The left cannot pretend that Israel is the only problem

Until Hamas renounces violence and stops arms smuggling, the problem will only get worse.

I do not know you, Mehdi, so I will not presume anything about you. I am saddened that you think to presume that I do not find the events a tragic, needless loss of life, just because I raise challenging political dilemmas. It is above all else a huge human tragedy. It was also clearly an absolute mistake by Israel that has caused it considerable diplomatic damage.

However, your approach is a manifestation of the problem, in that you seem unable to engage in a discussion about the serious policy and political problems relating to Israel that beset the international community. Serious dilemmas are faced by those that both want peace in the Middle East and also want to stop the suffering of innocents on all sides.

Given your presumption about me, you may be surprised to note that I think the arbitrary way that Israel appears to determine what foodstuffs enter Gaza is punitive, self-defeating and wrong. Furthermore, it detracts from the serious issues that I raised about the smuggling of arms, and the need to support Abu Mazen to ensure the peace process stands a chance. What is happening in Gaza is heartbreaking, but being a bleeding-heart liberal will not help resolve the wider issues.

What the people of Gaza need is for the international community to focus on the following: stop the smuggling of arms, get Hamas to renounce violence, and release Gilad Shalit. Then it will look as though we are not rewarding terror and keep the hope and chance of peace alive. This will in turn make reconciliation between Hamas and Fatah possible and then elections (which Hamas refuses to hold at present).

The best hope for Gaza is for Salam Fayyad to be able to extend his state-building programme there.

No matter how much you accuse me of not caring about human suffering, Mehdi, you can't get round these questions. Israel should answer the questions you raise about what is allowed into Gaza, but you have to acknowledge that the issue is not simple. There are enough good people in the US, UK, EU, PA and Israel that want to resolve this problem and have spent a very long time trying to sort it out. However, whatever Israel allows into Gaza, until Hamas renounces violence and stops arms smuggling, the problem will only get worse.

I feel it is equally shocking to hear someone on the left ignore the human rights abuses inflicted by Hamas, not least upon its own people. Even Amnesty International accepts Hamas is guilty of war crimes. Israel is guilty of many things, but we help no one, least of all the people of Gaza, by pretending that Israel is the sole problem.

Lorna Fitzsimons is chief executive of the Britain Israel Communications and Research Centre.

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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