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The NHS has a crisis in morale—it’s time for proper leadership to address doctors’ needs

The idea of a "Tsar" might worry some. But healthcare doesn't only have a good track record with Tsars—it has talented leaders ready on the front line

By Na’eem Ahmed  

Junior doctors and supporters of the BMA strikes sit down in a silent protest outside Bristol Royal Infirmary. Photo: PA

Every year I meet prospective medical students and their motivations are consistent: to enter a caring profession, to assist others in their time of need and to build on their interest in science. If you ask more probing questions they may say that becoming a doctor also ensures a stable job, respect from peers and a good salary.

Policymakers have taken comfort in the fact that, despite negative headlines, a place at medical school remains coveted. However, the feelings of those at the sharp end of delivering care are changing.

The frontline workforce has recently emerged from a protracted contract dispute with feelings of trepidation.

The tragic case of Jack Adcock and paediatric trainee Dr Hawa-Garba has led to widespread apprehension due to its possible implication on workplace transparency. In response to this case, Secretary of State has swiftly ordered a review to be led by Professor Sir Norman Williams.

What has become most apparent during the cycle of crises is a lack of stewardship. Royal Colleges and Unions have worked hard to represent their constituents, but not having their hands on the steering wheel of central policy has potentially hampered efforts.

The NHS workforce strategy is currently out for consultation from Health Education England. It will require skilful leadership to bring together the myriad of training and healthcare providers, clinical interest groups, and regulators with a common purpose to create a meaningful plan.

The initial response to the thought of a government-appointed policy advisor (‘Tsar’) may be one of suspicion. A central figure could be used to push through, and give credibility to, perceivably adverse government proposals.

But in healthcare we have seen Tsars work effectively—most notably in transforming cancer care, a complex and emotive area, through the efforts of Sir Mike Richards and his Cancer Plan. Our experience in cancer also demonstrates that healthcare staff, patient groups, and government can be aligned with positive outcomes.

It is incontrovertible that the galvanising force for highlighting recent workforce issues, and rallying NHS workers, has been a handful of frontline healthcare staff.

Doctors such as Rachel Clarke, a palliative care doctor, have sought opinion through a large social media following, organised demonstrations and been a compelling advocate for her peers in the media.

In appointing a Tsar, the government should break with tradition of hiring a seasoned expert and look at those with an ear to the ground in providing them with advice on workforce-related issues.

An ambition to train more general practitioners is a welcome step in line with the changing requirements from our health service but current recruitment and retention remains an issue.

The rising costs of education and loss of bursaries and its effect on the number, diversity and quality of applicants now pursuing a career in healthcare should also be explored.

Although by no means exhaustive, workforce issues can be distilled to three main domains: future workforce planning, current workforce provision and employee wellbeing, all of which require attention.

Those at the coalface would likely suggest quick wins in improving morale by improving induction processes, better financial support for mandatory courses, publishing work schedules at least six months in advance and minimising the distance travelled during training. Ideas mooted around compulsory NHS service for doctors should be shelved and instead a conciliatory approach of financial support for student loans in exchange for time spent in the NHS could be considered.

As pay continues to stagnate and the cost of living increases, working closely with the evolving NHS estates policy should ensure that affordable housing is earmarked for NHS workers. These relatively modest changes would make a big difference to the quality of life of someone working in the NHS.

Brexit dominates headlines and arguably has displaced the NHS in current political discourse. The consequences of the Brexit vote have caused unease, despite reassurances, amongst healthcare staff.

An incoming workforce Tsar would have to work to alleviate these concerns and also create a better understanding amongst other government offices such as the Home Office, in streamlining health worker visa processes, and with the Department for International Trade, in promoting the NHS as an attractive place to work.

The workforce Tsar would collaborate with the recently appointed National Guardian for the NHS at the Care Quality Commission to accelerate the creation of a healthcare culture that is consistently safe for staff and patients.

This includes examining staffing of rotas and our treatment of whistleblowers. There are also the more pernicious elements within our health service that need to be addressed such as bullying, and discrimination against minority groups.

We cannot wait for the discussion on NHS funding or a suggested Royal Commission to unfold before we address declining goodwill; an incoming Tsar already has a full inbox.

The NHS employs 1.3 million people, one of the largest employers in the world, behind Walmart and the People’s Liberation army of China, yet oversight of these hard-working individuals remains disparate over several national and local bodies. Low morale in a stretched system requires an urgent remedy.

A figurehead that is trusted by the clinical community should be tasked with this mandate immediately.

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