The biggest threat to the NHS is not lack of funding

by Bee Heller
May 4, 2017

My little sister is a first year junior doctor. I recently picked her up at the end of a shift and witnessed the impact working in the NHS is having on many junior doctors. During her shift she’d been in tears at least once and she ranted for most of a two hour car journey about the stress of her role, level of responsibility she felt and lack of support from too few senior colleagues.

The NHS is in crisis. Hospitals are in debt, A&E waiting times are growing, employees are overworked and patient care is getting worse. The cry we constantly hear is that the NHS needs more resources.

But I think there’s a bigger problem…

Junior doctors are leaving the NHS at an increasing rate.

Figures published last December show that only 50% of F2 (second year junior doctors) were continuing into speciality training posts in 2016. This figure is down over 20% since 2011. Instead of staying and accepting training posts in the NHS, doctors are increasingly moving abroad, taking non-doctor roles in the UK or simply taking career breaks.

People train for a minimum of 5 years to qualify as a doctor. For many, becoming a doctor is the fulfilment of a childhood ambition. And yet the current reality of working in the NHS is driving increasing numbers to make dramatically different life choices after just two years of professional work.

Typically half of those people who say they’re thinking of leaving their organisation in the next 12 months actually end up doing so. This suggests that close to 100% of newly qualified junior doctors are actively thinking of a way out!

In the public debates about how to fix the NHS, we constantly hear about the need for more resources, issues around bed blocking and patient waiting times. One thing that never gets mentioned is whether the NHS is still a place where smart, dedicated people want to work. This seems to be a huge blind spot for policy makers. Regardless of what happens with funding, more restructuring, collaboration with social care, newly negotiated contracts… if there simply aren’t enough doctors because it’s such a demoralising, unhealthy place to work, there is no NHS.

The situation reminds me of Shawn Achor’s TED talk and book about ‘the happiness advantage’. In life we often strive to be successful, in the belief that once we’re successful we’ll be happy. Achor believes the equation is the wrong way around. Instead of fighting for success and deferring happiness until we’ve achieved it, we should focus on the things that make us happy and then we’re more likely to be successful.

I’m not trying to argue that the NHS doesn’t need more funding, couldn’t be more efficient, or that there’s not a better way of delivering healthcare services. But I don’t think solving these issues will suddenly make everyone who works for the NHS happy and it certainly won’t bring lasting service performance improvements.

As I see it, the bigger problem is that the NHS employee value proposition is no longer stacking up. The unique benefits people receive in return for contributing their skills, capabilities, experience and energy to the NHS are no longer evident. The constant focus on costs, funding and resources is eliminating conversations about patient care, finding better ways of working or celebrating good health outcomes. In healthcare almost everyone has chosen to do their jobs because they believe it’s important work and they can really make a difference to people’s lives. At a time when these motivations could be sources of real strength, they’re being killed off.

In my view, those trying to solve the problems facing the NHS should spend less time worrying about how to make the UK healthcare service ‘successful’, and more time worrying about how they create a place where people actually want to work.

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