Beijing "ping-pong" speech, and at the audacity of calling for the Saudi Royal family to be hung from lamp posts. But quirky humour is no longer enough. Nor are free bus travel for under sixteens and community bicycles.

I want vision, I want drive, I want imagination. Above all, I want professionalism. Someone who will grab my city out of the hands of the rioters and the speculators and the city spivs and the gangsters, and give it back to the people who deserve it.

I don't care about the politics. I don't care if Labour wins in London, or if the Tories get a good hiding. All I care about now is that Londoners win in London.

I'll vote Tory. I'll vote Green. I'll vote independent. I still hope and pray I'll be able to vote Labour.

But I'm not helping place my city back into the hands of a clapped out revolutionary or an Etonian comic. Not after this week. Not ever again.

Ken Livingstone and Boris Johnson have been a great double-act. London now needs the act to take its final bow.

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