It’s 1am on nightshift and you are a junior doctor on call. It’s time for your first 30 minute break. You really need some time away from the ward and a quick bite to eat to recharge for the remainder of a busy shift that started at 9pm and is due to finish at 9.30am
As there is no junior doctors’ mess room on your hospital site, you’ve stored some leftovers in the communal breakroom fridge. However, you find the microwave is broken. The nearby vending machine is out of order and offers only chocolate and crisps anyway. The hospital canteen, a 10 minute walk away, shuts at 6pm.
If you are a doctor in training working in Northern Ireland, this will be an all too familiar scenario. Adequate food, facilities and dedicated rest areas available to juniors is lacking across all hospital sites and is particularly acute for those working unsociable / overnight shifts.
This festive period will be the busiest ever for all health service staff with severe workforce gaps and winter workload pressures intensifying exhaustion levels. A lack of access to hot and healthy food or standard break and rest facilities whilst working overnight shifts will contribute to fatigue levels and negatively affect our morale.
It’s not fair on us or the patients we care for.
This is something the Northern Ireland junior doctors committee has long been highlighting. Last year we published our Fatigue and Facilities Charter outlining simple steps that can be taken to improve these areas so we can safely, effectively and efficiently care for patients. The Charter refers to the minimum standards doctors should expect at their place of work as set out in ‘Circular HSS(TC8) 1/2002 – Living and Working Conditions for Hospital Doctors in Training’ a Health and Social Services procedural document that states unequivocally that 'doctors in training, who work busy hours, often round the clock, have a right to expect decent living and working conditions whilst on duty.'
The circular continues: ‘Patients too, have a right to be treated by doctors whose morale and motivation is not undermined by the conditions in which they live and work. Staff morale can often be given a big boost from relatively small outlays on improved facilities, and Trusts which provide good facilities can expect to attract and retain able applicants.’
This agreement is 20 years old yet any junior working here since will tell you, it has all but been ignored. This cannot go on. How are we supposed to recruit and retain junior doctors and address our workforce crisis if the basics are not in place for doctors and other healthcare staff during key shift periods?
Over this coming year NIJDC (Northern Ireland junior doctors committee) plans to address this issue head-on as part of ongoing discussions with the Department of Health on junior doctor pay, terms and conditions of service, morale, working conditions and potentially a reformed contract.
We want 2002 circular updated to align with recommendations set out in the Fatigue and Facilities Charter. We want trusts held accountable when they fail to hold up their end of the agreement, which has been the case for decades, and we want the reintroduction of a programme of accommodation and catering inspection visits.
Hospitals are open 24/7 and staffed 24/7. Trusts need to recognise their duty of care to staff does not stop at 6pm. Providing better access to hot, nutritious, healthy food particularly during night-shift periods as well as adequate break and rest facilities will go some way to addressing this.
Fiona Griffin is deputy chair of NIJDC