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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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Labour is launching a stealthy Scottish comeback - thanks to Jeremy Corbyn and the Daily Mail

The Scottish Labour strategy is paying off - and hard evidence that it works may be more plentiful come 8 June 2017

When I suggested to a senior Scottish Labour figure earlier this year that the party was a car crash, he rejected my assertion.

“We’re past that,” he said gloomily. “Now we’re the burnt-out wreck in a field that no-one even notices anymore.”

And yet, just as the election campaign has seen Jeremy Corbyn transformed from an outdated jalopy into Chitty Chitty Bang Bang magically soaring in the polls, Scottish Labour is beginning to look roadworthy again.

And it’s all down to two apparently contradictory forces – Corbyn and The Daily Mail.

Kezia Dugdale’s decision to hire Alan Roden, then the Scottish Daily Mail’s political editor, as her spin doctor in chief last summer was said to have lost her some party members. It may win her some new members of parliament just nine months later.

Roden’s undoubted nose for a story and nous in driving the news agenda, learned in his years at the Mail, has seen Nicola Sturgeon repeatedly forced to defend her government record on health and education in recent weeks, even though her Holyrood administration is not up for election next month.

On ITV’s leaders debate she confessed that, despite 10 years in power, the Scottish education system is in need of some attention. And a few days later she was taken to task during a BBC debate involving the Scottish leaders by a nurse who told her she had to visit a food bank to get by. The subsequent SNP attempt to smear that nurse was a pathetic mis-step by the party that suggested their media operation had gone awry.

It’s not the Tories putting Sturgeon on the defence. They, like the SNP, are happy to contend the general election on constitutional issues in the hope of corralling the unionist vote or even just the votes of those that don’t yet want a second independence referendum. It is Labour who are spotting the opportunities and maximising them.

However, that would not be enough alone. For although folk like Dugdale as a person – as evidenced in Lord Ashcroft’s latest polling - she lacks the policy chops to build on that. Witness her dopey proposal ahead of the last Holyrood election to raise income tax.

Dugdale may be a self-confessed Blairite but what’s powering Scottish Labour just now is Jeremy Corbyn’s more left-wing policy platform.

For as Brexit has dropped down the agenda at this election, and bread and butter stuff like health and education has moved centre stage, Scots are seeing that for all the SNP’s left wing rhetoric, after 10 years in power in Holyrood, there’s not a lot of progressive policy to show for it.

Corbyn’s manifesto, even though huge chunks of it won’t apply in Scotland, is progressive. The evidence is anecdotal at the moment, but it seems some Scots voters find it more attractive than the timid managerialism of the SNP. This is particularly the case with another independence referendum looking very unlikely before the 2020s, on either the nationalists' or the Conservatives' timetable.

Evidence that the Scottish Labour strategy has worked may be more plentiful come 8 June 2017. The polls, albeit with small sample sizes so best approached with caution, have Ian Murray streets ahead in the battle to defend Edinburgh South. There’s a lot of optimism in East Lothian where Labour won the council earlier in May and MSP Iain Gray increased his majority at the Scottish election last year. Labour have chosen their local candidate well in local teacher Martin Whitfield, and if the unionist vote swings behind him he could overhaul sitting MP George Kerevan’s 7,000 majority. (As we learned in 2015, apparently safe majorities mean nothing in the face of larger electoral forces). In East Renfrewshire, Labour's Blair McDougall, the man who led Better Together in 2014, can out-unionist the Tory candidate.

But, while in April, it was suggested that these three seats would be the sole focus of the Scottish Labour campaign, that attitude has changed after the local elections. Labour lost Glasgow but did not implode. In chunks of their former west of Scotland heartlands there was signs of life.

Mhairi Black’s a media darling, but her reputation as a local MP rather than a local celebrity is not great. Labour would love to unseat her, in what would be a huge upset, or perhaps more realistically go after Gavin Newlands in the neighbouring Paisley seat.

They are also sniffing Glasgow East. With Natalie McGarry’s stint as MP ending in tears – a police investigation, voting in her wedding dress and fainting in the chamber sums up her two years in Westminster – Labour ought to be in with a chance in the deprived neighbourhoods of Glasgow’s east end.

Labour in Scotland doesn’t feel like such a wreck anymore. Alan Roden’s Daily Mail-honed media nous has grabbed attention. Corbyn’s progressive policies have put fuel in the tank.

After polling day, the party will be able to fit all its Scottish MPs comfortably in a small hatchback, compared to the double decker bus necessary just a few years back.

But this general election could give the party the necessary shove to get on to the long road back.

James Millar is a political journalist and founder of the Political Yeti's Politics Podcast. He is co-author of The Gender Agenda, which will be published July 21 by Jessica Kingsley Publishing.

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