The missing piece in the NHS puzzle that no politician can find

There’s a lot of discussion about the NHS at the moment, partly because the service is in such a terrible state, and partly because the service has reached its 75th anniversary.

This important milestone presents an opportunity for politicians to consider the changes which must be made to improve things and rebuild the service for the future, and they’re taking up that opportunity enthusiastically.

At the end of May, Keir Starmer made an impassioned speech in Essex about his vision for the future of the service, offering up ambitious proposals including revolutionising technology within the NHS and bringing down waiting lists.

Rishi Sunak’s government has just unveiled the NHS workforce plan, which he described as the “most ambitious transformation in the way we staff the NHS in its history”. It’s a plan with big ideas and big numbers. Many people are extremely sceptical about the details of this plan; the practicalities of training so many staff within a service which is under such pressure. But the politicians are bold, and their confidence feels compelling.

We desperately need that confidence now, because for too long, the NHS has been ignored and allowed to stagnate by politicians, even as things have steadily worsened.

I speak to NHS doctors every day. When I talk to doctors about these plans from politicians; their bold proposals and big ideas, one phrase comes up again and again. They describe a “leaking bucket” of NHS skills and talent, and they’re right.

You cannot hope to rebuild a service on investment alone, by building technology or systems or hoping to train thousands of apprentices while ignoring the wellbeing and support of current NHS staff. The workforce is the backbone of the service. If any of these political parties truly want to rebuild the service, they’ll need to start caring for the staff. We will only deliver excellent care for patients if we’re caring for the staff properly too.

The service has been woefully underfunded since 2010; first suffering from a lack of investment during the “austerity years” and then entering the pandemic wholly unprepared; with over four million patients already on waiting lists in England alone. There was an opportunity to rebuild things as we emerged from the major waves of the pandemic, and many healthcare leaders warned the government about the state of the service and what was to come but were largely ignored.

Because of that, the NHS is in a desperate situation, with 124,000 full-time staff members missing in England alone at the last count, waiting lists of 7.4 million people in England alone (the highest ever on record), and a fractious relationship between the healthcare workforce and the government.

Pay disputes and industrial action have been rolling on for many months now, and look set to continue. The healthcare workforce, and their unhappiness, matters a great deal, and this is the key part of the puzzle which none of the politicians are paying adequate attention to currently.

The NHS workforce is a huge group of people, 1.26 million people in England alone. They’ve kept the service going through those difficult austerity years, throughout all of the challenges of the pandemic and beyond – and they aren’t being prioritised by politicians in their plans. Traditionally, many NHS staff enter the health service expecting to work within it for the entirety of their careers, and the service has benefited enormously from the richness of experience that this seasoned group has offered.

An experienced workforce, after all, can provide stability within the service, excellent training to new staff and a deep knowledge base of local patients and their specific needs. But the working conditions of doctors, nurses and others have deteriorated because of the actions of politicians, and the direct result of this behaviour is now many staff no longer plan to work within the NHS for their entire careers. In fact, many hope to leave as soon as possible.

A report at the beginning of last year showed that more than 400 staff members were leaving every single week, and one survey the BMA conducted last year showed that four in 10 junior doctors were planning to leave the NHS as soon as they could find another job. NHS staff morale has been ground down by real-term pay cuts of up to 35 per cent since 2008/2009, and mounting pressures at work, which transfers onto staff. This winter just passed was the worst ever in the NHS, and our healthcare workers went to work amid those pressures, taking on that stress and human tragedy every single day.

NHS staff have absorbed an awful lot, and many have now hit their limit. They’ve been expected to absorb too much for too long. It’s a terrible situation, with wages cut so severely that thousands of staff members are now reliant on food banks, many of which are run by NHS Trusts themselves. It’s not surprising that many staff are choosing to change careers, or retire early, or move to another country, where their equivalents are paid two or three times higher, and are better supported in other ways too.

Dr Julia Patterson is chief executive of EveryDoctor, a non-profit campaigning organisation which advocates for NHS patients and staff. Her new book, ‘Critical: Why the NHS is being betrayed and how we can fight for it’, is published by Harper Collins