No wonder morale is low in the NHS

NHS Staffing


This, from David Oliver’s timeline on Twitter, sums it up for me.

But the low morale amongst staff is in fact bordering on clinical depression – if it were not for the fact that employees of the NHS can be too scared to admit that they are depressed in case the regulator bombards them with fitness to practise warfare.

It’s the lack of control over your destiny which is a profoundly disempowering phenomenon. For junior doctors, it’s the fact that just because they’re employees of the NHS they’re not entitled to the same premium for weekend work you’d expect from a private provider.

And let’s face it – the private sector get a very good deal out of the NHS name. Private providers can use the NHS logo, and still make a handsome shareholder dividend: this legal misrepresentation is of course morally deeply fraudulent. They also don’t have to commit a penny into the education and training of the workforce at large.

It’s no better for nurses. Nurses are expected to be in more than one place at once, as described by Paula Sherriff in the Adjournment debate this evening, with some sort of blockage in implementing safe staffing in NHS Trusts currently. Nurses in training also have had hurdles imposed in their training – hence the #bursaryorbust hashtag.

In a recent BMJ Careers event at the Design Centre in Islington, Dr Pete Deveson brought up the notion of treating the medical workforce so as to propel its members into a state of ‘learned helplessness‘.

Learned helplessness is behaviour typical of an organism (human or other animals) that has endured repeated painful or otherwise aversive stimuli which it was unable to escape or avoid. After such experience, the organism often fails to learn escape or avoidance in new situations where such behavior would be effective.

In other words, the organism seems to have learned that it is helpless in aversive situations, that it has lost control, and so it gives up trying. Such an organism is said to have acquired “learned helplessness”. It has been argued that “learned helplessness” explains how clinical depression and related mental illnesses may result from such real or perceived absence of control over the outcome of a situation.

The NHS, thanks to this current Government, is in the process of outsourcing services at high speed to the private sector. The record of outsourcing is a depressing one, however. For instance, G4S’s monumental failure to perform fully on its contract to provide Olympic security meant that the government had to step in to avert a major national embarrassment in front of the whole world.

A number of strands have patently got out of hand in NHS policy, and descriptions of these are well rehearsed elsewhere. Recently, for example, nearly 200 London hospital service workers went on strike in a dispute which its organisers say highlights the increasingly difficult predicament of low-paid people in the capital, and problems particularly faced by women and migrant workers.

Those on strike work as cleaners and domestic staff at four mental health facilities run by the South London and Maudsley Trust: the Maudsley hospital in Camberwell, the Bethlem Royal hospital in Beckenham, the Lambeth hospital, and the Ladywell Unit at Lewisham hospital. But they are employed by Aramark, a multinational company based in the USA that also specialises in selling food and drink at American sports events.

Many of Aramark’s London hospital employees are paid £7.38 an hour, more than £2 below the London living wage set by the Greater London Authority. The workers on this pay rate also have restricted entitlements to sick pay and overtime.

The strikers were calling for changes to those conditions, and a new minimum hourly rate of £10. The GMB union called the strike after weeks of negotiations with the company failed to result in a resolution.

Another example of learned helplessness is how staff seem unable to control what Simon Stevens, CEO of NHS England, is doing ‘on their behalf’.

It emerged at the weekend that David Cameron and George Osborne were immersed in a new row over their Election pledge to give the NHS an extra £8 billion to fill a ‘black hole’ in its budget. The allegations, unproven, are made in a new book by David Laws.

Specifically, it is alleged that Downing Street was told in an official report that the health service needed a massive £16 billion extra a year by 2020 – but dismissed it as ‘a joke.’ No 10 allegedly ordered the head of the NHS to cut the figure in half. Cameron and Osborne’s extra £8 billion for the NHS was a centrepiece of their Election campaign.

All of this comes at a time when Jeremy Hunt MP, the current Secretary of State for Health, emphasises the need for ‘transparency’ to be the best disinfectant.

But part of the reason the NHS is so financially stretched is the fact that (a) it is underfunded as a whole (b) money is being siphoned off into all sorts of private ruses, such as the private finance initiative and outsourcing of contracts.

Cumulatively, it is argued that privatisation can be bad for safety –both for the public and for the workers in that industry. Privatisation can be bad for employees – this means fewer jobs, more stress on those left doing the job, and worse pay and conditions. This, conversely, is sold as “controlling an unsustainable budget” – or “efficiency savings”, the rose of austerity by another name.

As such nobody ‘voted’ for this privatisation (and even when Tony Blair introduced his internal market, Blair had promised that he wouldn’t; and the Health and Social Care Act [2012] came from nowhere).

No wonder, then, people feel profoundly disempowered and their morale is so low.