During my first year as a doctor, I worked in orthopaedics. One morning, I phoned the radiologist who was in charge of approving scans. He paused on the end of the line when I introduced myself, then asked if I still covered urology as well as orthopaedics over weekends. He let out a little laugh when I replied that I did, and told me he’d done the same job seven years before, and it had been the only time he’d ever cried at work. That was horrible, he said, but you’ll be OK.
The following weekend, when I was covering two specialities and about 80 patients, jumping between consultants who wanted many different things at the same time, I remembered what he had said. It was horrible, but I was OK. And the patients I was looking after were OK, too.
Some months later, halfway through my first year, the pandemic began. I remember a particularly awful moment, when a senior doctor who had been working on a night shift greeted me one morning. “It’s never going to end,” he said, shaking his head, almost speaking to himself. “It will be here for ever, and there’s nothing to do about it.” I had kept my belief in the first months of the pandemic that, no matter how horrible, things would one day get better; hearing a senior colleague say they may never change was devastating.
If you want to know why so many doctors and nurses are leaving the profession, you need to understand that we no longer have anything to say to each other about how terrible things are, and there’s no longer any belief that things can change. It’s important to share experiences with your colleagues; it meant something to know the radiologist I spoke to had experienced similar things. But the only stories we have now are of how patients are waiting endlessly to see a doctor in A&E, or for a bed once they’ve seen a doctor, or how there just aren’t enough doctors and nurses for our work to be anywhere close to being safe.
The second important thing is knowing that things can change. This belief is vital when you’re working at night, or on your own, or with someone who is acutely unwell. It’s important to know that people you work with have been through what you’re going through and have made it to the other side. But the only change many people I work with can see is quitting. I am currently taking time out of clinical practice, and so many of my colleagues are considering doing this permanently: four in 10 junior doctors report they plan to quit as soon as they can find another job.
There are other solutions besides leaving the profession. One crucial tool is industrial action. It’s heartening to see the public support for the recent nurses’ strikes. Junior doctors began balloting for strike action on 9 January and are asking for pay restoration, having faced a real-terms pay cut of 26% since 2008. Asking for such a restoration will inevitably cause a backlash, which has in fact already begun. But it’s vital to remember that the strikes are also an act of protest against a government that has overseen a 12-year destruction of the NHS, which has caused a catastrophic toll on patient safety.
While a restoration in pay would inevitably help staff retention in the NHS, the problem of people leaving their jobs will only be solved when staff feel they can safely and effectively care for their patients. Rishi Sunak has promised to “practically” eliminate waiting times for those who have waited a year and a half for treatment. It is estimated that this will take months (waiting times of a year are not expected to be eradicated until spring 2024). This is not enough to solve the current crisis in emergency care, and it is not enough to rebuild the NHS.
I have frequently been the only doctor looking after patients who are waiting 10 hours overnight in an urgent care centre, and for every patient who is rightly angry when it is their turn to be assessed there is another who thanks me for seeing them, even as I apologise for it taking so long.
Sometimes it feels as though continuing to work in such conditions makes me complicit in perpetuating a disastrous and dangerous system. Accepting the thanks of a patient who is just happy to be seen under any circumstances is accepting a situation that is unacceptable. It is no wonder that junior doctors are voting on strike action.
Sunak’s government needs to do better than the slow and steady approach it advocates. A first step should be to recognise that the NHS is in crisis. It is not enough to say, as a Downing Street spokesperson did last week, that what is being faced is an “unprecedented challenge”, and that the government is “providing the NHS with the funding it needs”. It is clear to myself and my colleagues, including the chair of the Royal College of GPs and the president of the Royal College of Emergency Medicine, that this challenge is an emergency and more funding is required to ensure patient safety.
While we wait for the government to recognise a crisis of its own making, people continue to work for a system where the problems and pressures are ever present and mounting, and there doesn’t seem to be an end in sight. It may be too late to stop doctors voting to strike, but it’s hopefully not too late to stop even more doctors voting with their feet and leaving the NHS for good.
Peter Endicott is a writer who has spent time working in the NHS as a junior doctor
