Covering our striking junior doctors - is there no end in sight?
This is the fuller version of the comment article published in the Sunday Times on the 16th April
It’s 2am and I have just been called to the labour ward. As a consultant anaesthetist with 25 years' experience I am covering the night shift normally worked by our junior doctors, who are on strike for the longest period in history.
Every hormone in my body is telling me I should be fast asleep as I walk down the long corridor to meet a woman enduring the most excruciating pain she is ever likely to experience in her life. She is in labour, her contractions have ramped up and she hasn’t slept for nearly two days. Her partner looks on, his distress palpable as the person he loves suffers, while he can only look on helplessly. In between contractions I explain the procedure of inserting an epidural and prepare my equipment. The procedure is quick, smooth and without complications. As I finish applying the dressings I can already see her shoulders relax a little as the contractions get easier and by the time I’ve finished my documentation she is out of pain, beaming an exhausted smile and able to rest for a few hours before she has to start pushing.
As I walk away with a feeling of achievement, I think to myself that this is precisely why I became a doctor. It’s a privilege to be able to help people at a crucial and vulnerable point in their lives. It’s not “just a job”, there is something quite special about it. The training is long and arduous, the exams are difficult, the expectations from patients and colleagues are daunting. I have lost count of the number of weddings I‘ve missed, engagements cancelled at short notice, the times I’ve let loved ones down because of work, the times I’ve not been there emotionally because work has simply emptied my tank.
I wander down to the emergency department to check on my colleagues who have received several critically injured patients in the previous couple of hours. Consultants in emergency medicine, surgery, anaesthesia and intensive care gather around the most injured patient, quickly and efficiently formulating a plan for his care and making space for him on the intensive care unit. The atmosphere is very different from how it was only a few weeks ago during the first strike. There is still immense support for the junior doctors, but now there is also a feeling of relentless weariness. Many colleagues have changed their working patterns, cancelled annual leave and taken on additional shifts to maintain safety. Working relationships are frayed, and clinicians and managers are under enormous pressure to cover shifts while working within the NHS’s tight financial envelope.
In my specialty of anaesthesia covering junior doctor shifts to maintain safety is nothing new. A career in anaesthesia is highly popular with junior doctors, and applications from some of the best to join the specialty outstrip the number of posts many times over. Despite a sustained increase in demand for our services, training posts are strictly regulated by NHS England. Fixed annual training recruitment and early retirement of senior doctors due to punitive pension taxation has resulted in a greater than 10% consultant vacancy rate in most anaesthetic departments. Gaps in the junior doctor shifts are a weekly occurrence and often have to be filled by consultants because there is no one else available. These rota gaps lead to a reduction in training opportunities and sap morale at a time when we’re still trying to recover from the impact of the biggest health care onslaught for a generation – the COVID-19 pandemic.
No one can dispute the figures that show how the pay of doctors has fallen behind inflation since 2008. The pay of newly qualified doctors is particularly low, and below that of a newly qualified nurse, while shouldering the burden of debt that accompanies an intensive 5 or 6 year course, with little opportunity for a holiday job to supplement the income. They are often required to move away from friends and family to a completely different part of the country, and start work in an unfamiliar hospital, all of which adds to the emotional and economic burden. Subsidised accommodation, which part-alleviated the low starting salary when I was training, is now very rare.
At 0630 this morning, between calls, I wrote yet another reference for an excellent junior doctor who has chosen to move to Australia. He will be welcomed with open arms into a system with significantly higher salaries, and much better terms and conditions for all healthcare workers than we currently provide.
None of the work that we were faced with last night was beyond our competence, and I know our patients got excellent care provided by experts. My heart goes out to all the patients whose appointments were cancelled to maintain a safe emergency service, but also to the patients who have been harmed in recent years by poor staffing levels, inability to recruit and retain doctors and nurses, and poor national workforce planning.
As more strikes are announced by both doctors and nurses it is clear from the response of the government that this is not going to be resolved quickly.
The government and the BMA must reach agreement, our nation’s health depends on it.