By: Novika Ramaiya
Doctors are falling asleep at the wheel, emigrating on mass and even committing suicide because of the stress – if the NHS doesn’t start looking after its staff, patients will continue to suffer
When I entered the NHS back in the early Nineties as a junior doctor, it was a completely different world. Patients received excellent care by and large, numbers were manageable and doctors, while overworked and underpaid, felt valued and appreciated.
Sadly, this is no longer the case. Since those relatively halcyon days, I have seen the slow but inexorable decline in standards – which has resulted in the NHS turning from the “envy of the world” to the sick man of Europe.
There are many reasons for this downward spiral – but the way doctors, nurses and healthcare staff are treated plays a huge role. Working conditions for doctors have deteriorated to such an extent that both newly qualified doctors as well as long-established senior doctors, including GPs, are fleeing overseas, where they feel healthcare standards are better and they are cherished as important members of the team.
The calibre of care that patients receive is a function of many things – but as working conditions and the general wellbeing of doctors and other staff have diminished, so has the service that is offered to patients.
The rights and privileges that doctors once had have been slowly eroded over the years – many things that contributed to wellbeing and job satisfaction have been summarily removed. No longer is it mandatory for trusts to offer on-site accommodation OR on-call rooms for juniors, and many a doctor has ended up losing their life as they drive home from a late-night shift having fallen asleep at the wheel, with two in five doctors admitting that they have fallen asleep while driving. This has not been dealt with, despite it having been repeatedly brought to the attention of the powers that be. Trusts no longer routinely provide hot food for doctors, and juniors on night duty have to fend for themselves or starve.
Increasing work pressures mean that there has been a spate of doctor suicides, particularly among juniors unable to cope with the stress.
One in 10 junior doctor posts continue to be vacant, and the number of consultant- and trust-grade posts that remain empty is significantly higher. Overall, at least 16 per cent of NHS jobs remain unfilled.
The number of nurses and health visitors has fallen year on yearsince 2013, which raises questions about the NHS’s continuing ability to deliver adequate healthcare and ensure patient safety.
Meanwhile, emergency admissions continue to soar and patient numbers have increased exponentially, partly due to immigration and population size. As management continues to cut budgets drastically in a desperate attempt to contain spending, this has meant a reduction in overall staffing levels, leaving patients at serious risk of neglect. About 40,000 nursing posts are now unfilled in the NHS in England, not least because EU nurses no longer wish to risk working in the NHS, as Theresa May refuses to guarantee their status in this country.
Bureaucracy has increased to a stifling degree. The introduction of futile time-wasting measures like appraisals and revalidation, initiated after Harold Shipman’s crimes, have meant that doctors spend an inordinate amount of time paper pushing – time better spent in clinical care – while the exercise does nothing to detect or inhibit the sociopaths who have given medicine a bad name.
Expanded managerial oversight, with impossible clinical targets imposed on the medical profession by people that are not medically qualified, has added to recruitment and retention problems. Targets inevitably mean that shortcuts will be resorted to, and will result in less than desirable clinical outcomes.
At the same time, patient numbers have increased substantially and doctor shortages across the board mean that many are struggling to cope with the workload. Waiting times for patients have increased. In many “service” specialities such as radiology, work remains undone/unreported for years – because there is no one available to do it. This then means that individual doctors (who are not radiologists and who, in fact, may be fairly inexperienced even as clinicians) have to interpret X-rays and other scan images for their own patients, and may miss vital diagnoses that would have been picked up by a radiologist.
Obviously this is not good news for the patient who goes home reassured that all is well, when it may not be.
The increase in patient numbers and doctor shortages has also meant that there is less time available to see each patient. Patients who suffer from complicated ailments, or require a complex care pathway, simply do not get adequate time with their specialist to answer all of their justifiable queries and concerns. They then leave these appointments unhappy.
Complaints against healthcare staff have increased, as patient dissatisfaction grows. The NHS is no longer a happy place to work in – hordes of doctors are leaving the profession, either to emigrate, retire early, or change career – and this has only exacerbated the situation. The declining standards, and the general discontent in the NHS are thus affecting staff numbers, which has then led to a further decline in standards and a poorer service for patients.
Meanwhile, the great and the good of the NHS have launched a campaign to change job titles for juniors, in an alleged attempt to give them respectability. This completely ignores the wider problem of disaffection. The Emperor has no clothes, but all that the CMO, Dame Sally Davies, can do is offer a fig leaf in the form of a name change for junior doctors.
Instead, she should concentrate on improving morale for doctors, which would go a long way towards addressing the recruitment and retention crisis, which would in turn lead to a better service for patients.