“If I don’t come to work today I genuinely won’t be able to pay my rent next month”.
“If I don’t come to work today I genuinely won’t be able to pay my rent next month”.
I anaesthetise our third patient of the day for a repair of a brain injury while the doctor assisting during the operation tells me of her feelings of guilt breaking the junior doctor strike and coming to work. Saddled with over £100,000 student debt after five or six years of medical school, a starting salary of £32k and spiralling rents in a very expensive London means that a six day strike is financially extremely painful.
As the longest junior doctor strike in the history of the NHS starts, we waved goodbye to the doctors doing the Tuesday night shift while consultants and specialist doctors took the emergency phones and got on with the day’s work. The weekly rota has been re-written, night shifts covered and the doctors in charge of our rota have ensured there is a safe level of basic staffing for the entire strikes. Only then can we see what additional services we can run.
On a Wednesday I normally anaesthetise patients undergoing specialist abdominal surgery, but this was cancelled to allow safe cover of the busy emergency and trauma service. On a normal day we would have treated four or five patients, all of whom have been waiting for around 18 months for their operation and undergone a six week strict preparatory treatment. I know how disappointed each one of those patients will have been when they received the phone call to say their surgery is cancelled. Many will have taken time off work, had childcare arrangements, and when motivation and a positive psychological state is so important for speedy recovery, this news will have set our patients back significantly. Most of my colleagues have seen a change in their working schedules, with impact well beyond the strike days and I know some have had to cancel annual leave over Christmas as a result.
We have learned much since the start of the strikes and we have been able to increase the service we provide through more efficient deployment of staff and great flexibility of our consultants and specialists, but still run less than we would on a full operating day. Nursing and operating staff shortages are an everyday problem for us without any strikes. Having our activity scaled back means we have a well staffed department and when at 3pm two patients need immediate emergency operations at the same time we can accommodate them without having to leave other areas severely understaffed.
In spring last year the strike was a relative novelty and there was passionate support for the junior doctors. The support expressed then still burns bright but is now mixed with frustration and some disbelief that we are in the same situation nearly a year later.
The day progresses smoothly and with efficiency. On the wards, the patient discharge procedures are completed by the consultants assigned to ward cover, referrals are made and the ward rounds continue. Having senior doctors at the frontline means decisions get made quickly and our patients get good quality care. Most of us have worked together for many years so there is an ease in our interactions and a great spirit of cooperation. I know this isn’t necessarily the case nationwide and many hospitals have struggled to staff rotas, but throughout the day there is a spirit of friendly cooperation.
Although the majority of junior doctors are on strike, there are more coming in. Many cite financial worries, but there are also concerns over the progress of their training, missing out on essential operating days and not losing out on maternity pay. When the news of the six day strike just after new year came out many of the doctors I know were surprised and concerned at the length proposed and I know some of them have elected to strike for just part of the time. I feel that six days is a long, long time to strike. Not necessarily because it compromises patient safety, but more because of the impact it has on the doctors themselves. Postgraduate specialist training is strenuous and demanding, with constant assessments and exams. I worry that the strikes will set the doctors’ training back significantly and some may have to extend their training to achieve all the milestones necessary to progress in their careers.
How have we got to this point? A generation ago the idea of doctors going on strike for even one day would have been inconceivable. The doctors I speak to freely share their anger, not just at their pay erosion but other factors such as the rigid, inflexible training pathways, enormous bureaucracy every time they change placements and frequent mistakes in their tax code and pay every time they rotate to a different hospital, which can be every three months. They also have to pay their own professional fees and postgraduate exams, often many thousands of pounds in a single year. The frequent change in employment can also lead to difficulties getting a mortgage approved as well as less tangible feelings of isolation, transience and insecurity. We risk creating a generation of doctors whose experience of practising medicine is tainted by mistrust of management, lack of respect and frustration.
What about our patients? As I wander down to the emergency department to help sedate a patient with a broken ankle the consultant in Emergency Medicine introduces me and she replies “ah of course, it’s the junior doctor strikes today” with a sigh of inevitability and acceptance, but not even a hint of anger or frustration. She received fast, efficient high quality treatment and I know this will be the same up and down the country during the strike days.
The atmosphere on the strike days is palpably different to a normal day. I work in a hospital that deals mainly with urgent and emergency work, so the workload isn’t that different from normal, but the buzz of teaching and training that is so integrated into our work just isn’t there. We can provide a good, safe service but without our doctors in training a part of the core team is missing. We need our future consultants and specialists back on the frontline. The NHS needs to regain the trust of junior doctors, our patients need the strikes to end.