There is a recipe for quality patient care.  First take lots of people with a good basic education and give them a good training to meet the huge variation in needs they are likely to encounter in meeting the health needs of a population of 65 million people.  Preferably do this for free so they don’t start work worrying about how they are going to pay off their debt  - staff distracted with money worries haven’t got their mind fully on the job.

Next create a supportive environment with enough staff and ongoing training to make the workload do-able without wearing the workforce out, or forcing it to work beyond it’s hours for free to get the job done.  Also provide enough materials for the job to be done properly.  Then make sure staff are paid enough to be able to recuperate from work and enjoy life enough so they can bring a positive outlook to work.   Finally do all the above in a political environment where the needs of the patients come before the profits of private  companies, and will always do so, so staff think their care matters and that there is something other than the profit of the boss at stake.

In today’s NHS these conditions are lacking for the majority of staff.  Wage levels are so low that many staff have to hold down second jobs, consistently work overtime (if they are lucky to work for a trust that pays this) or work additional shifts on zero hours contracts.  This overworking leaves staff fatigued and stressed, and piles pressure on their  home lives.  Too little time and money is available for staff to recuperate enough to maintain good morale and motivation - for too many life is being reduced to a treadmill of drudgery as they struggle to make ends meet. 

It should come as no surprise that staff on the lowest bands suffer the highest sickness rates, their resources to recuperate from work being the worst.  The sickness rates decrease the higher up the pay bands you go, with doctors faring best.  Other groups that suffer from higher absence rates are front line clinical workers around band 5  - ambulance crews in particular -  hardly surprising given the number of stressful situations they have to deal with combined with strenuous physical labour.

 It should be no wonder that stress is often the main cause of sickness absence amongst workers in the NHS, something that often arises from financial problems, overwork, difficulty maintaining family relationships, not to mention coping with inadequate staffing levels and high workloads.

Recruitment and retention of NHS staff is a major problem, leading to situations where teams are understaffed and forced to rely on casual workers to fill the gaps.  Recruitment is difficult when people need to work for a living wage, making low paid work unpopular.  Keeping staff becomes a problem as current workers look for better pay outside the NHS, or in areas that are less expensive to live in, or to escape developing burnout.  This tends to add to the stress teams are under as they struggle with rapidly changing members where consistency and continuity is needed.  Wards and departments with difficult and complex workloads find it difficult to get casual workers who can pick and choose the area they want to work in.   Nurses have turned up for work to find they are the only registered nurse on duty, with one other member of staff who is not familiar with the ward or patients.

Over time the persistence of these problems affects staff morale and motivation.  To cap it all the announcement of further attacks on NHS wages can only make the situation worse, as does the motivation behind it - to soften the NHS workforce up for privatisation. 

Low pay is a recipe for disaster for quality care in the NHS and social care.  The strikes in the NHS are the new ingredient that can change the mix.