Your BMA: breaking point

by Latifa Patel

In a health service starved of investment and with a brutal working environment, doctors are saying enough is enough

Location: UK
Published: Tuesday 13 December 2022
Latifa Patel

I regularly write about the state of the healthcare environment we work in and the brutal effects of facing relentless demand with continually dwindling resources.

To date, the Government has ignored our calls for action – and ministers have buried their heads in the sand despite our repeated warnings about staff burnout and patient safety.

However, those calls are going to become harder to ignore this winter because doctors and other healthcare staff are deciding enough is enough.

At the time of going to press nurses are expected to take at least two days of industrial action, and next month junior doctors across England will be balloted on their own.

In the case of my colleagues, it is hardly surprising this question is being asked given the sustained and continued real-terms cut of more than a quarter to our salaries since 2008/09 while working in an increasingly impossible environment.

The statistics behind our demands for action could hardly be any starker. The NHS in England alone has 133,000 unfilled clinical vacancies. We have one of the lowest ratios of practising doctors per 1,000 inhabitants in the OECD (Organisation for Economic Co-operation and Development) – we have 2.9 per 1,000 compared with Austria at 5.6 and the OECD average of 3.7.

BMA analysis suggests we would need some 46,000 doctors to meet the OECD average. And it’s not just about doctors. We are down at the bottom of the list when it comes to the number of hospital beds per 1,000 people and have one of the lowest ratios for CT scanners to population.

The effects of all this under-investment are becoming ever clearer now. They include having 8.9 million people on the waiting list for secondary care in the UK, GPs managing ever-increasing risk in the communities and healthcare staff say they feel they have to take industrial action.

The numbers only tell part of the story. All of this is evidence for what most of us see in our daily working lives – that our colleagues are struggling under the burden of all this need, and that we aren’t able to give patients the safe, high-quality care they deserve.

And this is a safety issue. So often we are having to say to patients: ‘I’m sorry I’m late,’ or ‘I’m sorry you don’t have a bed’ and ‘I’m sorry I haven’t got the time to talk to you in more detail’. This leads to moral distress – to genuine moral injury.

It leads to a broken workforce. And a broken workforce means poor care for patients. If the Government needs any roadmap for how we ended up here – with industrial action being planned – this is it. Doctors, and other healthcare workers, are now saying ‘not only do I need to take this action for myself but I need to do it for my patients and society’.

I applaud people who are taking this stand. Beyond the under-resourcing, the relentless demand and the moral injury there is another reason why the NHS can be a brutal working environment: culture. Often, we are told we have to fill a rota gap because hospital staff need us to or the GMC would say we have to help out. This is nonsense – as doctors we are not responsible for fixing the existing unsafe staffing levels and management of health services.

As we approach the festive season, typically a time of reflection, I want you to know your BMA sees the difficulties you face and is fighting for better and demanding change. We recognise the pressures on you, and we are having these conversations with ministers and stakeholders day in day out, trying to drive positive change.

In the meantime what is really important is that our members aren’t put under undue pressure – and don’t feel a personal responsibility to solve the NHS’s problems, when those issues lie with politicians and health leaders.

This festive period, take time to reflect. If you need help and support please contact the BMA. We are your trade union and we have your back when you need us. We also offer counselling sessions completely free, with support available 24/7.

As always, you can also contact me via email at [email protected]


Dr Latifa Patel is chair of the BMA representative body


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