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Taking the morale high ground

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Heidi Alexander describes the scrapping of nursing Heidi Alexander describes the scrapping of nursing bursaries as ‘a huge gamble with the future of the NHS workforce’

Some shoes are tough to fill, and following Andy Burnham as Shadow Secretary of State for Health was a big ask for Heidi Alexander when she was appointed last September.

And yet if she has ever been daunted, it has never shown. She’s been a cool-headed and effective player, operating outside the Labour Party’s current psychodramas, but there’s a glint of steel there too.

As an MP she was best known for her work on housing, until she led a successful campaign against the downgrading of Lewisham Hospital. It culminated in a court ruling that the Health Secretary had acted outside his legal powers, and left her with a visible disdain for the man she now faces across the dispatch box. ‘Jeremy Hunt is a very savvy operator,’ she says. ‘But sooner or later, the polish will start to come off.’

She had a gentler putdown for serial trolling newspaper columnist Sarah Vine (wife of the justice minister Michael Gove) who responded to Ms Alexander’s appointment with the unsisterly words: ‘Not exactly a picture of health is she? Perhaps she should lay off the Hobnobs.’

‘I decided to respond to this comment by tweeting: “Yes, you’re probably right, I should lay off the Hobnobs, but I’m doing a 5k run on Saturday, care to join me?”’ she says. Don’t mess with Heidi.

As a result I’m on my best behaviour when I meet her in her well-appointed office overlooking the Houses of Parliament. I’m repaid with a smile that’s probably worth three points in the opinion polls on its own, and a much better cup of coffee (without Hobnobs, disappointingly) than an MP usually offers. But I’m also left in no doubt that this is a politician sincere in her anger about the current direction of the health service.

‘What’s become clear to me in the six months I’ve been doing the job is that the NHS is in a critical state,’ she says. ‘There are huge problems with funding and problems with workforce morale and as a result we’re seeing standards of patient care fall.’

A large part of her early focus has been the problem of staff morale in the NHS. It’s an issue that has started to get a little traction amongst the public because of the junior doctors’ contract dispute. Ms Alexander has been scathing about her old nemesis’ hardline negotiating stance, describing Mr Hunt as acting like a ‘recruiting sergeant for the Australian health service’.

But she describes the junior doctors as ‘merely the tip of the iceberg’ in terms of NHS workforce issues. ‘A lot of staff feel under pressure, particularly in primary care: the message I get from GPs and practice nurses is that it’s understaffed, underfunded and undervalued,’ she says. ‘We need to change that because if we’re going to have a sustainable NHS, many of the answers to creating it will be found in primary care.

‘There’s been quite an evolution in primary care over the last decade, particularly with practice nurses assuming some of the responsibilities GPs once had in triage-ing patients or diagnosing and treating minor illnesses,’ she says. ‘The whole idea of nurse-led primary care might help with some of the GP shortages we’re facing at the moment.’

Of course this model is predicated on the nurses actually coming through, and Ms Alexander has been highly critical of Government’s proposal to abolish the student nurse bursary, describing it as a ‘huge gamble for the future of the NHS workforce’.

‘At a time when we have nursing shortages and at a time when we are importing nurses from other countries, we could be putting off the next generation of homegrown nurses,’ she says. ‘I’ve met a number of student nurses who have explained to me that – while the current bursary system might not be perfect –they simply wouldn’t have been able to do their training under the new system.

‘My biggest fear is that we end up with people training to be nurses who are the best able to pay, as opposed to those who are best able to care.’

So what would her own favoured solution be: to expand the bursary scheme perhaps? Her answer is sensibly technocratic, or a neat sidestep, depending on your point of view. ‘If I was in the Department of Health right now I would want to do a review of the finance available to student nurses and to work with Health Education England to look at ways we could properly plan the workforce needs and ensure that we have adequate numbers coming through into training.’

She has warm words for her predecessor’s approach – ‘I think Andy Burnham was completely right to focus on integrating the health and social care system,’ – but brings an interesting personal perspective to the policy. ‘My own grandmother who had multiple long-term conditions towards the end of her life received care and support from all manner of different places, but I’m not sure that we ever got to the underlying issue,’ she says.

‘She would be treated by her GP, she would be in and out of hospital seeing a respiratory consultant, she would have the community matron visiting her at home, she would have the social care support provided by the local authority, and yet on the occasions which she was admitted to hospital I personally feel it was as much as a result of a crisis of loneliness as a medical crisis.

‘What we need to do is to find a way in which we can join together the services that are provided, to people who are vulnerable who are often living alone and have multiple conditions because at the moment I’m not sure the system provides decent care for those individuals,’ she continues, before sounding a cautionary note on the cost of such a rethink: ‘If we assume that integration automatically saves money in the short term we’re going to be in quite a dangerous place.’

Given where we are in the political cycle, it is perhaps understandable that there are few big ideas coming from Labour on health, and Ms Alexander makes no apologies for her robust inquisitions of ministers. ‘My immediate priority it to hold the government to account with regards to spending,’ she says.

‘Two thirds of the money which was announced at the comprehensive spending review for next year will be taken up paying the bills left over from this year, and that’s before you start to deal with the problems of rising demand and the cost of new drugs.’

But looking forward Ms Alexander hints at a more evidence-based policy-making style than we’ve seen in the past. ‘I’ve been very clear that the answers to the problems facing the NHS at the moment aren’t going to be solved by me sitting behind a desk in Whitehall,’ she says. ‘I need to get out there and listen to people who are on the frontline. I’d be really interested in shadowing a health visitor or a practice nurse for a day, so if any of your readers are interested in having me along it’s something I’m really keen to do.’ Over to you readers…

There’s time for one more question before she rushes off to a hospital visit in Harlow, and I can’t resist it. Did Sarah Vine ever turn up for that run?

‘I didn’t receive a response for a little while but then she came back and told me she had a problem with her knees and so couldn’t do the 5k run but could we meet up for a cup of tea and a Hobnob,’ she says. ‘We haven’t got round to doing it yet, but I did that 5k park run on the Saturday morning and had a couple of middle-aged women coming up to me saying ‘I’ve never done this run before, but I read what was said about you and I thought I’d come out and join you.’ And I thought, if I achieved nothing else in my first week as Shadow Health Secretary that’s not a bad outcome.’

The pace of change in the NHS might continue to accelerate in the next couple of years, but expect Ms Alexander to keep up every step of the way. Mr Hunt should be in no doubt, he has a duel on his hands.

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