Things did not only get better for NHS staff

Pop quiz: NHS highlights of the 2000s please. Yes, 18 weeks, nice. A&E waits, good. GP access, yes. MRSA, big falls from 2008 onwards (let’s ignore for a moment the increases which led to it). Cancer care, heart disease, stroke, tick, tick, tick. Very good.

All very genuine, major changes. But what didn’t change over that time? And what does that mean for where we are now?

Barring bizarre events we will soon have our first right-to-left transition of government for 27 years. Already the echoes of 1997 are being heard loud and clear, with pledges to improve GP access and reduce hospital waiting times.

But where in all of this is what happened in the 2000s to the NHS’s people?

Pay up, morale down

The easy bit is that numbers of staff, and their pay, went up. More than 300,000 more people in the NHS in England between 2000 and 2010; consultant numbers up 50%, and their pay 68%.

It starts to get awkward when you turn to their experience. In 2003, 12% of acute trust staff reported harassment, bullying or abuse from colleagues. Less than half thought their employer took effective action in response. Fast-forward to 2009, and these figures had barely changed: marginally up for bullying, marginally down for action in response. Job satisfaction? The same story.

Given technical changes, these figures give an indication of change rather than a direct comparison. But they do show that the story of NHS ‘glory years’ didn’t particularly extend to what it felt like to be a member of NHS staff.

This is a story we don’t talk about, and, rather amazingly, hasn’t been the subject of a single major study. It’s concerning for a whole host of reasons – not least that an improvement model of ‘targets and terror’ might be feasible (even if morally horrible) when lubricated with truckloads of cash – but not when the coffers are empty.

The story of NHS ‘glory years’ didn’t particularly extend to what it felt like to be a member of NHS staff.

Add to this that whoever is in Downing Street on 5 July will inherit a workforce that is both at a historically low ebb (more than 30% of NHS staff are reporting burn out), and in the middle of fundamentally reappraising what matters most to them (surveys show that those born between 1980 and 2001 value most of all having an employer that cares about wellbeing).

So what can be done? Three actions:

• For politicians, to lead the argument. The public are worried about the NHS: the lowest level of satisfaction in how the service is run since such records began. But (understandably) they’re most concerned about the bits they can see: GP and hospital waits, staff shortages, lack of money. They’re not complaining about the NHS’ colossal deficit in psychological safety, or that a higher proportion of UK trained doctors are now practising overseas than any other developed country. It falls to politicians to lead the debate that if the NHS has no staff, we have no NHS. “Politics is the trap,” Alan Miburn reflected on the NHS. “And the only thing that can break it is politics.”
• For health leaders, to make clear the trade-off. What’s not to like about a pledge to get the NHS back to delivering 18-week waits within five years? How about a conversation about what it would take to get there. I was working in Whitehall in 2010 writing “congratulations, you won!” briefings for a new government about how their plans will become reality. You want to please. To spell out the risks, but show you’re on their side. It can seem weak to say “the staff won’t have it”, but ministers are best served by hearing the truth, however hard, including that if anything will kill the NHS sooner rather than later, it will be workforce not waits.
• For health organisations, to show how to improve staff and patient experience together. The most exciting health experiment of the last 20 years happened first in Holland, with the rise of Buurtzorg, a company able to achieve the holy grail of improving patient outcomes and staff experience, while reducing cost. The secret to its success? Creating a healthcare workplace capable of winning Dutch employer of the year five years in a row. Examples such as the wonderful Oxleas NHS FT – the only NHS organisation to feature in the Sunday Times Best Place to Work list – or the Sussex social enterprise Here (which I chair) show that deeply caring for staff and patients can be done.

At Kaleidoscope our mission is to work with others to build a future that is kind, connected and joyful. We’re not doing this because we’re a cult, but because we’ve seen the evidence, and have a firm belief that kindness, collaboration, and joy in work are the only ways for the NHS, and organisations in general, to be able to deliver their purpose in a future very different to our past. Change is needed. Cutting and pasting yesterday’s change isn’t.