The biggest threat facing the NHS is workforce. The availability of doctors, nurses, pharmacists and therapists. I know when you watch the news you are often told about the paltry lack of investment in the NHS, the bed-closures, 90-year-old women left incontinent in A&E departments, yet, the cause isn’t money or beds or access to fancy drugs. It is the people.

This of course is ironic when the population of the planet and the UK has never been bigger. Where has everyone gone?

I can tell you the single biggest impediment to you, me, your family, receiving high-quality healthcare during our times of need are the working conditions created by the government who then pressurise the hospitals and GPs to perform to a certain level, which, owing to a tendency of humans to be mean (when stressed) (like squid pooping black ink), particularly when controlling the lives of others results in an imbalance.

Where have they gone? Well, many retire early; despite our ever-increasing lifespan, people leave the workplace as soon as possible. Why? Is this because they are lazy? No. It is because the workplace has become so unfulfilling, challenging. Instead of hospitals being places for people to grow and find meaning in life, they have become or are becoming sausage factories, where you don’t even get to take home some of the produce.

Work-life balance.

It’s a shame.

We all interpret life differently; some want more hours in bed, others, the shops, the park, watching TV, seeing our children grow. Many of us squander what we have – wanting time with the children, but, instead, typing on the computer or lost in fiction. We have a concept of what is a Good Life but we fail to follow the principles.

We become caught in a cycle of dissatisfaction. Can’t have enough time doing what I want/don’t really know what I want/too tired/spent/worn-out to do what I want/alarm clock, Monday morning.

No, everyone can’t find the meaning of life in work, but so many of us find no meaning at all – the existential treadmill drawing us along.

How do we unravel? How do we make work fun, how do we subtract the obligation from work, blur the boundaries between must do, should do and love to do?

The NHS appears to have this spectacularly wrong.

There is no reason why every moment working in a hospital, clinic or GP surgery shouldn’t be fun. Sure, there will be the tragedies, complaints, mistakes, dissatisfaction – but, predominantly it should be laughter.

Much of the NHS workforce is caught in a vicious cycle of locum rates (often 2x the norm) – take the 40,000 nurse vacancies in the NHS – the vast majority filled with agency locums, who provide flexibility, but predominantly return on investment to shareholders.

Why this imbalance, why this mismatch? Control is certainly key; we all seek some sort of control in life – when you arrive for your day-job only to be told, your plans are now different, we are taking you from ward A to ward C, where you will fill a gap, and no, Mr Ben who you had been chumming along yesterday, the old man in the bed by the window, won’t get to see you, you are forced into modularity. Like a Lego brick. Don’t have one with eight connectors, then take two fours, of four twos, we can do it, we can get there, we can, we will. OK when this a one-off, but, when every day becomes a repetition of the next, this is when your beautiful block house loses its sense of proportion, its internal consistency.

The answer?

As with all complex systems, there can never be a, do this and that will happen. More nurses some will say, but more significantly it will be ensuring that the nurses who are working are happy, that they have meaning, that they have teamwork, purpose, a goal, structure, hope; efficiency and organisation to minimise wasted effort and energy. Economy of scale and listening to what people say. Don’t dictate – collaborate.

Take a team, any team, shuffle them up and before you know it things don’t work. It takes time; time, love and a vision.

Allow people to self-organise, to self-manage, to direct themselves the way that they understand best meets the needs of the service; here, you go there, do that, doesn’t do anyone any good. Get to know your staff, get to understand what they want, their aspirations, their fears?

This is turning the model upside down.

This is the workforce recruiting the managers, the leaders determined by the populace. This is failing fast and trying again, it is agility, responding to an unpredictable environment by thinking outside of the mind-set that created the problem.

We have plenty of money.

We very often forget how much we have, how much privilege compared to almost everyone else on the planet, we become ground-down by the minutiae of our selves, forgetting what it outside. Parochial.

Use the money wisely.

Don’t but the first sparkly thing your eyes see. Don’t invest without consultation and, when you consult, listen more than you talk. Less of the cynicism, the foregone conclusions the outcomes predicated on plans designed months before. Openness and honesty to the uncertainty that governs us all.

Dali was right.

We perceive the world as being linear, when in reality it is anything but, it is chaos, it is an hallucinogenic distortion that can only be perceived through sharing and talking, listening and understanding, talking and reassuring.

Carry-on as we are and, who knows.

Time to change.

Museo Civico

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