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‘This is your captain speaking. My co-pilot today has called in sick, I’m afraid, but I can probably cope. Enjoy the flight.’
It’s unthinkable, isn’t it? An airline run on such a shoestring that, when a pilot is ill, the rest of the crew simply limp on with the flight as best they can. You wouldn’t dream of setting foot inside an aircraft in such circumstances.
Yet the chances are, in the majority of UK hospitals tonight, so called ‘rota gaps’ will force the skeleton crew of junior doctors to cover the additional burden of their missing colleagues’ shifts all night long.
The full horror, for us, of an innocuous-sounding ‘rota gap’, stems from how crippling even a normal, run-of-the-mill night shift can be.
We often carry an emergency bleep covering one or two hundred patients, plus the ‘crash bleep’ for every patient in the hospital who has a cardiac arrest.
If another doctor’s night shift isn’t filled, that person’s bleep may be thrust upon you as well — so suddenly you are responsible for 400, not 200 patients.
You know your night will be a living hell: impossibly stretched, racing from one barely patched-up patient to another, their bedsides blurring into one, your brain as slurred and drunken with fatigue as if you’d been downing tequila all night long.
There is nothing quite as terrifying as holding people’s lives in your hands, while drowning in conditions at work that render you so stupefied with exhaustion you doubt your basic competency.
‘Safe staffing’ — sufficient staff on the frontline to protect public safety — is a phrase bandied around by politicians and healthcare professionals alike. Civilian aviation has safe staffing nailed. Insufficient pilots or aircrew mean a flight is grounded, end of discussion.
But in a publicly funded health service, the temptation for hospitals to pare back NHS staff to a precarious minimum stems from the incessant, top-down, political pressures to drive down costs in hospitals.
Only last year, to widespread fury from doctors’ and nurses’ leaders, health secretary Jeremy Hunt told NICE (the National Institute for Health and Care Excellence) to stop its work on appropriate staffing levels — a report the Government itself had commissioned.
As of last week, we know the reason why. Leaked material from this report reveals that the UK’s emergency care departments are ‘significantly understaffed half of the time’.
It’s not rocket science to see why the Government wants to suppress such alarming data: new staff cannot be concocted from spin alone, they require actual, bona fide funding.
Small chance of this at a time when the percentage of GDP our Government spends on health is set to fall at the fastest rate since any period since the early 1950s.
While the political expediency of staffing the NHS on a shoestring may be obvious, the true cost of understaffing can literally be measured in patients’ lives.
Last month, a five-year study revealed that the NHS trusts with the lowest mortality rates for those admitted with emergency surgery had 24 per cent more nurses than those with the highest death rates.
Right now, alongside our nursing colleagues, my fellow junior doctors and I are the shoestring, frayed and threadbare beyond belief. It’s not just the unexpected gaps in our rotas.
Even when HR is told many months in advance of long-term doctor absences — for maternity leave, elective surgery, or many other predictable reasons — it tends to prioritise cost-cutting above safety by simply not filling the gaps.
Instead, we are ordered to cover the increased workload ourselves, to just get on with it. Cheap this may be — but at what public cost? Tired doctors make mistakes: you don’t want us near you when our brains are swimming with exhaustion.
Under Mr Hunt’s stewardship of the NHS, numbers of rota gaps are destined to rise and rise. Morale is crumbling, we have been forced into a second period of industrial action next week, and record levels of young doctors are already voting with their feet.
Only 52 per cent of doctors chose to take a further training post after completing their two foundation years, according to figures released in December.
Depleting the NHS of its doctors will make it impossible for those that are left to practise safely. If Mr Hunt really cared about patients' safety, he would work with us, not against us, to protect them - and he would stop driving us away in droves.
Rachel Clarke is an Oxford specialty trainee 2 in cardiology
What are the rota gaps like in your trust? Use the comments section below
Clearly NHS Management & Ministers have forgotten their foolish roles in spreading frontline staff too thin and tired at the mid-staffordshire disaster where 1200+ patients died avoidably !!!
Seriously, these people shouldn't be meddling in Healthcare OR airlines.......
Significant rota gaps on registrar and consultant ROTA for anesthetics and Intensive care . Number of nurses on Critical Care has been reduced so much ,to cut costs ,that patients have to be triaged, when that should only happen in times of disaster or major emergency.
I believe Hunt and the government are NOT unaware.They are doing it with full knowledge ,so that they can call it unsustainable and break up the NHS to provide only emergency care and some more , farming off more elective work like routine operations to private companies .
Covering rota gaps is so common that we just accept it. It doesn't surprise or horrify people any more. Part of the normalization of deviance in healthcare.
Exactly the same sort of shortages affecting General Practice - partners retiring, vacancies unfilled, practices closing and their thousands of patients dumped on neighbouring practices by NHSE - system unsafe and close to collapse. This malaise is affecting all areas of the NHS, and we need to work together and speak out so the public realise this #oneprofession
I work in a chronically understaffed hospital. The only word I would use to describe the care we provide most of the time is 'dangerous'. There is no way O would ever want to be a patient in that hospital. And that breaks my heart. Because individually, we are dedicated doctors trying our very best. But as a cohort we are used and abused in such a way that we have no choice but to provide grossly suboptimal care. And no one in management gives a damn. Because they simply don't understand what it's like.
And that makes me so cross. A few years ago, I wouldn't have dreamt of working anywhere else than the UK. Now, it seems likelihood. I love medicine, but I hate my job as it is. And there is no way I can do this for years to come.
A colleague recently admitted to me that she had called in sick because she mentally couldn't take it anymore. And I wholeheartedly sympathise. It takes a lot to get a doctor to call in sick - but I think many of us are now at breaking point.
All I can hope for is that another strike acts as a wake up call for the department of health and also the general public. The NHS is on it's last legs.
One of my postings last year in a busy tertiary intensive care had only 10 of the 16 SHOs - the remaining 6 fellows, having achieved training positions, resigned their non training posts before starting, (which I think most people would have done). But where can you find more junior doctors in the middle of a training cycle from? This pigeon holing into the MTAS treadmill leaves minimal flexibility or slack for workforce planning.
With some very supportive consultants, we managed, but it still made for a crazy rota, and even with locum shifts offered at sometimes eye-watering rates, some very busy shifts.
Healthcare and the airline industry are often compared and for good reason - highly trained professionals working in an environment with high stakes. But as is nicely pointed out above - one is adequately funded, adequately staffed and has a culture of valuing safety over everything else. The other is taken for granted, horrifyingly stretched and waiting for something to go tragically wrong. Like with most things in life - you get what you give.
I think the most unfair things about inadequate staffing levels is that no matter how hard you try to do the job of two or three people, there are times when that is simply not possible.
And if/when things go wrong, the blame will be on you. Never mind the fact you were doing your best in a difficult situation, you will be held accountable. Not the managers (for having once again miserably failed to find adequate staff) or the many others who should be held accountable. It will be you. That is all the support you get for being the junior doctor working through the night, trying to do an impossible job for (at least in my case) a little over £10 an hour. So when Jeremy Hunt tells us we need more doctors at weekends, I would like to ask him where he is going to find all these extra doctors? We can't staff the place properly during the week, let alone at weekends. And those of us here are already worked to the bone.
At paediatric registrar level rota gaps have been an issue for a long time but I am only just understanding how bad it can be. We are 5 and a half people down on a 14 person rota. That equates to 280 on call shifts (required for skeleton staffing levels) vacant in 6 months.
It is completely un-manageable.
I'm a junior reg and completely terrified of trying to learn to look after poorly children in this environment.
1/4 trainees down in my unit - not replaced and consultants angry because things are slipping, hate my job:(
It is not only about rota gaps. Firms frequently function with missing members.
For instance, I am on a planned sick leave and will be out of work for 6 months. No provision were made to arrange cover for my abscence. My colleagues are stretched and "working hard" (positive twist of words for overworking people) as the workload hasn't changed.
Can you please make a f##%% video for YouTube ! All my patient population of 5500 cannot read this. Put this on YouTube if you don't want this on expensive TV add. Give the creative arts people a bursary vs cartoon ads
As a Matron in a busy university hospital I regularly support and debrief junior doctors who feel over stretched, undervalued and not listened to when they raise concerns about patient safety due to staffing levels. Nurses have to display staffing levels daily both on the ward safe staffing board and in the national arena on the safe staffing national data. Whilst it doesn't solve the huge recruitment crisis it shows where the gaps are and is less of a 'hidden' problem. We need to have consistent regulation and guidance for minimum levels and actions for when it dros below minimum that are driven by our own professions - NOT governmental leaders who have a political rather than patient safety agenda. I suggest the BMA advocates for a national display of medical staffing that is live for the public and hospital managers to see that shows the minimum and actual staff on duty and the ratio of doctors to patients and when this hits a level less than is clinically safe. Only then will action be a possibility around our genuine safety issues. We owe it to the patients in our care. The government need to stop having control over our professional standards.
I've been a short haul pilot for over ten years, the reality of the opening statement isn't a joke. Most of us scrape through the summer drugged up, trying to beat infections etc so as to avoid a meeting with HR. 3 colds etc in a year! CHOP
I wholeheartedly support Drs Hisham Haq and LMR below. PLEASE BMA push for some way of publicising your side of this apalling situation - every non-NHS person I meet is beginning to believe a lot of what is being stuffed down their throats by Hunt and the media.
A video on Youtube, or better an advert of the TV or in the papers, would be a start. The idea of staffing levels being publicised in hospital departments is an excellent one - people could see and believe and perhaps understand.