The Gryphon speaks to Lucie Ward, one of the junior doctors staging a peaceful protest outside the Department of Health’s Leeds HQ at Quarry House, about the current state of the NHS, working conditions for junior doctors, and the implications of the government’s proposed new contract.
How long have you worked in the NHS for?
“I qualified in 2001. I’ve taken quite a long route for a junior doctor, I qualified when things were very different. I’ve seen a lot of changes but this is the worst I’ve ever seen it in terms of morale and people actually leaving because it’s not sustainable or safe the way things are going at the moment.”
Are junior doctors being stretched too thin?
“They’re consistently underfunded – the NHS – since they [the Conservatives] got into power so over the last five years most of the UK hospital trusts have flipped from doing okay with their budgets to being in deficit, and we can see that on the frontline – we hear the government talk about how much extra money is being put in but we can see clinically on the frontline that’s not the case.
There’s increasing numbers of rota gaps, so if you have a rota with eight doctors, there may be six doctors, so that’s a quarter of your workforce that’s missing. Those gaps are filled by agency workers, and then since November this government has imposed agency caps for junior doctors and for nurses. While that seems on the face of it an admirable idea, to reduce the amount of money that’s spent on locums, at a time of chronic shortages of staff because there’s no funding it leaves the service demoralised and you restrict the options hospitals have to actually keep things safe, to fill those gaps and get staff. Then you have situations like in Chorley – their A&E department is closing, not because it’s a planned cut, but because they’ve simply run out of doctors by the end of this month. The gaps are unsustainable and unsafe since the locum cap came in in line with this changing junior doctors’ pay to be less – although they keep telling everyone it’s the same.
They’re restricting that, and then emergency medicine is one of the most short staffed specialties, with huge gaps at senior levels, so anybody that they [the A&E department] try to get, there’s just nobody responding to them. Similarly here in Leeds at the St. James’ intensive care unit, they had an extra six-bedded intensive care unit area and that’s had to close because of ongoing issues with nurse staffing related to nurse agency pay being reduced – and then the skilled intensive care nurses who are required to run those beds aren’t working. There have been eight liver transplants cancelled due to not having beds available.
I’ve worked in that unit five or six years ago and I don’t remember them ever saying we’ll have to reject this organ/send it back or deny our patient a liver transplant because there’s no nurse. There’d always be a bed, there’d always be a way. So things are really desperate, they’re really, really bad. It’s already at crisis point.”
And will this new contract make it worse?
“It’s going to make it worse. You’re talking across hospital care and primary care, it’s all been cut. This is why doctors are out on strike – it’s not about pay, we’ve never asked for more pay. A lot of us have been promised a pay freeze, and they’re offering to reduce wages for new entrants. They’ve been saying it’s cost neutral and we’ll be working more antisocial hours but it won’t reduce coverage in the week. But there aren’t any extra doctors. It just doesn’t make sense.
There are the same number of doctors, they want us to do more weekend and evening work to have this seven-day NHS which is to increase elective care, so planned operations like knee replacements that don’t need to be done on a Sunday but that’s what they’re asking us to do. We’re at crisis point to cover the emergency care we’re doing already – they want to have extra cover on Sundays to put on extra clinics etc. which don’t need to be there, and this is going to drive doctors away because doctors are already working maybe every third weekend. The government’s kindly offered to limit it to a maximum of every second weekend… but that’s not sustainable, and doctors will choose to go and practice in Australia or just give up because they’re so demoralised. It’s totally counterintuitive, taking our most trained individuals and telling them you don’t support them and putting them in dangerous conditions.
They’ve also removed the safeguards against long hours. On paper there will be safeguards, but instead of the system we have now to back that up, the system that they’re going to have is essentially to pay the doctor for the hours they have done over and above the contracted hours – which shouldn’t happen anyway – but at the moment they have heavy punitive fines, and have to pay the doctor a penalty fee, but the heavy fines are on the trust so they avoid doing that because it costs them. Now they have a nominal fine to pay to themselves and that budget will go to the hospital library or such like which they should be funding anyway, so it’s ludicrous – if doctors are worked over the limits, they can just say we’ll fine ourselves and give that money to the library. That’s not a safe system. The hospital isn’t taking any kind of hit to stop that behaviour, there’s nothing to stop them from trying to run units with no staff.”
Does Hunt have the legal authority to impose the contract?
“That’s an interesting question. There’s a group of junior doctors who call themselves Justice for Health, they’ve crowdfunded tens of thousands of pounds to be able to mount a legal challenge to the government, separate to the BMA’s actions. Within a few hours they were able to hit their first targets, so they could have a legal team. It’s now starting to look like the government might not be able to impose it, which would be shocking, to have had the first strikes for decades off the back of something that can’t actually be imposed. We’re very hopeful that that will progress, but the government have made a statement saying they are going ahead with it anyway, so we have to continue to fight that battle”.
The General Medical Council recently suggested hospitals might struggle in the event of a total strike. Is a strike a proportionate response?
That’s not exactly what they suggested – if you think about it, consultants are the backstop of the service anyway. If a junior doctor was hit by a bus, the consultant would be the first person that would step in to do their job for the night. They have to be capable of doing the job.
What the GMC has said is, if you work in a department where you don’t think your consultant will be able to cope or there won’t be enough staff available and you think patients would be harmed, it would be unethical to participate in the strike. That’s fair, but hospitals have had a long notice period – they know it’s going to be a full walkout strike – so they can cancel their outpatient clinics and scheduled operations that are not time critical like knee operations. They have been warned that this is happening and have had plenty of time to put safeguards in place.
Then consultants are very unified in saying they have our back, they are covering the important services and patient safety will not be compromised. And that’s an important message for us to get out to the public.”
So the GMC has been misquoted in the press?
“I think they’ve been misrepresented – you can say what you like about the tone of a statement saying consider that if you’re endangering patients that’s unethical, I mean that’s not exactly warm and encouraging, but you have to ask what government pressure’s been put on them to make those statements. It’s been interesting that the royal college – each major specialty has a royal college that organises training and development to do with that specialty – the royal college of paediatrics has been incredibly forceful this week, as Neena Modi, their head, has come out to say that they’re absolutely confident that the strike will be safe, but that what’s really important is that it’s getting dangerous day-to-day in hospitals because of staff shortages.
I’m hearing from paediatricians, junior doctors that I know, that they’re being asked to do the job of two doctors looking after sick children at nights and weekends, and no provision is being made to cover that shortfall – it’s not sustainable. I did a paediatrics job a couple of years ago in Bradford and there were huge gaps of maybe two or three doctors missing out of nine or ten. So we’d constantly be doing extra shifts, and just trying to keep going. For Jeremy Hunt to turn round in that climate and say that we don’t have a sense of professionalism is just horrendous. The royal college of paediatricians, Neena Modi’s statement has been a watershed.
This is the reason doctors are on strike. They’re not very motivated by pay really, but patient safety is under threat and that is why we can’t accept this contract.”
Finally, why are you personally so passionate about opposing the contract?
“I’m a woman, I work part-time, and I’ve personally had consequences of stress-related illness due to working days into nights into days and feeling constantly jetlagged for years. Doctors sign up to do a minimum of five years to be a GP, ten years to be a consultant. So you’re looking at ten years of constant jetlag, never knowing if you’ll be able to be off for Christmas, or your birthday, or even your wedding, you know – I don’t think it’s sustainable for junior doctors to accept a worsening of that for no reason and with the prospect of their status being downgraded moving forward. I can only see that more people are going to suffer as a consequence of that, potentially leave the profession and not be able to keep the NHS going. I think it’s vandalism on a national scale, it’s a national resource. British people want the NHS and they want it to be public, but the Health & Social Care Bill means that in England the government is already making these huge changes to the NHS so that it’s not in public hands anymore and it’s moving to an American-style system where they’re asking private companies to come in and bid for care like cataract operations. And they can exclude whoever they want. That is not what British people want, and it’s all been done by stealth.
In places like the U.S. they spend about a third of the health budget on admin and chasing people around. We have one of the cheapest health services in any modern economy because there is no chasing people around or over-investigating, we make the best of the limited budget we have – but anyone can walk in. If you go to a system where you can only get care if you’re a registered person, if you’re a disenfranchised person – a traveller, an abused child, or you can’t get organised payments or bring birth certificates etc. – you get nothing.
It’s small government, just trying to get profits for private healthcare companies and it’s not about patient safety. This is a totally bizarre ideological project.”
[Image: Alexander Scott]
Sam Robinson