Who are the Junior Doctors? In the UK, anyone below consultant level is a ‘junior’. This is a misleading term in itself because some juniors have been working for over ten years. Most commonly, you will complete two foundation years after university then go into core medical or surgical training for about 5-7 years in your chosen specialty. ‘Juniors’ therefore make up a large majority of the medical work force.
Whats the deal with Jeremy Hunt? Jeremy Hunt is the UK’s health secretary (who’s background is nicely summed up by Frankie Boyle in The Guardian here). Pre-existing discontent stems from a tension between workers of an NHS founded on socialist principles and changes forced through by this conservative government. There is a wide-spread lack of trust in top down management, fear of back-door privatisation and a frustrated feeling that the government are deliberately trying to mislead the public (biggest media outlet culprits being the Daily Fail and the BBC). There is a history of poor relations between those at the top and employees on the front line regarding bureaucracy, poor management, funding, pension cuts, bursary cuts and additional yearly fees amongst other things.
Low Morales: Low morale seems to be a contagious epidemic (especially in London) due to long periods of expensive study (exams until your 30s anyone?), long extra / un-clocked hours, high burn-out, on top of the 6 year student debt there are extra fees for progression, college membership and annual GMC fees (you have to pay hefty fees annually to be able to work in the first place), high emotional demands of the job and the breakdown of interpersonal relations between colleagues or loved ones that accompanies being plain tired and fed-up!
There is also a general feeling of being treated with contempt, viewed as nameless figures within an out-of-touch dictatorship and of having our ‘sense of vocation’ exploited as a means of guilt-tripping people into feeling shameful for complaining about feeling pushed to work far longer, for far less. To add insult to injury, MPs have steadily awarded themselves pay rises in the mean time and while barking at us to work harder, they rarely make it past 5pm themselves, claim on expenses, never work a bank holiday, know not what a night shift entails and rarely empathise with anyone outside of their immediate Westminster bubble.
They block their ears like stubborn children and avoid protesters in their chauffer driven cars – Hunt went across the road in a car to avoid doctors waiting for him outside the DoH in Whitehall, whilst maintaing on camera that he has an ‘open door policy’. Hunt claims the strikes are a result of the BMA (doctors union) failing to co-operate and negotiate. In fact, when he initially brought the contract in for ‘negotiation’ last year, the BMA were told that all the key proposals were non-negotiable and only the fine print was up for discussion. Naturally signatures were refused, members simply walked out until a more rational offering was available and we have been waiting ever since.
Why Strike? Strikes were an absolute last resort, there hasn’t been action like this on such a scale for many decades and yet what else is there to do when the Health Minister simply responds by stating that it’s his way or the highway? Forgive me for thinking that our society had a modicum of democracy. In addition to this hypocrisy there are the plain and simple lies. Hunt claims that the change is such a necessity because there is no ‘7 day NHS’ and as a result weekend death rates are higher than they are during the week. In fact this was completely wrong and his analysis of the statistics was flawed. In spite of this being pointed out to him on numerous occasions, he sits in every constructed appearance like a puppet on a string, playing the same old broken record. Its no surprise that trying to get a politician to admit they were wrong, is about as hopeful as teaching a dog to speak Mandarin but to be so shamelessly nonchalant in ones defiance seems unprecedented.
A 24/7 Service: There is 7 day cover in the NHS. Doctors work weekends, bank holidays, Christmas’ and birthdays 365 days of the year. What he is not making clear to the public, is that there is not 7 day access to diagnostic services such as lab results and imaging as everyone else has gone home by the time Friday night rolls around – most doctors would agree it would be a good thing to have these available at the weekends! However instead of supplying the extra funding and additional work force required to make this a realistic possibility, Hunt decides the solution is to somehow stretch the limited number of doctors we already have and just force them to work longer for less.
But is it really just about the money? Doctors already work over their paid hours, they voluntarily stay on shifts for longer for the safety of their patients. There is no feeling quite like having the responsibility of another human’s life and health improve or deteriorate under your watch, its not a job where you clock out of work and forget about it all until the next morning. When I walk into hospital its not uncommon to still see people who are supposed to be starting a rota’d day off still on the wards, following up results or ensuring a safe handover.
The other week I was on an Infectious Diseases rotation at St Mary’s, where a consultant had left his family abroad and flown back to London to operate on a girl who urgently needed his time and expertise – for no extra payment to himself. When we argue that this is not merely about the money and the cynics sneer that we are using patient safety as just an excuse, we mean it. We don’t want the responsibility and the soul crushing feeling of someone getting hurt, having their quality of life impacted, or dying because we were too tired and overworked to prevent it. We are human, we should collectively be doing all we can to minimise the risk of human error in such a setting. In the aviation industry pilots can call in ‘fatigued’ in which case they are not allowed to work, yet we are removing such safety netting from the NHS.
Proclaiming 7 day services do not exist is resulting in direct harm; there have been notified cases of patients waiting until Monday to present to A+E because they believed they would not be seen over the weekend and have therefore delayed treatment to their own detriment. Yet Hunt, in his solitary state of tantrum, jumps up and down and points the finger at doctors saying that by striking we are harming the public. No we do not want to strike and no it is not an ideal rebuttal but even when there is little other choice, it will not come at human cost – for every junior doctor that walks out on their shift, a senior consultant has voluntarily agreed to come in and cover their care. These are experts with over 10 years experience in the field that are behind us 100%; the solidarity between colleagues and patients is truly a touching silver lining.
This has been a reason for those in the profession to unite, appreciate what we have and feel passionate enough to defend it. I am so proud of the attitudes and actions of those around me, there were no media reports of tragedies over the strike and I can guarantee you the media were sniffing around for some like truffle pigs. I am also very proud that every interview with a Junior doctor on TV has been nothing but articulate, passionate, modest and truthful – it’s a shame that the same cannot be said for the politicians involved, the ones running our country (into the ground) and only concerned with personal gain.
Responses from some members of the public have also been heartwarming fuel for worn out motivation, from delivering tea and coffee to the picket lines, holding up placards, proudly passing out leaflets and stickers or telling their own moving and personal tales about how the NHS has benefitted them and affected their lives. One touching post I read was about a junior who had left her shopping at a supermarket checkout while she went to get change from outside, when she returned, a note and a cake had been left by an elderly lady in the next queue who had noticed her BMA badge and thought she ‘could do with a pick me up’.
There are some that say the reason hours and wages are being targeted is because we can no longer afford the NHS and wages for the entire workforce must makeup a large proportion of its funding. I agree that we live in a time where the original model of the NHS is now possibly outdated and creaking under the strain, people are living longer and returning with more chronic diseases. Since it was founded, it has become less about prevention and increasingly about lengthy treatment, which it cannot sustain without change. However parachuting in short-term consultants with short-term targets and short-term fixes is going to lead to – surprise surprise, no long-term solutions. There are too few large-scale innovations, remodeling and negotiations happening to support the current system and carry it into the future, the wrong reasons are being identified and targeted as points of focus.
What I think about the Health Minister: Jeremy Hunt has stated that this will be his last big job in politics, as the Panama scandal highlighted, he gets paid more than the prime minister and Jeremy Corbyn combined and increased personal wealth is clearly a priority on his agenda. It doesn’t seem hard to believe that such a man would be determined to push this through, undermining the very people that underpin the functioning of a thinly spread NHS, in the name of financial gain. He has co-authored a book on dismantling the NHS in the past and the permanent smirk he wears seems completely un-phased by the record-breaking unpopularity he has earned himself nationwide. To me this does not resonate with the persona of someone who truly cares about social healthcare, other people or in fact anyone but themselves.
A future within medicine?
If the contract were to go through, and it looks as though it may go ahead anyway, a large number of people would start looking for options abroad, withdraw from full time work, switch to private care or quit medicine altogether. Spaces would no doubt be filled by more candidates from EU countries (provided we stay in the EU) but I know that many would also choose to keep their jobs, despite facing increasing stress, burn out and responsibility. This is because of the nature of the vocation and the resilience of such an ambitious group of people, I have nothing but respect for each of them.
When I was on a GP placement recently I saw an elderly lady that had come in for a follow up appointment but was mostly seeking consolation for the third year anniversary of the death of her granddaughter. The doctor was not a personal friend but she was able to confide in him and reveal a vulnerability that would not have been the privilege of any other stranger. Despite the time pressures GPs face they always find time for such emotional needs, untreatable by conventional medicine. In fact my consultant himself had lost his own daughter to terminal illness and so they spent just a few short minutes empathising with each others grief, whilst contemplating the unfairness of life. I was moved by what I witnessed but as is so often the case, also made to feel incredibly grateful for everything I take for granted, including my own health and that of those closest to me.
There aren’t many jobs that can touch you so deeply on a weekly basis and there’s often an associated guilt that comes with just contemplating alternative options – ‘so you don’t want to save lives or help people any more?’… However I have to admit that this no longer a confident vision that I have for the rest of my life, its something I’m going to face and evaluate in baby steps, year by year. Like many other people I don’t want to be working for an organisation that treats me as another expendable cog in a wheel, under a contract that discriminates against women in 2016 and with a stagnant environment devoid of useful change or innovative ideas that can be successfully carried through the tide of red tape and bureaucracy. I haven’t yet become so institutionalised, as to believe that the skills are not readily transferable and could not have much to offer others elsewhere.