There’s a sign on the fridge in the staff coffee room. It reads ‘Would all those willing to contribute to a kitty for teabags, milk and sugar please sign up below?’ Underneath, someone has added ‘and washing-up liquid’. Further down, someone else has written ‘and toilet paper’. But that bit’s a joke. I hope.
Washing up liquid’s the latest loss; tea and coffee went a couple of months ago. I seldom used to drink them – NHS-grade instant coffee is pretty revolting. But in the middle of a busy night shift, with nothing else available, they were occasionally very welcome indeed, and now I notice their absence far more than their presence.
Many trusts withdrew free teabags for staff long ago. Now that ours are gone, it’s claimed they were anyway being provided for the patients. Given all our patients are babies, to whom tea’s tannin is poison, this was a fairly odd policy. (On the other hand, many of our premature infants are on caffeine as a respiratory stimulant – perhaps we should have been saving money by feeding them coffee granules.)
This is not a moral issue – there’s no human right to free teabags at work. Nor is it a question of management being ‘mean’: it’s the nation’s money they’re disbursing, intended for the care of the sick. No, my objection to the withdrawal of free tea, coffee and washing-up liquid is a practical one.
Sickness absence rates in the NHS are about 4 per cent. The rate of vacant nursing posts is 10 per cent - in London 17 per cent. Junior doctor morale – well, let’s not go there. I’m not suggesting that these problems could be solved overnight with strategically-deployed free teabags, but surely cheap, simple steps to make staff feel valued would help.
For too many of us in the health service, ‘management’ is a faceless, malign force, imposing unattainable targets, swooping mercilessly on errors and squeezing yet more labour out of exhausted staff. Of course, this is rubbish: the vast majority of managers are doing the best they can in increasingly trying circumstances.
But when an employer saves a few pennies by taking away teabags, they reinforce the impression of themselves as distant, heartless bureaucrats: people with no recollection of how it feels to be on your fourth consecutive night, taking your first break somewhere around 5am. They lose a little bit of institutional loyalty, a little bit of commitment, a little bit of willingness.
No-one resigns over a teabag. But if every creature-comfort and concession has to be pared away under the pressures on NHS finances, the cumulative effect on staff morale is genuinely harmful. Teabags cost 0.5p each. Finding a new doctor or nurse? Not quite so cheap.
Miranda Barry is a junior doctor. She writes under a pseudonym.
I cannot remember the last place I worked where teabags were provided. We are expected to provide our own drinks and are not allowed to carry mugs without lids for health and safety reasons. I now have a large flask in my bag which I use to keep me going but I appreciate this is not practical in certain departments. I agree, it's the little things that get you down sometimes.
As a per-registration houseman in a teaching hospital, I and my colleagues benefitted from the endowment fund, gathered over a many years specifically for the resident medical staff. It paid for a mess dinner each month, and was greatly appreciated. The hospital administration regarded it as unfair, and it was absorbed into hospital funds. No more mess dinners, but no evidence of the benefits being shared with any other staff (except, perhaps, the managers' performance related pay). You may imagine how happy we were, as we beavered away on one in two rotas. This was more than forty years ago; the only surprise is that there are any perks left to be taken away. Surely no-one thinks the staff, at any level, are valued beyond the minimum pay to get them to turn up. As effective monopoly employer, they are soon to be reduced to restricting emigration to prevent doctors from leaving their jobs. Hands up anyone who voted Tory?
Goodwill is term frequently bandied about but very difficult to define. Having recently retired after 35 years in the trenches, 27 as a consultant, I have seen this cornerstone of the NHS eroded by years of bureaucratic ignorance. I use the word ignorance without malice; quite often our management colleagues just don't get it because they've never been in a situation where a simple cup of tea after hours of dealing with the sick and injured is a huge moral booster. It sounds trite, but we've all been there and know the truth of it. My interpretation of this is simply that no one has read the memo that says 'your staff are the most valuable asset in any organisation'. Or perhaps no one has written it on a note with an NHS letterhead. Contrast this with forward looking businesses in the City and elsewhere who provide a plethora of workplace perks in order to potentiate 'beneficial serendipitous interaction', or to encourage staff not to stray too far from their workstations. Or perhaps , God forfend, as a reward for working hard. I'm not a big fan of the insistence some politicians have of constantly applying business practices and theories to clinical medicine, but they could do worse than take a leaf out of some big companies' books. Or even wake up and smell the coffee--pun intended-- in the light of the constant barrage of evidence attesting to the plummeting morale of staff. The medical school I attended had a motto; "Miseris Succurrere Disco'--'I learn to succour the distressed'. Most clinical staff already employ this maxim but there's a dangerous irony in the GMC's warning today that there is a 'state of unease' in the NHS. For state of unease I read distress --employers take note.
This article goes a lot deeper than it appears on first reflection. This is one of the basic issues why the NHS has arrived at the situation it finds itself in. Staff is given the impression that they are not valued in any way, they are just there to function. This works well with robots but not with highly skilled staff in a very challenging environment. City companies are well aware of this and would hence supply all sorts of perks to their collaborators, such as private health care, cars, etc., rather than just increasing their salaries.
I am firmly of the believe that the NHS receives still enough funding that basic health care could be provided. The UK must not compare itself with countries like Switzerland, where patients have all the choices they (don't) need or sometimes not even want provided for in luxury establishments. Despite all the glamour, the excellence in care, the abondance in choices and the high income of staff (not only doctors, nursing staff as well) they only spend about 11% of their GDP on health care, whilst the UK spends 9% of its GDP on health care. The UK should therefore be able to provide an excellent basic non-luxurious health care service. The fact that the GDP per capita of Switzerland is a lot higher than that of the UK is no excuse at all, as salaries are a lot higher the costs of living are higher, drugs and implants cost at times 3 to 4 times those of the equivalent item in the UK.
There are other reasons than funding as to why the NHS is at breakdown point, one of which is excellently highlighted in the article above.
Sadly very true everywhere I worked here in London. Nurses regularly fund the teabags and doctors do chip in, though not all the time. In some places, a Consultant that brings in few croissants, juice, and fruit (paid with his own money, of course) for the weekend team to carry on is seen as a holiness entity (and yes, does it help the morale!).
Feeling devalued starts from the small things: the parking you have to pay for the honour of getting to work; the doctors' mess automatic opt-in fee that is charged on your salary every month - and the mess being in the living condition of a squat house (but, hey, health and safety does not apply there!); the ever-so-long contorted and bureaucratic way of claiming back the money YOU spent on a compulsory course to work in hospital but, that for some reason, it always get delayed (and sometimes is never paid back); the HR that almost inevitably will get your salary wrong every time you change place (alas, always paying you less, never more!)... and I could go on and on...
When I speak to my friend in the private sector, and they tell me of 'those (rare) late work nights' (up to 10pm) when 'it was really hard work' but hey, the boss ordered sushi for 50 people to get them to finish for the deadline and then paid for a night out to thank everyone... or when someone had to go for a training course in the US - company paid everything in advance, including flights in business and 5-star hotel... well, that is the moment I realise how much our standard and expectation from our employers have come low...
As a junior doctor in Oxford we always had excellent tea. I was told one of the recently qualified nurses provided the tea bags. I thought I should also contribute but sister told me not to worry......the benefactor was Nurse Twining! Morale was kept on the boil!
So she wasn't an old bag then ?
I was a Jouse physician in 1963 and received £650 per year but the the contract was for one year and after ttax in hand Received £43 per month after boarding charges were deducted. So there was no favour , We had good will from the ward domestic staff to receive cups of tea after the ward round. The Hospital Secretary overlooked this perk. Now the Perks are for the Managers sandwich and tea/coffee after the meetings. Or do they pay?
Our Trust has an annual 'staff appreciation day' where Managers wear silly T shirts and hand out sweets....it's a shame they have no understanding of how we work and got rid of the doctors mess and hot food out of hours years ago. So glad I'm not a junior on night shift now.
Maybe the 'staff' should have a 'manager depreciation day ' and be able to get rid of a few !
Any work place morale or good will towards my employer went past the point that it could be saved by a tea bag a long time ago.
And doctors messes, and hot food in the canteen overnight - the working conditions for doctors have progressively worsened. Medicine is being turned into teaching
I think you have hit on something very important here. I now contribute to tea funds in 4 separate working areas; someone has to remember to buy tea and coffee and milk and washing liquid (we too are banned from wasting NHS detergent). Add this to staff car parking charges, increasing use of doctors as data entry clerks, withdrawal of secretarial services, making it difficult for us to wear smart clothes - anyone would think they were trying to demoralise us.
It is staff survey time: perhaps we should all explain we feel undervalued by management as evidenced by the lack of basic amenities.
The other thing to consider is whether the management staff have such a restriction on beverages or is there a rather nice coffee machine in the corner of their office? I remember returning to medicine in 2006 after a long career break and being stunned to see the quality of the decor in the corridor of the gynae outpatient department-scuffed paintwork, ceiling tiles threatening to peel away and no pictures or 'creature comforts' what so ever-not even a neglected pot plant, compared with the offices of the PCT where I had to deliver my documentation-air conditioned, smoked glass architecturally designed and laid out in a beautiful landscaped garden.......
That may be a reflection of primary care vs secondary....or management vs clinicians/patients....who's to say?
As long as I have been working as a consultant I have provided the coffee (1 large family jar on a weekly basis) & sweet treats on Monday and Friday for the wards. Coffee and tea has not been made available by the Trust for at least 10 years.
If managers sink to the level of level of taking away coffee and tea, which is basically the fuel we run on, do we as doctors sink to the same level?
I noticed I am not the only one to provide treats or coffe/tea. Everyone contributes in their own way without having to be asked or reminded.
We all want to work in a pleasant environment and have coffee or tea at hand when we need it and people do want to do the effort to make it livable and workable.
Financially managers save a few pennies by not providing tea and coffee. They are not unaware of the goodwill they lose; generally they just don't care and we cannot make them care.
Of course taking away coffee and tea is inconsiderate and inefficient. The money they save from coffee and tea will not stop a Trust from going into special measures if it is already not performing.
As doctors we don't have to sink to managers' level, and we can use the opportunity to boost morale and make our own working conditions better by not just providing coffee and tea, but by also creating a few moments of joy and time (minutes) to re-charge.