The biggest issue faced by the NHS workforce seems to be of perceived value – how valued people feel by their wider organisations. By Mark Szymankiewicz

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There is, I believe, a matter that requires urgent and long overdue attention at all levels within the NHS. Whilst often paid lip service, it is not given the consideration it sorely deserves nor is it valued enough. It is a matter of culture and education.

As a surgical registrar, it was an absolute privilege to shadow senior management activity in my local trust. Particularly at a time of significant extra pressure following the nerve agent attacks in Salisbury.

As a frontline clinician, I was genuinely impressed with the quality of work that takes place “behind the scenes” to keep a major organisation running. However, having completed what was a fantastic experience, I was then left puzzling over an issue which is well recognised throughout the NHS – the tension between “management” and “front line clinical staff”.

There seem to be three major NHS wide pressures currently – financial, performance targets, and the recruitment and retention of staff.

Performance target

It is interesting to unpick these issues, which for me is not so much about the values we hold but the currency we use to value them. Most people would agree that the most important aspect of healthcare is the care provided. Yet in modern society, we have developed a surrogate “performance target” currency with which to value it.

This sits between the “financial” healthcare economy at government level and the “care” economy of frontline clinical staff. These are clearly at odds.

Furthermore, this “performance target” currency not only has questionable exchange rates but is then immediately traded with another currency – money. One, perhaps unintended but serious, consequence of this approach is that staff feel devalued by its reductionist nature.

Relating this to plastic? Well, plastic is very useful stuff. It covers, protects, encases, packages – a remarkable invention that has transformed modern living. But it’s hard to miss the increasing media attention devoted to environmental issues it has created.

Investing in our staffs’ development is crucial, and the key to this lies in education

Sir David Attenborough’s coverage of this is particularly sobering. Today we are faced with islands of the stuff polluting the oceans and rivers. It is even entering our food chain with microplastics found in UK shellfish and sea salt. Having permeated the whole of society, it has become a massively overused convenience that now presents us with a pending global disaster. The irony is that plastic, when used correctly, is potentially one of the most environmentally friendly assets we have.

One of the biggest challenges faced by the NHS currently is the recruitment and retention of staff. Having talked to colleagues recently who have chosen to leave, the issues are complex. But, and this is crucial, whilst pay is not ideal, it is rarely the precipitant or main driver.

The biggest issue seems to be perceived value; how valued people feel by their wider organisations. I was fascinated by this and was left feeling very sad after one particular discussion. How can we be losing fantastic colleagues that genuinely want to work within the NHS, but just reach a place where they feel they no longer can?

I believe it comes down to the subtle but important cultural issues eluded to above. These have slowly, almost silently, grown and spread throughout the NHS over the last 20 years to be absolutely ingrained into how “we” behave. Analogous to the plastic issue, it has permeated NHS culture at every level, and is characterised by the overwhelming focus that has developed upon measurement and regulation. Like plastic, it has become toxic.

Whilst seemingly protective and transparent, performance measures have become a “cover up”, preventing us from getting at things that really matter – care for example. We have become more interested in auditing our staff and practices than we are investing in and developing them. How we have got here is very interesting. But it is a real issue and needs urgent attention.

Passionate about education, and whilst not underestimating the challenge in presenting this, I would suggest that the answer may actually be relatively simple, albeit difficult to achieve. We need a change in focus, a change in the way we perceive, a paradigm shift. A change in how we “measure” value.

Movement from the mindset of the accountant to that of a Growth Mindset; celebrating what we do so well in the NHS whilst continually looking for ways to improve. It is not about abolishing performance targets overnight – like plastics, their correct use may play an important role – but it is about abolishing the ingrained culture they have generated. Investing in our staffs’ development is crucial, and the key to this lies in education.

We must embrace complexity and accept that trying to measure much of what we do is neither helpful nor possible. We need to do the right thing, regardless of how uncomfortable that may feel. If we can, we will reap the benefits.