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NHS crisis: a junior doctor’s view

NHS crisis: a junior doctor’s view

New junior doctors have just completed their first week working in England’s hospitals. With the NHS facing a summer crisis, what’s it been like?

Every year, on the first Wednesday of August, one of the largest workforce changeovers takes place.

Fresh out of med school, new junior doctors start on hospital wards up and down England. And at the same time more experienced staff change roles, meet their colleagues, and familiarise themselves with new patients and ways of doing things. 

In 2009 the day became known as “Black Wednesday” after a report  found that people admitted to English hospitals had, on average, a six per cent higher mortality rate than people admitted the previous Wednesday. 

In response, NHS trusts introduced induction programmes and mandatory training to be completed before the first Wednesday of August.

But when the NHS is tackling a huge backlog due to the pandemic, nurses and doctors are threatening to strike, and there are tens of thousands of vacancies to fill, what’s it really like to start work in a hospital right now?

***

Tortoise spoke to one new junior doctor who’s just completed their first week in a busy London hospital. 

We’ve voiced up what they told us…

“After my first day, I went home and all I wanted to do was cry. I was overwhelmed. My training was meant to be three days by the old team, just before they moved on.

There were two staff covering six positions. They were fighting an impossible task of keeping patients alive with below necessary staffing numbers. There was no time to teach us.

So I started on day one, with a username and log in to the most deadly computer system in the country, and I still don’t know what 90 per cent of the buttons do.”

Junior Doctor

Induction programmes are designed to help prepare junior doctors before they start. But the stark reality is that staff are too busy, and starting on the wards is a baptism of fire.

“The staffing crisis means that there’s a complete lack of support. You’re told, “It’s the NHS, you learn through doing it wrong first time” and that’s the reality when there’s too few staff and, therefore, no training given. This would be alright if my job was something like watering flowers, but it’s a heavy personal toll when each decision could save or kill a patient. It’s unsustainable for the NHS.”

Junior Doctor

Last month, a report by the Health and Social Care Committee found NHS England is short of 12,000 hospital doctors, and more than 50,000 nurses and midwives, calling it “the worst workforce crisis in NHS history”.

“One day, we were three nurses short on the ward. We were taking shortcuts because we couldn’t physically complete tasks, which could genuinely impact patient health.”

Junior Doctor

And although the government promised to publish its workforce plan in the Spring, it’s yet to materialise.

“Almost half the registrar jobs remain unfilled. That means those who are in are worked to the bone, covering ridiculous hours, and cannot support new juniors.

The stark reality has hit me. In the NHS, we don’t have safe levels of staffing to maintain good patient care, and doctors and nurses are leaving to work in other careers or to work in other countries. The exodus of staff is so obvious and yet the government deflect and turn a blind eye.”

Junior Doctor

***

Then, there’s the poor condition of the hospitals. 

In his 2019 manifesto, Boris Johnson promised to build 40 new hospitals by 2030. But that’s  currently being reviewed by the government’s spending watchdog after it was found that the Department of Health was counting a new wing as a new hospital. 

“The hospitals are out of date, they’re falling apart. You’ll often notice hospitals are by far the older buildings in the vicinity.

Basic items like bed lamps dangle broken from their arms, bits of building are crumbling away, and corridors are partially blocked with “wet floor signs” from leaks.

Most worryingly, the poor infrastructure impacts patient health on a daily basis – we’re running around, trying three different printers to send investigations off for a suddenly very ill patient rather than being able to present at the bedside and monitor… then there’s prescriptions that won’t register on the system because there’s a “system fault.”

Junior Doctor

***

The pressure from understaffing and poor working conditions means there’s high stress and low morale amongst staff.

“Burnout is through the roof. I’m 5 days in, 61 hours worked. During my 13 hour shifts, I’ve had no breaks. I’m not paid for those break times, but I don’t get the break times either. Because, if I have a break, or leave work on time, patients don’t get the basic minimum of care they need.

I’ve hardly slept because I’m dreaming about patients dying.

Of my 61 hours this week, I will be paid for 50 of them. Pay comes to £11 an hour. That’s £11 an hour for the stress of saving dying patients. It’s £11 an hour, where one mistake could kill my patient. £11 an hour to stay awake at night worrying about patients.

We’ve been offered a two per cent pay rise this year. With inflation expected to hit 12 per cent in October, that’s a 10 per cent relative pay cut to last year. Essentially, I’m working a month for free.

The NHS will strike. If there aren’t changes, the current exodus of staff will bring the NHS to a standstill.”

Junior Doctor

But amid all the chaos, just like throughout the pandemic, there’s a familiar message. It’s the people who make the NHS. And it’s those people who are sounding the alarm.

“My favourite part of the NHS is the team. In the face of adversity, everyone forms a strong connection and fights for each other and their patients. The nurses and doctors I’ve met so far are truly inspiring… and in just 5 days, I guess I achieved what I’m supposed to do, I saved my first patient.”

Junior Doctor

This episode was written and mixed by Imy Harper.


After this episode was published, Health Education England responded:

“We have worked hard to ensure that robust educational and personal support mechanisms for F1 doctors are in place, such as named clinical and educational supervisors, a shadowing period prior to commencing in post, and structured teaching programmes. 

We know that Foundation doctors may have been exposed to a range of traumatic and distressing experiences as they begin their medical careers, but we would like to encourage them to seek the support that is available through their supervisor networks and their training programme directors.” Dr Mike Masding, Lead Foundation School Director at Health Education England