NEWS FOCUS: If the NHS can't retain its staff, all the reforms in the world will not solve its problems. Ann McGauran reports

Staff are what It is all about for the King's Fund - without them the NHS and the government simply will not be able to deliver.

So the government must start immediately promoting an 'ethos of public service', according to King's Fund chief executive Rabbi Julia Neuberger (above), laying out the organisation's agenda for the NHS in Labour's second term.

She believes that bringing in fresh blood will not solve the underlying problem of inadequate capacity or address the key issue of low morale.

Rabbi Neuberger insists that the NHS must 'retain, retain and retain' staff rather than depending solely on 'quick-fix' solutions such as overseas recruitment.

In an exclusive interview with HSJ, Rabbi Neuberger warned that the government must convince people facing an everwider range of career possibilities that working in the NHS is both of value to society and personally rewarding.

Otherwise - as the government continues to promote mechanisms such as publicprivate partnerships - there is a danger of conflicting messages.

While the King's Fund is 'not closed-minded' about the private sector, she believes the message that private is inherently better may make NHS staff 'feel worse about themselves'.

And she questions how much additional capacity private delivery of state-funded health services can offer, given that it will often be 'using the same pool of people'.

'We use the private sector for medium-secure psychiatric care and for cold surgery to knock people off the waiting list and a lot of that is very good, ' she says.

'But We have got a demoralised workforce . . . . and the last thing we want to do is say 'you are rubbish'. '

The solely vocational motive for entering the health service has diminished; It is now much more traditionally career focused, she believes. But even so, 'people do not go in to make big bucks - It is still the glue that holds society together, supporting people who are ill. '

The politicians 'ignore this at their peril', she insists, and now is the time for radical thinking about staffing, including allowing people to work more flexibly with much more selfrostering so staff can work 'very eccentric shifts if need be'.

The other key issue for the King's Fund over the next few years is rationing of healthcare, a debate that cannot be dodged any longer.

Sorting out capacity head-on includes being radical about ending queuing, Rabbi Neuberger points out.

She wants the government to assess the viability of an objective method of rating need so that those whose problems are not too severe may be told to use their savings to pay for private treatment.

She stresses the need for discussion on 'what we are prepared to do and what we will not do, what are we prepared to pay out of our own pockets'.

The King's Fund is not saying that it advocates rationing, she adds, but opening the debate would acknowledge there is 'rationing in the system'.

Will the government have the bravery to launch that debate?