Intended for healthcare professionals

Views And Reviews No Holds Barred

Margaret McCartney: Staff hold the answer to our failing NHS

BMJ 2016; 354 doi: (Published 26 August 2016) Cite this as: BMJ 2016;354:i4690
  1. Margaret McCartney, general practitioner
  1. Glasgow
  1. margaret{at}

The NHS will not suddenly fail. Instead, it’s being made to fail in degrees.

The workplace will become unbearably stressful. Staff will leave or work fewer hours. Patients will be less well cared for as gaps on rotas widen. General practices will go bust. Schoolchildren will read the headlines, see the hours doctors work, and think: maybe medicine’s not for me.

The small cracks in the NHS that have been papered over with goodwill and vocation are gaping now, for the stock ingredients are running out. Staff are exhausted and distressed, practising in a toxic culture of fear and impossible efficiency savings, counting down the days to retirement or jobs elsewhere.

Right now, nothing in the NHS is more important than getting it right for staff. If the staff aren’t cared for, they can’t care for patients. Junior doctors are being pushed into filling rota gaps because of a lack of doctors. One junior recently told me that medical staff couldn’t be guaranteed time off to get married despite asking almost a year in advance.

Politicians and management must immediately focus on ensuring that staff have the resources to do their jobs safely

Medical workforce planning has been serially mismanaged, with female part time doctors (me, for example) blamed in the press for many of the woes. The truth is that many part timers work full time hours; for many of us full time is beyond possible.

Spending in the NHS has also been serially mismanaged: short term political policies with no evidence base (health checks, dementia screening, telehealth, seven day working, and—worst of all—the Health and Social Care Act) have been launched on us, distracting and demoralising us and taking us away from the most important thing we need to work well: job satisfaction. Without the feeling that we’re doing a good job, and without being able to leave work with satisfaction or pride, the NHS will predictably fail.

What can be done? Politicians and management must immediately focus on ensuring that staff have the resources to do their jobs safely. This doesn’t mean sending them on resilience courses. It means safe staffing. It means asking them to do only important and useful work. It means being kind and considerate to juniors, in particular, who must be shown that they’re valued and respected through being treated in ways that demonstrate that value and respect.

The NHS is being allowed to fail. This is not simply a matter of underfunding but also of what we spend our money on. The time for short term political populism must be over. It’s either evidence based policy making, starting with how we treat the staff, or no more NHS.


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