Claps Don't Staff Hospitals: Why are Doctors Striking?
Back in the day…….
I moved to England from Russia at the turn of 2008. It was the time when the NHS was at its best – morale was high, pride in the system was high, it was the closest thing to a National Religion of the Country. We were absolutely mind boggled by how our local GP practices scooped us into out care – my dad got streamlined into the community diabetic services which he never before had a named nurse/doctor overseeing his care. Mine and my siblings vaccinations records were recorded in urdu to the sheer nightmare practise nurse but they didn’t give up on us, they went through it regardless and gave us any booster or catch up vaccines we didn’t have. Previously we had been used to a private healthcare set-up, going to the doctor only when absolutely necessary – we were not used the state proactively looking after out health.
Around this time I was also beginning to select my GCSEs and A-levels and pick my career options. I went from wanting to be an engineer in Year 9, to Medicine in year 10, then economist in Year 11 then finally settling back on Medicine. Medicine was a career regarded with prestige and awe, it was deemed to be an honour to for the NHS. Doctors who got involved with private practice were still hushed and taboo with no one openly admitting they want the extra cash by doing this godforsaken thing like charging people. Working for the NHS was enough.
To the current state…..
Fast Forward 10 years to where we are now. We are post-pandemic where our profession was proved indispensable having gone through its toughest trial. We saw colleagues risking their own lives by being at work caring for COVID patient frequently without adequate Personal Protective Equipment (PPE) particularly in the early days of the pandemic. We held our breaths hoping that our own nurses or any other colleague would battle the coronavirus and recover and walk out from the Intensive Care Unit. The nation clapped, but claps don’t protect lives or pay bills.
The morale is now the lowest it has ever been. We are no longer in the middle of a pandemic, but we are in a deep deep in a crisis. The NHS is not just crumbling, it has crumbled.
Challenges of a Junior Doctor
Let’s start with the basics that are unfathomable in today’s working world. Depening on the hospital I work at, it is not uncommon for the me to expect that it can easily take up to 20 minutes for a computer to start– my home laptop would take seconds so why should I wait for a good quarter of an hour watching the windows dots circling and circling but not loading? There is either a clinic to run, a ward round to do or decision to be made and the computer just doesn’t work. The amount of patient discharge summaries because the computer screen has timed out and I have to spend a painstaking amount of time having to re-do it. And time is precious. Having to hurriedly do a discharge summary again to get it to pharmacy in time before it closes or in time for the when the patient transport home is booked means human errors because of time pressure and also due to the sheer annoyance of needing to redo things through no fault of your own. Those darn computers. It’s not just computers it also the phones- I sat to run assist a telephone clinic once and when I picked up the phone to call my first patient, the phone line was dead. It wasn’t connected to the main and no one had any idea where the cable was. How are you supposed to run a telephone clinic without a telephone?
In one of the hospitals I worked in previously, doctors had to pay £10/month just to find a comfortable place to sit down on their on-calls and night shift. If I am 13-hour night shifts, I deserve to be a provided a place where I can sit comfortably- the half broken and semi unstable wheely spinny terrible quality office chair which run away from its position A as you lean back on it just doesn’t cut it. You can only imagine how patient care would suffer with tired unrested doctors. Free tea and coffee and a delight rather than a staple. The nature of shift work requires caffeine and whilst some hospitals and department may have full stocked staff rooms for doctors, I have worked in plenty which don’t. I end up having to take my own tea bags and mugs and hoping I can source milk and hot water from the patient’s kitchen if the dinner staff are not there preparing patient meals.
In most hospitals there is a daily morning parking battle, you either need to arrive super early to get a parking space way sometimes over an hour before your shift starts or be late to work as you wait for the night staff to leave and free up parking spaces. On the one hand if you arrive ridiculously early over an hour before you shift starts for a parking spot (which lets be real very few people do as it is not practical) its unpaid hours that you are forgoing for work daily. Alternatively, If you turn up to your ward late because it has taken you 40 minutes to find an available parking space, that is patient contact time lost. As a doctor, you expect to get to work and just start, paring should not be the most difficult and stressful part of your day and in some trusts it frequently is.
Getting leave can be a challenge of its very own crushing our autonomy over our lives. My colleague’s leave for her graduation day was rejected, a day that she spent a good 6 years of medical school working towards because of “staff shortages”. We frequently miss study leave and training opportunities which would help us on the next stage of seniority of being doctors because of “staff shortage”. Both training and pleasure is halted because of staff shortages. You are too busy trying to provide a service, frequently doing the jobs of 2 or 3 doctors (I was paired with 2 rota gaps for all my on-call shifts day or night for a good 5 months) that when it comes to learning, a new procudre or skills, or examining an interesting and rare patient case, we just don’t get time to do it as we are too busy focussed on the getting through the routine.
This is just the tip of the iceberg of the things we experience as doctors or a daily level. It’s a knock TO the morale every time you find a mundane battle – by the time you have found a parking spot and a mundane computer in the morning, whatever little energy you started with is already drained and that’s even before you have started patient contact.
I don’t fault any of the hospitals for what the doctors are going through. This is a recurring theme nationally, some hospital and departments manage it better than other but this struggle is nationwide is reflected in the unified determination of needing to strike. In my experience consultants have your back, the managers try and be accommodating but they are also struggling and a lot of the times they are conflicted between giving leave vs staffing adequately on the day. It’s a difficult decision and I wouldn’t want to be them.
What has driven the coming of the Doctors’ Strikes
But why strike? Because the NHS has fallen apart and it will be past the point of salvage if something is NOT done now. So many hospital across the country are on critical alert with bed spaces. The community health and social care does not match the requirements of an ageing population and there is no safe space for them to be discharged to. Doctors, pharmacists and nurses are already at capacity and do not always have enough pair of hands to complete discharge requirements or timely care needs. There is a backlog leading to the front end of the hospital, the Emergency Department being flooded. There are not enough doctors leading to Wait time in A&E to be upwards of 10 hours in some trusts. There are patients waiting everywhere, sick patients in trolleys unmonitored in corridors. It is not just about the delays, they are are potentially unavoidable harm everyday due to lack of staff.
Sometime back, I had a 70 year-old lady walk into the A&E once with a bit of chest and tummy pain. She was generally fit and would have been a candidate for surgery. A&E was significantly short staffed, corridors were overflowing with patients waiting and the wait time was upwards of 14 hours that night. By the time she got seen by the ED doctors and sent to an overnight CT scanner she had a cardiac arrest in the radiology department. The emergency buzzers went off and us on the medical team rushed in to attempt CPR and resuscitate her, but there was futile, the scan had shown the main artery in her body, the aorta had ruptured and there was no bringing her ack. Had she been seen within the 4 hours; I couldn’t say for sure she would have been saved but she definitely would have had a better chance of survival. That night we were half the number of doctors on the arrest team (3 out of a full staffing of 6) and whilst this didn’t take away our ability to give good emergency care to this patient, it did mean we didn’t have any doctors to spare to continue clerking patient in the emergency department who needed admission by the medical team. This is one story, there are many others like this result in in low level harm like delayed discharge or delay in obtaining routine scans to something more serious like death. I know on the whole, anytime a team is short staffed in whichever hospital I have worked, each doctor and nurse on my shifts have given their 200% to try and make it work but there is only so much we can do despite prioritising. If we as a profession continue like this day in day out across the nation- burnout becomes real. The NTS (national training survey) revealed that 39 per cent of junior doctors reported experiencing burnout to a high or very high degree because of their work, the highest level ever recorded and up six percentage points on last year’s survey.
The number of deaths which may be avoidable are growing. Life Expectancy is taking a downturn. And therefore, we as doctors have no choice but tostrike. We need staff, and they are quitting the profession, FAST. We need to retain staff. However, in a poor environment, with crumbling infrastructure, lack of equipment, and poor pay (In fact a 30% pay cut compared to what our colleagues were paid in 2008 when adjusting for inflation) retaining staff is almost impossible. Sooner rather than later, the workforce will leave for a better quality of life.
When I started, talking about working in private was a relative taboo and the NHS had a divine quality. Now, doctors are not just openly leaving the NHS or reducing their time working with the institution in favour of private work, but they are also openly saying how they are thinking about leaving the profession altogether. And why shouldn’t they?
Cost of Living for a Doctor
30% real time pay cut compared to our peers in 2008 is A LOT. As a junior doctor your outgoing are only increasing. We need to pay approx £156 every year for your GMC License, we also need to pay for your medical indemnity cover which could be in several £100s depending on your stage of training. I had to pay nearly £600 just to store some certificates in an online eportfolio prior to starting internal medical training. We also need to pay monthly subscriptions to our royal college and trade unions which could vary depending on the stage of training. We also have to pay for your own parking at the hospital (never mind the fuel costs which you are not re-imbursed for which could be £65 a month or more for the junior doctors. And lets come to the exams – to get membership with the Royal Colleges our exam cost around £2000 which you will NOT get re-imbursed for. The exams are also set so pass rates are very low sometimes only 30% to “uphold standards” but deplete junior doctors bank accounts as many have to give repeated attempts. The vast majority of doctors have to spend way more than £2000. On top of that you have to pay for learning material – subscriptions can easily be £200 for each exam depending on the question bank you choose, and the practical exam course is £1450 (you may get some of these course fees back from the Health Education England but its at discretion of your supervisors to approve this).
Furthermore, a long 6 year medical school training means we have accrued a big student debt upwards of £80,000 for most doctors and this is another chunk of your salary removed from your pay for a large part of your professional life. And on top of the mandatory monthly “medical outgoings” which we must pay to remain being a doctor, we are also faced with the cost-of-living crisis which grips the whole of the nation. A Foundation year 1 doctor is paid £14/hour, and a senior medical registrar who could be decade into the medical profession, also another “junior doctor” who leads the cardiac arrest team at night is paid £25/hour frequently having to stay late in their shifts for many “goodwill” unpaid hours on top of that. A Junior Doctor is a clear misnomer – they are not Junior. They could be 12 years into their careers as doctor with exceptional set of specialist skills and responsibilities, and have families and kids to support, yet they are called Junior. They need to be rewarded fairly for their work, skillset and responsibilities.
I was paid more as a tutor as a student in University than my hourly income as a doctor. What is stopping me picking a less stressful job for a better quality of life? Nothing. And as a doctor you have many transferable skills – whether it be global development, pharmaceuticals, healthcare consultancies, Research and Teaching. Before getting into a medical school, doctors required the highest educational achievement and grades and if that is some testament to our ability, we could hopefully choose another well-paying profession. We did Medicine not because we had no other option, but because we proactively chose this vocation because we wanted to. If a 30 something year old doctor with young children is struggling to manage bills and support for a family, they will change ships and choose a profession which will rewards them fairly. Doctors can and are actively un-choosing medicine just like we actively chose it at the ages of 18. Ethics of doctors should not be doing this for the money doesn’t apply when their own families and children are struggling and they know they can do and provide better for them – so our option is to either strike and restore pay or simply leave for greener pastures either by switching professions or switching countries. It’s a no-brainer.
But why strike? Because the NHS has fallen apart and it will be past the point of salvage if something is NOT done now. So many hospital across the country are on critical alert with bed spaces. The community health and social care does not match the requirements of an ageing population and there is no safe space for them to be discharged to. On occasion there are very few doctors, pharmacists or nurses that they are already at capacity and do not have enough hands to do the discharge paperwork in time. This results in a backlog leading to the front end of the hospital, the Emergency Department being flooded. There are patient waiting everywhere, sick patient on trolley unmonitored in corridors. It is not just about the delays, they are are potentially unavoidable harm everyday due to lack of staff.
Sometime back, I had a 70 year-old lady walk into the A&E once with a bit of chest and tummy pain. She was generally fit and would have been a candidate for surgery. A&E was significantly short staffed, corridors were overflowing with patients waiting and the wait time was upwards of 14 hours that night. By the time she got seen by the ED doctors and sent to an overnight CT scanner she had a cardiac arrest in the radiology department. The emergency buzzers went off and us on the medical team rushed in to attempt CPR and resuscitate her, but there was futile, the scan had shown the main artery in her body, the aorta had ruptured and there was no bringing her ack. Had she been seen within the 4 hours; I couldn’t say for sure she would have been saved but she definitely would have had a better chance of survival. That night we were half the number of doctors on the arrest team (3 out of a full staffing of 6) and whilst this didn’t take away our ability to give good emergency care to this patient, it did mean we didn’t have any doctors to spare to continue clerking patient in the emergency department who needed admission by the medical team. This is one story, there are many others like this result in in low level harm like delayed discharge or delay in obtaining routine scans to something more serious like death. I know on the whole, anytime a team is short staffed in whichever hospital I have worked, each doctor and nurse on my shifts have given their 200% to try and make it work but there is only so much we can do despite prioritising. If we as a profession continue like this day in day out across the nation- burnout becomes real. The NTS (national training survey) revealed that 39 per cent of junior doctors reported experiencing burnout to a high or very high degree because of their work, the highest level ever recorded and up six percentage points on last year’s survey.
The number of deaths which may be avoidable are growing. Life Expectancy is taking a downturn. And therefore, we as doctors have no choice but tostrike. We need staff, and they are quitting the profession, FAST. We need to retain staff. However, in a poor environment, with crumbling infrastructure, lack of equipment, and poor pay (In fact a 30% pay cut compared to what our colleagues were paid in 2008 when adjusting for inflation) retaining staff is almost impossible. Sooner rather than later, the workforce will leave for a better quality of life.
When I started, talking about working in private was a relative taboo and the NHS had a divine quality. Now, doctors are not just openly leaving the NHS or reducing their time working with the institution in favour of private work, but they are also openly saying how they are seriously thinking about leaving the profession altogether. And why shouldn’t they?
We need STAFF
For the health of the population and survival of the NHS, these strikes are mandatory. We DO NOT have enough staff. And as we stand today. the patients are NOT ALWAYS BE SAFE and this is becoming a growing concern for us. Waiting lists are the highest it have been. The government and media will 100% spin the strikes as irresponsibility of doctors and patient will come to harm – my argument is that they will NOT come to any more harm than they are already based on how the government has been treating the NHS over the last decade. From the 2012 NHS reforms which fragmented the system, to reducing bed and ICU capacity, not increased GDP spending in proportion to inflation and needs of an ageing population and technologically advancing medical care – patients have already been put at harm and it is time to reverse that. We know from our colleagues striking in New Zealand and research at Harvard, that a strike day doesn’t increase patient mortality but if we let the government continue to neglect that health care service, patient mortality will increase. We need to act. And the first step of this is to retain its staff – doctors, nurses, ambulance drivers and then also improve resources available to NHS hospitals, more beds, better social care and community discharge services.
The short staffing is reflected in our over reliance on international medical graduates which is rapidly rising. Of the 125,741 full-time equivalent (FTE) hospital and community health service doctors in England in June 2022 whose nationality was known, just over a third (33.8 per cent, or 42,531) were from overseas.This is up from around a quarter (26.7 per cent) six years earlier, in June 2016, and is the highest proportion since current data began in 2009. WE DON’T HAVE STAFF.
Is it ethical for doctors to strike? YES. We took an oath that we will not let patients come to harm and we need to be upholding that. The medical profession is burnt out, devalued and overworked and in this state cannot look after the sickest and most vulnerable patients. We need more staff. For that we need better pay, better working conditions and incentives to remain in the profession. Doctors are now struggling to pay bills with many frequently having to supplement their pay with locum work to make ends meet. We are not asking for a pay rise, we are asking for a pay restoration – to pay us the same amount our colleagues in 2008 were paid adjusted for inflation.
We don’t need Claps for Carers; we need a pay restoration. And if the government doesn’t engage in meaningful and fruitful pay negotiations, we have no choice but to strike.