In parallel, I have been following the party conference season. The rhetoric from the Conservatives has been that of ‘supporting the strivers’. I like the sentiment, and yet I’m still waiting for the deeds to match the rhetoric.
You see, as doctors we work hard — we strive. So do the nurses, the porters, the healthcare assistants, and the myriad of other supporting professions. And yet to what reward?
A good friend of mine is an audiologist who has just found out that she must work Saturdays, because the audiology department must out-compete any other willing provider. But we already have a great audiology service at our trust. Employee morale in her department has never been so low.
On the wards, the nursing staff clings tenuously to their current bandings and contracts. Men and women with 30 years of experience are having an ever lower value placed on their service.
It is my belief that the government has a rose-tinted view of life in the NHS, perhaps gleaned from the occasional PR visit to a shining ward filled with smiling patients who love their NHS. This is far from the truth. I worked nights last week and, let me tell you, my patients don’t smile. From the drug-user with chest pain, who self-discharged against advice, to the confused old man who took a swing at me, and the chronic alcohol misuser deprived of his drink and under police custody. There are no polite ‘thanks’ at 3am, no pleasant cards or smiling patients.
There is no night when nobody dies: every battle won is still against an enemy who will one day win the war. I don’t see this as exceptional — it is the norm, it is the same for every doctor the length and breadth of the country, for every nurse, porter and healthcare assistant.
We work in a profession where the stress, responsibility and shift patterns are recognised to have a negative impact on both physical and mental health, where the levels of divorce, alcoholism and suicide are disproportionately high.
So this is my problem. I enjoy my job — most of the time — it is ever changing, fascinating and challenging but it’s also tough, for everyone.
And this is what the government is missing out on. There was a time when at the age of 65 you could leave with a pat on the back and a good pension. A time when pay rose with the cost of living and where the NHS was all there was and it was valued.
And now? What we have given is not enough. After all, any willing provider can just step in and take our place. Our pay doesn’t need to rise with the cost of living, and retirement is a moving target, ever further away as it approaches.
So this is a warning, from a Tory voter to her government. There is a crisis in the NHS and it is not necessarily financial, it is a crisis of morale. And if you would have us carry on striving, you must act.
Zoe Greaves is a South Tees foundation year 2 and a member of the BMA Junior Doctors Committee
I completely agree with everything Zoe has to say. Our work ethic and integrity are taken advantage of at every instance.Moralle is low and respect for the the NHS and what it stands for is diminishing. This needs to be addressed before it spirals out of control and the quality of applicants into the field diminishes affecting patient care and disgracing the profession. For the qualifications required for entry and the never ending postgraduate exams to the new revalidation - people will move to careers which pay astronomically more that actual reward the 'strivers'. Also to be addressed is the media. Healthcare professionals moan and post on forums but still allow daily mail journalists to present medical affairs in any light they choose and for the public to take as gospel. It is often beneath many practitioners to rebut on the TV or papers and defend what is said fully rather than a small quote which does not connect with the public. With changing times shouldnt someone sensible take a stand on our behalf? A candidate working on the forefront- the medical registrar to me is ideal. Who better? Recent accusations of the implemetation of the Liverpool care pathway and previous comments on pay... Why hasn't the true facts been provided so when I meet people don't assumea junior doctors earn 150k and get paid triple for on calls! The reality of endless revision, the respomsibilty of the job and the constant need to improve the CV to even progress a year is only evident to those we hold close.
So don't vote for them....
And you carry the weight of management and their salaries on your shoulders,all of whom would love to increase these by working in the private sector. Who made the money when BR privatised ?! The management who had been preparing for it,same pattern same carpet baggers.
Clinician work costs can be inevitably squeezed because they are good souls who believe in what they do,but the smart operator is the chancer in management who sees
opportunities for the promotion they feel so inevitably entitled to, second home in Algarve, expensive kids private school fees, all entitlements, so squeeze the care at the clinical face. Cut corners, cut safety, cut quality, isolate and out any detractors
Attempts to broaden healthcare provision - and the demand is there and the private health sector provides a lot of jobs - have seen the NHS left without a level playing field and being ripped off by PFI.
"Independent" providers get paid the same as the NHS per procedure, but are able to cherry-pick healthier patients for elective surgery by pleading that they lack the facilities to care for the sicker candidates. Just like I'd do if I was in business. And if it all goes horribly wrong at the private hospital and the patient is blue-lighted to the nearest NHS ITU then that funding does not necessarily follow them. The emergency buck stops with the NHS, and patients with pre-existing health problems cost a lot more to treat and are more likely to have extended hospital stays which can even see the NHS paying fines if elective patients can't get beds. For fair competition this needs toi be redressed, and the NHS paid more for taking the sicker patients. Fixed contracts which had Diagnostic and Treatment Centres being paid even if they did no work should be torn up.
As for PFI, the way forward is for a Trust with some cojones to tell the financiers that it will pay what it can afford, or at any rate something within the original Governent guidelines. Some fat cat suing would give us the public enquiry we all want, and I would suggest that it would be a foolhardy MP who spoke up against the NHS case. But that's not going to happen because the revolving door is working and executives who signed the contracts have moved on, some of them to jobs with those very contractors, and their successors don't want to upset the gravy train.
I agree with what Zoe has said. My thoughts about her opinion is as follows: "better late than Never". Unfortunately Zoe, (with regards to your opinion amongst NHS staff on this matter), you are sadly in the minority. I came to this conclusion well over 2 years ago when a friends wife was looking desperately for a job and asked for my help to get her "anything" in the NHS. Just after emailing this individual the weblink for NHS Professionals site, I was looking at a newspaper article and to my utmost suprise found out that a tube train driver in London has a start off salary just greater than an SHO/ST1/CT1 and they spend less than 6 months training. I promptly directed her towards this Job. I promptly pointed this out to some of my fellow colleagues who gave it very little attention or thought. They did not seem to be on the same page with me (and you zoe) making me realise that----"things are not likely to change in the NHS unless a majority of NHS staff recognise that we sincerely and slowly are beginning to work too hard for too little". Enough Said.
What is all this about working harder for less? Amnesia - epidemic amnesia! Did not the last government take away GP's emergency duties at night night and weekends. Did they not accept the 48 hours week for hospital junior doctors? Did they not increase GP pay (by paying extra for routine services) and hospital seniors by over 30%?
When the rest of the community is losing employment or getting less pay - in part because that government spent billions more on health which we could not afford - it's a bit rich to be complaining in this way.
I totally disagree with C B Fearn. Everyone expects to get paid what they're worth. A change in the GP contract has nothing to do with this discussion. Pay for a clinicians time, knowledge and expertise.
As an F2, I really relate to what Zoe is saying. I love my job and learn something new every day. My salary is big enough to live on. And I certainly have friends who work longer hours than I do.
However, these friends get paid much more for the trouble, usually more than double, and often have 3 years fewer of university debt to pay for. They also do not have to revise for professional exams whilst maintaining a fulltime job and pay Â£460 for the pleasure, in order to progress to the next year of training. They do not have to resit these exams (at a further cost of Â£460) if they happen to be one of the 60-70% of candidates who do not pass each time. They do not have to pay Â£630 for Basic Surgical Skills courses, to ensure they are considered for interviews for a place in the next year of training. They do not relax in a port-a-cabin next to A&E drinking Nescafe (as long as the Styrafoam cups haven't run out again), for which they pay Â£10 a month for the privilege. They are not placed in physical danger by their clients on a daily basis. They are also not verbally abused daily by clients, like the ones Zoe mentioned from her recent night shifts, who have learned from the media and our politicians that we are not to be trusted, not to be respected, and above all not to be rewarded for hard work.
Every good moan deserves a some good anecdotal illustration (and every doctor loves to play the game 'my job is harder than yours', especially to a public audience), so to that end I will provide an example from a recent on-call. I was looking after 15 inpatients as well as A&E referrals, and assisting in theatre for emergency operations - standard SHO on-call fare. One patient in A&E had been seen already by the A&E doctor, but was awaiting my review as the 'specialist'. It was 4pm and I had not yet had a chance to sit down, have lunch, have a glass of water, or pee all day, but the patient was coming up to her 4 hour breech time, and so, dutifully, in I went. Upon entering the side room where the patient had been comfortably waiting in a bed for my arrival, the patient's husband squared up to me (as a 5 ft 3 in girl, he was easily a foot taller than me and probably twice as wide), and let me know what he thought about the wait. After 10 minutes of uninterrupted, threatening and aggressive behaviour, this gentleman paused, took a breath, and told me he realised it wasn't my fault, but that someone ought to hire more doctors to help with the workload, so patients could be seen in a more timely fashion (I can only assume his implicit desire for doctors to be paid more as well). I couldn't help myself - I cracked a smile. 'Well, my dear,' I said, 'in that case you need to elect a new government. So tell me what you've come into hospital with today?'
So yes, I think morale is sinking, and it's set to get worse with pension cuts, pay freezes, and, for the next generation of doctors, the recent astronomical increase in university fees.
My response to this, sadly, is to explore leaving the NHS, and indeed medicine, albeit with great pain in my heart. This is truly a sad state of affairs for our once wonderful NHS.
As a first year med student I don't have enough experience to comment directly on the main substance of the article but just on a side note, I can't agree with the logic that the patients' lack of smile directly represents their dissatisfaction with the NHS. "The drug-user with chest pain, ... the confused old man, ... and the chronic alcohol misuser deprived of his drink" don't sound like the kind of people who would ever easily smile satisfied with the health service or no. Personally I am happy with the fact that we have free healthcare service at all... Given that patients have their physical pain and illness to deal with, the matter of staff dissatisfaction and patients dissatisfaction with NHS may be different from their root, is my opinion. More explanation on how low staff rewards affect NHS patients would be appreciated.
Guys you have to make a choice now in order to be paid smartly but more so a good quality and satisfaction of job as well. Either start agency locums or better still go overseas to a place of your choice. I enjoy both! In an overseas job with triple the pay and half the work! Enjoy my locums in UK in summer- again for double the price. NHS had long last the attraction in every sense for more than 5 years now.
Agree at least with sentiments Zoe, even if not with all details. The problem is that everyone in the economy is working harder for less - it has just taken rather longer to come to the public sector, and even longer to come to the NHS with our protected budget.
From the day Labour abandoned Conservative spending plans in the late '90s until the day they left office, this country was living grossly beyond our means, borrowing more and more. Anyone who has qualified in the last 10 or so years has only worked (until now) in this unsustainable system.
So it is not surprising that a serious squeeze is now felt. At this rate it will take decades to pay off Gordon Brown's profligacy - so it won't get better quikcly. Private involvement and 'any willing provider' might actually be the solution this problem - but will of course reduce security for many.
Its interesting to note comments about overseas above - there is indeed more money in at least a few places, but most of these systems make a lot more use of non-government services than we do.
NHS staff will increasingly realise that they are working too hard for too little - the result is likely to be an acceleration of the inevitable transfer of work to the private sector, or a signficant drop in the capacity of the NHS as staff retention gets harder.
Ultimately only when we get Britain's debt down is there likely to be spare money ...
No pay rise for 7years. Took a5% pay cut last year and terrible deal on pensions. Moral in go land is low, low low.
As a full time GP for 20 years, Ive seen various trends but have never been worried, seriously worried about GP recruitment. There were 40 applicants for my job. We have failed to recruit to our latest vacancy.
The reasons are multifactorial but I am sure that a large one relates to Zoe's comments. Throw in negative media publicity, rising stress levels, medico-legal factors.......and you can see the problem.
Yes, losing 24hour cover gave us some family life again - for a while and yes, the new contract improved income for a few years, but both those factors have largely been reversed now with no sign of respite.
The fault is not in our stars but in ourselves that we are treated as underlings. I have worked hundreds of 80 hour weekends with little sleep, once or twice no sleep at all. It was torture. Who spoke for me ? Who is supposed to speak for me ? I point you to barristers earning 2 million a year from the public purse in legal aid, solicitors at Â£ 200.00 an hour legal aid and management consultants at Â£1500.00 a day. Perhaps we should contact the legal union to negotiate on our behalf. We can be much, much stronger if we choose. Invincible as doctors are essential. Work harder and harder for less and less. We are mugs to do it.