Cowper’s Cut is a new weekly column from HSJ’s comment editor Andy Cowper. It will be published every Monday and seeks to serve as an informative and entertaining stimulant for HSJ’s subscribers at the start of the working week.

In a delightful echo of the concept of ”life imitating art”, at the moment NHS reform is imitating Brexit: the plan is that we haven’t got a plan. This is going to prove quite tricky.

We have of course got a view, a vision. The Five Year Forward Hallucination remains a persuasive document: everybody likes a room with a view.

Operational challenge

The operational challenge is that once your five tests haven’t been met quite as spectacularly as Skipton House Sun King Simon Stevens’ haven’t, marrying that view with the reality based community is not straightforward.

“Cowper’s Cut” is nothing if not helpful: as such, this is the first of “Five Easy Pieces”: five linked pieces on the biggest issues facing NHS reform. For the record, these are workforce; wages; Brexit; planning; and culture.

So we start with workforce. It’s not exactly the same as wages, though the links are huge. But the biggest issue facing NHS reform is the workforce crisis.

My HSJ colleague, Shaun Lintern, has chronicled the emergence and importance of this workforce crisis accurately, clearly, diligently and persistently. All the right people hate him as a result: that’s a big badge of journalistic honour, and Shaun wears it well.

The bad news about the workforce crisis is that it has its roots in all of the other four areas this series of columns will discuss. But there is some good news as well.

Solvable problems

The first bit of good news is that with the right ideas, resources and will, these problems are all solvable or soluble.

The second bit of good news is that the NHS has had workforce problems before, notably with primary care in the late 1990s and early 2000s.

We resolved that problem by dint of paying GPs A Lot More Money - and endearingly, the Daily Mail has been soiling its diapers about this free market capitalist political paradigm ever since.

This leads me on to the first of Cowper’s Universal Laws Of Healthcare: while solving a workforce crisis is neither cheap, nor easy nor quick, it is straightforward. You find out why people are leaving early, and you fix that (see the later “culture” instalment in this series); and you spend a lot of money and a great deal of care on recruiting more of the right kind of people into the right kind of careers and roles.

The second of Cowper’s Universal Laws Of Healthcare is this: meaning matters. Many people do jobs that aren’t ultimately all that important or impactful (at this point, most comment journalists are twisting nervously in their seats). Healthcare staff – be they in clinical or associated roles – do not fall into this category by a country mile.

Were it not for the freely given discretionary effort of NHS staff, the system would have toppled over a long time ago. It’s the sonographer who scans an extra patient on a Sunday (thank you, West Middlesex); it’s the maintenance man who designs a “dignity trolley to remove dead bodies through public corridors without those passing by realising what is being transported; it’s a million and one things that people aren’t being paid for and very often not being thanked for that keeps the ship upright.

It’s easy to forget that, and we do. And it’s probably fatal if we don’t change our ways. Because meaning is fine, and noble, but we also have to say thank you – both personally and economically. Which will lead us into the next instalment of this series, the one on wages. See you then, I hope.

Andy Cowper is comment editor of HSJ