It will take more than infrastructure spending to create a "northern global powerhouse". Photo: Oli Scarff, Getty
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Infrastructure spending isn’t enough, we need a radical shift of power away from London

City regions should be at the heart of future economic and social development, with powers and responsibilities devolved from Westminster.

There is an awakening interest in the regional economies and cities at present. After four years of austerity which have reinforced all of the inequalities that divide the south-east and the other English regions, it looks as though some spending on infra-structure may be heading north but it will take more than infrastructure spending alone to create a “northern global powerhouse”.

A major initiative to improve rail transport across the five key northern cities was announced last week in The One North Report, which, proposes a 125mph trans-pennine rail link and a faster link to Newcastle and Manchester airport. It is part of a 15 year plan for improving east-west transport links across the north. The cost of the rail improvements are around £15bn - roughly the same as Crossrail in London and George Osborne is likely to make this a “centrepiece” of his autumn statement which in turn forms part of the government’s proposals for a “northern global powerhouse”.

This may be cynical electioneering ahead of next year’s and it will take a much more comprehensive approach to regional economic planning to address the imbalances in in the English and the UK economies, let alone tackling the continued growth of inequality across society. Yes, we need economic development across the regions but we need strategies that can genuinely address inequality by moving power and economic investment away from Westminster and delivering economic development that meets aspirations for a fairer society that is concerned with equality and sustainability. For more on this see my essay in ‘Building Blocks for a New Economy’, out today.

It is interesting to look north to Scotland and the debate on Scottish Independence as a solution to the regional problems of England. In Scotland, the debate on Scottish Independence has brought forward a strong economic case for independence, arguing the importance of greater natural resources and strengths in education, innovation and ingenuity. They clearly, argue that a one-size fits all policy for economic development in the UK deprives Scotland of the economic levers that are necessary to set the economy on the right path to recovery. In England the patterns of centralised policy making continually reinforce the economic pull of the London and the South East and this deprives the regions of the necessary levers to deliver the economic and social aspirations of people in the regions. The case for different economic policies is a strong one but also is the argument for greater self-determination in social policy, developing economic policies that reflect the values of a fairer society in terms of education, health and equality.

In developing a new strategy for economic development we need to look to city regions as a main focus for economic development with powers and responsibilities devolved from Westminster that require them to place economic justice and sustainability at the heart of economic activity. This cannot be achieved without radical shift in power away from London and the creation of a new banking and investment infrastructure to support this shift.

Cities should be at the heart of future economic and social development. It is here that innovation and creativity thrive and where ideas will develop to create economic and social change.

Stuart Speeden is an independent equalities consultant. His essay on radical decentralisation is published by Compass today in Building blocks: for a new political economy and can be downloaded at http://bit.ly/1qVCH5X  

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