Can the NHS get its head and practice around the alarming reality that people don’t HAVE to work for it – and can it do this in time?

Regular readers will not be surprised to learn that I spent my formative years being brought up by parents and relatives that were firmly within the politics and tradition of the Labour Party. That has created all sort of different parts of me, but probably the most significant is always contained within the name Labour. I was brought up to believe in the importance of workers not simply as a group, but because they did work.

Workers doing work was what made the world go round and was what created goods, services and products in our society. And conflict, at its sharpest, meant that when workers stopped doing work, well, goods services and products didn’t get created. Then in my late teens I studies economics at school and at University and that ‘miserable science’ insisted that there were three factors of production that were necessary to create anything. Labour, Capital and Land. I suppose I went along with this to get my grades, but actually I still believed that labour was what made the world go round.

Half way through my degree I was introduced to Marxism which explained to me the “Labour Theory of Value”. This states that all value comes in one way or another from labour. Capital is just value that has been previously constructed by labour and land and, well, it didn’t have any value unless labour did something to it.

For me this provided some theoretical underpinning to the lesson that my parents had been teaching me years ago – that labour was the source of value.

Why is this important for the NHS?

For the last year or so, culminating in the NHS Long-term plan in January this year, there has been a growing recognition that the main problem for the NHS isn’t a lack of money but a lack of staff. I’ve talked before about the different causes of this crisis. It’s true that Brexit has an impact. It’s true that we should be training more, and it’s true that we need to increase the pool of the population (beyond those with A levels) that have the opportunity to become carers in the NHS.

But as I’ve said before all of this adds up to Dido Harding’s statement last October that said “the single biggest problem in the NHS at the moment is that we don’t have enough people wanting to work in it”    When I repeat this to leaders in the NHS it is often met with a world weary – well what can you do shrug – but it’s a strong indictment of how we are running the NHS. If we don’t change that within next few years we won’t reach the end of the long-term plan.

Sunday’s Observer story about the statistics of why people leave the NHS, reported that in the 12 months to June 2018 10,257 people left the NHS because of poor work-life balance. This is nearly treble the 3689 people who gave that reason for leaving in the 12 months up to June 2011.

Of course this is a shocking increase, but my worry is that I’m pretty sure the data is a great underestimation of the number of staff leaving. I am sure the problems caused by poor work-life balance is much higher.

And that is the problem.

These stats will come from NHS employers trying to find out why staff are leaving but I suspect the quality of the investigation is congruent with the reasons they are leaving. What I mean by this is that if we really cared about  knowing in detail why people are leaving then we would probably have been doing something about it well before they left. If the NHS creates a poor work-life balance for staff, it probably doesn’t spend a lot of time asking staff that leave, if that is what it has been doing.

At an intellectual level NHS leaders recognise that they – we – all of us really need staff. But there seems to be a fatalism that “Well the work is hard and pressurised and therefore people leave.

Just not true.

The environment created for people to work in is just that – created. And because of that a different environment can be created. Managers and leaders are in charge of that. If they create a poor environment, people leave.

So back to my political point at the beginning. Labour creates value. In the NHS staff create value. No staff – no value.

And the obvious truth that all leaders need to recognise is – as Dido Harding pointed out – since people don’t HAVE to work in the NHS, they won’t if they don’t want to.

Creating an environment that persuades staff to want to work in the NHS is now, in 2019, the crucial task for management and leaders. And there probably isn’t very long to learn how to do it – and make it universal.

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