Free the Canaries

‘It is deeply ironic and paradoxical that we are killing, through work stress, the very people who are charged with caring for us.’ So said Professor Michael West, a Senior Fellow at the King’s Fund, to a meeting of London GPs and their staff last week. West highlighted the stark contrast between the values of the NHS – compassion, collaboration, treatment according to need – and the reality. The NHS has the highest levels of work related stress, staff illness, bullying and discrimination of any organisation he has studied in over 30 years. 26.8% of NHS staff have significant anxiety and stress – 50% higher than in the general population. And long-term, unremitting stress can kill.

Not investing in the NHS is disastrous not just for patient care but also for the economy. Prompt, high quality healthcare returns patients and their carers to work. The NHS employs 1.4 million people – a huge benefit to the economy – and is crying out for more doctors and nurses. Any yet disastrous workforce planning means many great potential doctors are refused entry to medical school, and many great nurses may be put off nursing by the abolition of bursaries. At least fund the NHS to the GDP average of other European countries, staff it safely and then see how it compares.

Professor West cited unsurprising evidence that showed the key to improving the NHS was engaging and including staff rather than bullying and enforcement. There is strong research to support fact that staff happiness and job satisfaction are strong predictors of not just absenteeism and staff turnover, but patient satisfaction, mortality rates, safety and even CQC ratings. Staff are happiest when those at the top of the organisation share the same values as those at the bottom. Unfortunately for the government, NHS staff believe in evidence as well as empathy.

Handing statistics to Jeremy Hunt is like handing a flame thrower to a hyperactive child. The harm done by his misinterpretation – deliberate or otherwise – of weekend mortality rates and stroke outcomes has destroyed trust in his ability to think critically. In answering an urgent Common’s question about the all-out strikes, Hunt set about the BMA like a man demolishing a watermelon with a sledgehammer. Even more alarming is that the BMA did not fight back. Hunt has been briefed that those at the very top of the BMA do not share the goals of the junior doctors and is hoping the organisation will implode. Chair Dr Mark Porter has been suspiciously silent although he was flushed out to appear in front of the Department of Health and the empty chair reserved for Hunt. Junior doctors have kept this vigil for two weeks in the hope Hunt will return to talks as every sane authority has pleaded for him to do. But Hunt would not reopen negotiations with the BMA if you kidnapped his children. He’s trapped in a macho mind-set that could do incalculable damage to the NHS.

Ironically, Andrew Lansley may be the person to take down Hunt. His ‘sell off the NHS’ Heath Bill removed the legal responsibility of the secretary of state to provide universal NHS care. Lansley saw himself floating above the market chaos as an SoS for public health, telling people to lose weight whilst Virgin et al picked over the profitable NHS services. When the junior doctors behind Justice for Health take Hunt to the High Court over the legality of his imposition on June 8/9, he may find Lansley has neutered his power.

Whoever wins, the NHS has hit the wall. It’s now in the sixth year of a decade of flat line funding and rising demand. Patients are suffering, managers are drowning in complaints, whistle-blowers are still silenced. Excellent FOI work by whistle-blower Minh Alexander has found that many trusts are still using super-gag clauses to silence departing employees. Over a year after Sir Robert Francis’s report into how NHS whistle-blowers are treated, there has been no meaningful change. Not a single sacked whistle-blower has been found comparable re-employment. The national whistleblowing guardian, Dame Eileen Sills, resigned before taking up her post, as did her deputy. The Health Service Ombudsman service is in total disarray after yet more accusations of cover up. Junior doctors at least have the bravery to speak up about work-related stress, poor training and unsafe staffing. They are the canaries in the mine. If we silence them, the lights go out on the NHS.