It was in a hospital corridor at 4am that anaesthetic registrar Layth Tameem first realised something was dreadfully wrong.
For Dr Tameem, a ST6 in a specialty he says allows time for thought and to ask questions, the NHS has always represented ‘brilliant opportunities’ – a ‘brilliant job’.
But the junior doctor he had just encountered looked dazed and broken.
Dr Tameem had initially walked past his younger colleague after a robotic, affirmative response of ‘yes, fine’ came to his ‘are you OK?’ But something wasn’t right, so he turned back and asked again.
‘She said, I’m really thirsty – I want a cup of tea but I don’t know where the mess is and it’s probably got a code and I don’t know what it is. She said she hadn’t seen another doctor on that shift, and she didn’t want to bleep or call someone as it might have seemed like she was weak or not coping.’
People leave and that just makes the place of work worse and the staffing more problematic. We need to break that cycle.
What sort of a health service arms the people entrusted with the care of the most vulnerable in society with thought processes like this? What sort of NHS leaves doctors in training scared to ask for help? What sort of employer – let alone an employer of care-givers and life-savers – leaves staff not knowing if they have a safe space for a cup of tea, or, indeed, the time to use it.
The truth, as hard as it is to admit when it comes to our national treasure, is that this is our NHS. Dr Tameem’s story elicits a sympathetic ear but it does not shock or stun.
‘Something just wasn’t right – I thought there was something fundamentally wrong with the culture and the way we were caring for ourselves and each other.’
He adds: ‘I feel very strongly when I see injustices like that where I want to make things better. I was lucky to be in a specialty where I have the time to stop and say, “how are you?” It was a real eye-opener seeing that.’
Dr Tameem’s experiences of a health service which can be a difficult place to live – after all, we always say this is a vocation, not just a job – run deeper than his interaction in a hospital corridor that night. Five years ago his best friend, a fellow junior doctor, took his own life.
‘We’ve just got this all wrong,’ he says. ‘It’s a vicious circle. We say we don’t have the time to make things better but then more people leave and that just makes the place of work worse and the staffing more problematic. We somehow need to break that cycle.’
Where these sorts of realisations have led many to leave the NHS for more comfortable lives elsewhere, Dr Tameem (pictured below) – who himself experienced life in an Australian emergency department where doctors are ‘more than a name on a rota’, with ideas that would seem radical over here such as allowing partners working in the same department to share working hours – has been inspired to take action.
Following his experiences and the death of another junior doctor in his hospital trust he divulged his ideas for change to a consultant colleague one evening, unaware she was a senior leader at the trust, in a position to enact genuine change.
An invitation to take action soon came, as well as an introduction to another junior doctor with similar ideas. Soon the early shoots of an organisation which was to become WARD (Well and Resilient Doctors) came to life.
Dr Tameem and a group of colleagues began creating seminars and educational sessions for junior doctors about what to expect in their jobs, how to ask for help and support and answering some of the questions they all had in their early days on the wards.
Doctors leading sessions, which take place during curriculum teaching time, stay behind after to answer more personal questions or signpost to services. The WARD programme covers Dr Tameem’s entire deanery and discussions with senior NHS leaders could lead to further growth, with ambitions of national coverage one day.
Bullying and harassment
Dr Tameem’s work shows the obvious problems in the system: doctors feel isolated and alone, staff are at risk of burnout and support services, if there, are not always easy to access. But his efforts also show that, with a bit of drive and energy, things can be changed for the better – every little improvement could help to keep doctors in the NHS. And Dr Tameem is positive about the future as he says Health Education England has been supportive of his work, particularly around education.
Earlier this year the NHS unveiled its interim people plan in a bid to address some of these issues – and to give the health service a workforce foundation strong enough to cope in the coming years.
It’s a bit hazy on the details. There are pledges to tackle the NHS culture of bullying and harassment, a major focus for the BMA, and improvements to the leadership culture.
The plan’s creator-in-chief, the NHS’s new chief people officer Prerana Issar, has arrived in the health service from the UN and speaks passionately about creating a more diverse workforce where people feel valued.
We all go into work to make a difference every day but there are things that get in the way
‘We all go into work to make a difference every day but there are things that get in the way’
Speaking at the NHS’s flagship annual conference, NHS Expo, last month she outlined her thoughts on the issues facing the workforce.
She said: ‘There are 1.3 million stories in the NHS – each of them counts, each is unique, and each brings something to the NHS. The golden thread between them is serving the patients who come to the NHS.
‘We all go into work to make a difference every day but there are things that get in the way – from the laptop that takes 10 minutes to boot up, the line manager who excludes us from key discussions and a lack of flexibility about balancing family and commitments.’
These were warm words, as were NHS chief executive Simon Stevens’s at the same conference when he said that addressing workforce issues was ‘mission critical’.
But what should the NHS actually be doing? It may sound self-evident but any ‘people plan’ needs enough people to make it work.
The NHS is chronically under-staffed.
More than nine in 10 doctors surveyed for the BMA Caring, supportive, collaborative project said staffing levels were not adequate to deliver safe, high-quality patient care, and more than seven in 10 said this had worsened in their main place of work in the previous 12 months.
In Scotland, there has been legislation for safe staffing – a move welcomed by the BMA, although as BMA Scottish council chair Lewis Morrison says: ‘It will not create more doctors – or staff of any type – simply by becoming law. Instead, we need much more concerted and targeted action to recruit and retain doctors and make the profession an attractive career choice once again.’
In Wales, the BMA has called for statutory safe-staffing provisions in its response to the consultation on the Health and Social Care (Quality and Engagement) (Wales) Bill.
There are some trusts that get it and they understand staff are the backbone.
If the NHS is truly in listening mode, listening to Dr Tameem would be an excellent start.
He cites everything from compassionate rota planning and flexible working, to giving everyone the opportunity to take leadership roles and sharing best practice around the country.
‘There are some trusts that get it and they understand staff are the backbone’
He says: ‘This is not impossible stuff. We have shown what can be done.
‘I’ve seen some wonderful practice in 10 years working in the NHS, but I’ve seen too many where staff simply aren’t people and are treated as names on a rota. There are some trusts that get it and they understand staff are the backbone.
‘But I’ve also been told that there is just no time in the foundation year curriculum for non-clinical work. This is a problem. You can’t achieve targets if you aren’t looking after people – by looking after wellbeing we can deliver better care for patients too.
‘There needs to be a reorientation of thinking – we need to challenge what is seen as the norm in the NHS.’
Fear, blame and isolation
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People become doctors because this career embodies their values. It’s a long and arduous journey and it is a commitment that extends beyond working days.
Yet many doctors find themselves in a working environment that, instead or recognising this commitment, perversely works against them. Our own survey shows that nine out of 10 doctors feel they can’t provide safe, high-quality care because of the stress and strain placed on themselves, colleagues and the wider system.
To add insult to injury, if things do go wrong, more than half of doctors fear they will be blamed for errors caused by system and capacity issues and only half of doctors would feel confident to raise concerns.
Not only does this adverse environment prevent doctors from achieving their best but it is also denying patients the full potential skills and capability of care from our medical workforce.
Given this tough – and often unfair – working environment, one would expect employers to support frontline staff and offer them gratitude, understanding and support – rather than a culture many doctors inhabit of fear, blame and isolation.
As part of our Caring, supportive, collaborative project, the BMA will continue to campaign for an NHS that has adequate resources so that doctors can do their best for patients, underpinned by a culture rooted in learning and improvement rather than blame, and which values its workforce as its strongest asset.