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The answer to the NHS crisis is treating its staff better

For too long the government has allowed goodwill and vocation to mop up funding shortfalls and bad policymaking.

The NHS is suffocating under huge pressure. Even the regulator of the UK’s doctors, the General Medical Council - which is not normally known for speaking out - has offered with stark words. The NHS is struggling to cope with the demand placed on it, the GMC says. The "growing number of people with multiple, complex, long term needs" who needed treatment at a time of "severely constrained funding" was made "significantly worse by the fragility of social care services". This is exactly right. The NHS is doing more, with less, with the added pressure of the financial and bureaucratic costs of service fragmentation under the Health and Social Care Act 2012.

The junior doctor strikes were ostensibly about a new contract, which has now been imposed. But the unrest in the medical profession was and is not confined to that one issue. Doctors are also concerned about Jeremy Hunt's repeated use of misleading statistics about weekend death rates, continuing even after he had been corrected; and his claims that medicine had turned into a 9 to 5 job, which meant he wanted a “sense of vocation and professionalism brought back into the contract”.

To the doctors routinely working nights, weekends and regular unpaid overtime, this was insulting. Put simply: workers who are well resourced and respected will repay their fulfilment by routinely going beyond the letter for their contract. When staff are treated badly, how can patients be treated well? Morale is the burning, unignorable safety issue in the NHS and yet its governing powers seem unable to admit their responsibility for contributing to its decline. Morale is not just affected by simple unkindnesses - such as the junior doctors unable to know, thanks to the vagaries of the rota system, if they can have time off to get married. It is a systematic problem, with chronic understaffing, frequent rota gaps, fatigue and stress and avoidable mistakes in a toxic mix. No wonder there was such anger when Hunt told parliament that he would arrange a review into why junior doctors morale was so low - ironically on the same day as imposition of the new contract was announced.Good morale usually comes with the feeling that one is doing a good job.

In 2013, research was published in BMJ Quality and Safety which found that staff had an “almost universal desire to provide the best quality of care” and “deeply felt personal professional commitment”. But they also found professionals wasting time over poorly designed IT systems, conflicts between different teams (even within single organisations), heavy workloads and staff shortages, with multiple external agencies creating mess about where time and effort should be spent. Yet, as they wrote “the wellbeing of staff is closely linked to the wellbeing of patients”. It makes sense: staff who are stressed and distressed are not going to give consistently high quality care. Yet sickness rates of the staff in the NHS are higher than the general population and 59 per cent of GPs in the UK describe their work as very or extremely stressful, the highest of any country surveyed by the Health Foundation. There are high levels of burnout.

A target-driven culture is exacerbating this problem. A typical example was when the government seemingly became convinced by poor quality data which suggested that dementia was under diagnosed So it decided to offer GPs £55 per new diagnosis of dementia. Targets were set for screening to take place - despite the UK National Screening Committee having said for years that screening for dementia was ineffective, causing misdiagnosis. And when better data on how many people had dementia was published - which revised the figures down - it was clear that the targets GPs were told to meet were highly error-prone. The cash carrot was accompanied with beating stick, with the results - naming and shaming supposedly poorly diagnosing practices - published online. Setting doctors harmful tasks, leading them almost to "process" patients, fails to respect patient or professional dignity, let alone the principle of "do no harm".

The rocket fuel of the NHS is the staff. But even the most fundamental part of running the NHS - making sure there are enough people working - has been badly managed. Safer staffing research being done by NICE was stopped by NHS England. And, as the Commons Select Committee put it, there has been “no coherent attempt to assess headcount implications of 7-day NHS". There is, though, evidence that fewer junior doctors are applying to specialist training. Jeremy Hunt’s response to the ongoing recruitment crisis - a fifth of GP training posts were vacant last year - was an announcement that doctors would be compelled to work for four years for the NHS after graduation. Indeed, a conservative MP has previously proposed this because "investment of taxpayers' money demands a return for the taxpayer". This sort of fiscal guilt trip ignores the debts for fees and maintenance accumulated by graduates via the Student Loans Company - over £110,000 for the average male doctor. As an evidence-free policy, who knows what the effect will be - it’s difficult to see long term loyalty nurtured with these terms and conditions.

Working in the NHS should be joyful, a matter of love. But for too long the government has allowed goodwill and vocation to mop up funding shortfalls and bad policymaking. These are now chasmic. As Bevan said, the NHS does not run “as a creature of magic, called out of the void by the wand of the Minister for Health". Treat the staff better, and patients will be treated better too.

Margaret McCartney is the author of The State of Medicine - keeping the promise of the NHS (Pinter and Martin)

Margaret McCartney is a GP in Glasgow who broadcasts for Radio 4's Inside Health and is author of The Patient Paradox: Why Sexed-Up Medicine is Bad for Your Health.

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Rising crime and fewer police show the most damaging impacts of austerity

We need to protect those who protect us.

Today’s revelation that police-recorded crime has risen by 10 per cent across England and Wales shows one of the most damaging impacts of austerity. Behind the cold figures are countless stories of personal misery; 723 homicides, 466,018 crimes with violence resulting in injury, and 205,869 domestic burglaries to take just a few examples.

It is crucial that politicians of all parties seek to address this rising level of violence and offer solutions to halt the increase in violent crime. I challenge any Tory to defend the idea that their constituents are best served by a continued squeeze on police budgets, when the number of officers is already at the lowest level for more than 30 years.

This week saw the launch Chris Bryant's Protect The Protectors Private Member’s Bill, which aims to secure greater protections for emergency service workers. It carries on where my attempts in the last parliament left off, and could not come at a more important time. Cuts to the number of police officers on our streets have not only left our communities less safe, but officers themselves are now more vulnerable as well.

As an MP I work closely with the local neighbourhood policing teams in my constituency of Halifax. There is some outstanding work going on to address the underlying causes of crime, to tackle antisocial behaviour, and to build trust and engagement across communities. I am always amazed that neighbourhood police officers seem to know the name of every kid in their patch. However cuts to West Yorkshire Police, which have totalled more than £160m since 2010, have meant that the number of neighbourhood officers in my district has been cut by half in the last year, as the budget squeeze continues and more resources are drawn into counter-terrorism and other specialisms .

Overall, West Yorkshire Police have seen a loss of around 1,200 officers. West Yorkshire Police Federation chairman Nick Smart is clear about the result: "To say it’s had no effect on frontline policing is just a nonsense.” Yet for years the Conservatives have argued just this, with the Prime Minister recently telling MPs that crime was at a record low, and ministers frequently arguing that the changing nature of crime means that the number of officers is a poor measure of police effectiveness. These figures today completely debunk that myth.

Constituents are also increasingly coming to me with concerns that crimes are not investigated once they are reported. Where the police simply do not have the resources to follow-up and attend or investigate crimes, communities lose faith and the criminals grow in confidence.

A frequently overlooked part of this discussion is that the demands on police have increased hugely, often in some unexpected ways. A clear example of this is that cuts in our mental health services have resulted in police officers having to deal with mental health issues in the custody suite. While on shift with the police last year, I saw how an average night included a series of people detained under the Mental Health Act. Due to a lack of specialist beds, vulnerable patients were held in a police cell, or even in the back of a police car, for their own safety. We should all be concerned that the police are becoming a catch-all for the state’s failures.

While the politically charged campaign to restore police numbers is ongoing, Protect The Protectors is seeking to build cross-party support for measures that would offer greater protections to officers immediately. In February, the Police Federation of England and Wales released the results of its latest welfare survey data which suggest that there were more than two million unarmed physical assaults on officers over a 12-month period, and a further 302,842 assaults using a deadly weapon.

This is partly due to an increase in single crewing, which sees officers sent out on their own into often hostile circumstances. Morale in the police has suffered hugely in recent years and almost every front-line officer will be able to recall a time when they were recently assaulted.

If we want to tackle this undeniable rise in violent crime, then a large part of the solution is protecting those who protect us; strengthening the law to keep them from harm where possible, restoring morale by removing the pay cap, and most importantly, increasing their numbers.

Holly Lynch is the MP for Halifax. The Protect the Protectors bill will get its second reading on the Friday 20th October. 

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