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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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How the Lib Dems learned to love all-women shortlists

Yes, the sitting Lib Dem MPs are mostly white, middle-aged middle class men. But the party's not taking any chances. 

I can’t tell you who’ll be the Lib Dem candidate in Southport on 8 June, but I do know one thing about them. As they’re replacing a sitting Lib Dem (John Pugh is retiring) - they’ll be female.

The same is true in many of our top 20 target seats, including places like Lewes (Kelly-Marie Blundell), Yeovil (Daisy Benson), Thornbury and Yate (Clare Young), and Sutton and Cheam (Amna Ahmad). There was air punching in Lib Dem offices all over the country on Tuesday when it was announced Jo Swinson was standing again in East Dunbartonshire.

And while every current Lib Dem constituency MP will get showered with love and attention in the campaign, one will get rather more attention than most - it’s no coincidence that Tim Farron’s first stop of the campaign was in Richmond Park, standing side by side with Sarah Olney.

How so?

Because the party membership took a long look at itself after the 2015 election - and a rather longer look at the eight white, middle-aged middle class men (sorry chaps) who now formed the Parliamentary party and said - "we’ve really got to sort this out".

And so after decades of prevarication, we put a policy in place to deliberately increase the diversity of candidates.

Quietly, over the last two years, the Liberal Democrats have been putting candidates into place in key target constituencies . There were more than 300 in total before this week’s general election call, and many of them have been there for a year or more. And they’ve been selected under new procedures adopted at Lib Dem Spring Conference in 2016, designed to deliberately promote the diversity of candidates in winnable seats

This includes mandating all-women shortlists when selecting candidates who are replacing sitting MPs, similar rules in our strongest electoral regions. In our top 10 per cent of constituencies, there is a requirement that at least two candidates are shortlisted from underrepresented groups on every list. We became the first party to reserve spaces on the shortlists of winnable seats for underrepresented candidates including women, BAME, LGBT+ and disabled candidates

It’s not going to be perfect - the hugely welcome return of Lib Dem grandees like Vince Cable, Ed Davey and Julian Huppert to their old stomping grounds will strengthen the party but not our gender imbalance. But excluding those former MPs coming back to the fray, every top 20 target constituency bar one has to date selected a female candidate.

Equality (together with liberty and community) is one of the three key values framed in the preamble to the Lib Dem constitution. It’s a relief that after this election, the Liberal Democratic party in the Commons will reflect that aspiration rather better than it has done in the past.

Richard Morris blogs at A View From Ham Common, which was named Best New Blog at the 2011 Lib Dem Conference

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