What next for junior doctors?
The first junior doctors’ strike in 40 years could be the making or the breaking of the NHS. The optimistic view is that the bravery of junior doctors in speaking up in such numbers will inspire all frontline staff to find their voice, expose the spin, tell the truth and get involved in improving the NHS. The NHS is unusual in that it has so few clinicians in senior management, and yet the best hospitals globally tend to be run by clinicians. The less optimistic view is that doctors are being de-professionalised to line them up as employees in a more corporatised NHS, and that the breakdown in trust between this government and the frontline is irreversible. Applications to medical school dropped by 11% in 2015, and also fell in the two years prior. 52% of junior doctors who finish foundation years currently take a break from NHS training and some will never return. If too many ditch the NHS, its future will indeed be bleak.
Many doctors have lost all trust in health secretary Jeremy Hunt to present data accurately and fairly (Eyes passim), and they simply don’t believe that more NHS services can be extended over 7 days with the same number of staff and no extra money without making the staff work longer or harder for the same money or less. In a recession, many employees are expected to work harder and longer for no more money, but the NHS is a ‘safety critical industry’ and many frontline staff are already working full throttle. To make them work harder would be bad for their mental health and dangerous for patients.
Hunt has asked Sir David Dalton, chief executive of Salford Royal NHS foundation trust, to enter the fray and broker a deal between the BMA’s Junior Doctors Committee and NHS Employers. Dalton has the advantage of running a highly regarded hospital that has managed to provide excellent 7 day urgent and emergency services using the existing junior doctors’ contract. However, it has not extended its 7 day routine services as Hunt and David Cameron seem to have suggested (Eye …). On the downside for some doctors, Dalton lead a review of the NHS that suggested concessions for companies who took contracts to operate publicly funded hospitals and that a single private or public organisation could own and operate chains of hospitals across wide geographical areas.
Dalton, and all NHS staff, realise that junior doctors’ working conditions and the government’s ‘promise’ of 7 day services can’t be seen out of context of wider problems in an NHS and social care system facing an unprecedented 10 year funding squeeze. As one junior doctor I spoke to put it: ‘The problem is not just lack of doctors, it’s lack of nurses and support staff and the fact that the hospitals and emergency departments are already full so we couldn’t do more routine work anyway at weekends. Even if we could, we have nowhere to discharge patients to in the community. On my last on call in paediatrics there was one registrar and one senior house officer looking after 22 cots on the Neonatal Intensive Care Unit with very sick babies in them, and also covering all the labour ward emergencies and post-natal wards. To help we had just three band 5 nurses and one healthcare assistant. It was a nightmare and clearly isn’t safely staffed, but the government refuses to publish all the evidence on safe-staffing. I end up having to do ECG’s (heart tracings) on call as there is no ECG technician and it takes me ages figuring out how to work the different machines. When I work out my total hours, many unpaid, I get less than the living wage. But what helped was when a senior manager spotted how hard I’d worked and said thank you.’
Another doctor added: ‘If the NHS wants to keep its doctors and nurses, it needs safer staffing levels, shorter shifts, more breaks, healthy meals and study leave paid for. But above all it has to inspire and value them. It doesn’t need a macho tit of a health secretary who seems incapable of telling the truth and enjoys confrontation. It just alienates and angers us all, and makes us suspicious he’s trying to soften us up for a sell off.’ The government and the BMA will eventually reach a very dull, detailed and disappointing settlement. But the anger and passion of the junior doctors must be welcomed and harnessed before it’s allowed to escape to the Antipodes. Hunt claims that the NHS needs whislteblowers and now he has 53,000 more of them. All he has to do is shut up and listen.
MD’s book, Staying Alive – How to Get the Best from the NHS – is available here