The government's NHS plan has promised us thousands more health professionals, not only to overcome staff shortages faced in many areas but also to expand provision through extra hospital and intermediate care beds, GP surgeries and nurse-led, walk-in centres. All of this is excellent news. But there is one small problem. All the extra money and all the promises on paper will make no difference unless thousands of willing people decide to work for the NHS.
Skilled people are the single most important resource for any health service. At present, they are also the most scarce - and the prospects of keeping them are not good. Growing proportions of nurses and inner-city GPs are nearing retirement age. Many more health workers are moving into the private sector, or to job opportunities outside the health system, and are not being replaced by sufficient new recruits.
A recent King's Fund report, The Last Straw, found that NHS nurses were unhappy about poor pay, bleak conditions and chronic shortages of basic resources that they experience on a daily basis. They were frustrated by inflexible working arrangements, limited career development opportunities and lack of control over their working environment. Racist harassment and discrimination were also strongly in evidence. The implications of these findings for the recruitment and retention of health workers are considerable.
There is a wider issue here, too, which should be of concern to anyone who works for, or with, the public sector. The concept of public service, which in recent history has been a source of pride and commitment, has gradually fallen into disrepute. Ambitious young people, leaving schools and universities, no longer see public service as the height of personal achievement. Instead, it is associated with ponderous bureaucracy, political manipulation, poor opportunities and low pay.
If the government wants to succeed with its NHS plan, it must make public service seem worthwhile to a wider group of people. Ministers must show they value public sector workers, not just by saying so, but by demonstrating their commitment in practice. They must provide bigger pay packets, better (and broader) career opportunities, more flexible working arrangements and much more of a chance for workers at all levels to influence how services are run.
The concept of public service, wrapped up in the values of another century, looks dated. The challenge for ministers is to build a new vision of public service that harnesses the values of equity and altruism, as well as chiming with the personal goals of the kinds of people the state needs to get to work for it - and for all of us.
