NHS Workforce Needs Care

My daughter has a strong independent streak. Over the months, I’ve learned that if I want her to come to me, the quickest way is often to tell her to go away. Tell her to come and she’ll dig her heels in. Tell her to leave and, before I’ve finished the sentence, she’s wrapped around my legs.

It isn’t naughtiness. It’s something more fundamental. People resist being controlled when they feel they have no agency. Children do it. Adults do too.

The difference is that adults do it with much higher stakes. Prisons are full of people who knowingly broke laws despite understanding the consequences. The threat of punishment has never eliminated human choice. Free will survives even the threat of imprisonment.

Which is why people cannot simply be controlled. They have to be accommodated, negotiated with and inspired.

I’ve started to notice this pattern everywhere. Life seems to run on opposites. The more we rush, the less time we seem to have. Slow down and somehow there is more room to think. The more we give away, the more connected and fulfilled we become. Order often emerges from what first looks like chaos. Life rarely rewards perfect control. It rewards adaptation. The anomaly isn’t a flaw in the system. It is the system.

Healthcare is one of the clearest examples.

When something goes wrong, our instinct is to investigate. The Ockenden Review spent years uncovering what went wrong in maternity services. Then Amos Review. Maybe we get the next one as post-Streeting Review or Cooper Inquiry (who knows).

These reviews matter. They identify failures that need addressing but there is a question sitting underneath them all. Why do similar failures keep reappearing in different organisations, under different leaders and with different recommendations?

Every inquiry gives us greater precision about what staff should have done differently. Far fewer ask why intelligent, caring professionals repeatedly find themselves unable to behave differently within the systems they work in. A workforce is not a machine whose performance improves by tightening instructions. It behaves much more like my daughter. The harder you try to control it, the more resistance you create. Under enough pressure, people protect themselves. They withdraw instead of innovating. Eventually, they leave altogether.

If we want compassionate care for patients, then we need compassionate systems for the people delivering it.

That does not mean lowering standards. It means recognising that scrutiny alone has never made an exhausted workforce feel safe enough to change.

Instead of asking:

“How do we get staff to comply?”

Maybe we should ask:

“What kind of system makes compassionate behaviour the easiest behaviour?”

Because you cannot control people into caring. You can only create the conditions where care becomes the natural response.

Three principles for leading people

Rather than trying to control behaviour, effective systems tend to do three things:

• Inspire
  Give people a meaningful purpose that is bigger than compliance. People will often do far more for a mission they believe in than for a target they are told to hit.
• Negotiate
  Recognise that professionals have expertise, judgement and competing pressures. Improvement comes through dialogue and shared ownership, not simply issuing policies.
• Accommodate
  Design systems around how people actually behave, not how we wish they behaved. Remove unnecessary friction, reduce fear, create psychological safety and make the right thing easier to do.

If care is what we want from the NHS workforce, then care is what the workforce needs from the NHS.

Anything else risks creating exactly the behaviours we were trying to prevent.