Goodwill has kept NHS going, but the government has even taken that

A junior doctor explains how she and her colleagues have been driven to an all-out strike

Image: The Weekly Bull

I don’t want to go on strike. I don’t want to leave my patients, my seniors or my healthcare colleagues alone in the hospital.

I don’t want to sit worrying about what will happen to our patients, how the hospital will cope, or what the knock-on effects of cancelled elective and routine care will be. None of us wanted it to come to this.

But I will strike. I will join the picket line. And I would like to try to explain why.

As a junior doctor, I’ve become used to working long hours, often far over my contracted hours (for which I don’t receive overtime pay, whatever rumours you may have heard). I’ve become accustomed to having a stunted social life, turning down wedding invitations, family reunions, Christmas days, birthdays.

Like most of my colleagues, I work one in four weekends and I work two sets of three to four night shifts every seven weeks. I work as a junior doctor: I knew what to expect.

As an NHS employee, I’ve become used to working in a ‘no-frills’ profession. No car park spaces, no free printing or teabags, no funding for your training courses or your exams. I spent £412 of my own money on the last compulsory exam I took.

We get basic on-call accommodation a student might turn their nose up at. We work in the public sector— we know what to expect.

What we didn’t expect was for the government to come for what little we have. To treat us as the enemy, to paint us as greedy and lacking a sense of vocation. To cut what is not a huge pay cheque and to increase our already considerable antisocial working hours.

We can put up with a lot. Working in the NHS you do tough things on a shoestring every single day. Everybody who works in the NHS is used to having to make up gaps, take in the slack, bear the brunt— and we did so cheerfully because we knew the NHS runs on the goodwill of its workers.

But this contract is asking us to go beyond the bounds of what we consider safe, what we consider fair. Goodwill is the oil which keeps the battered, rusting machine that is the NHS running. And now Jeremy Hunt has robbed it even of that.

On the front line I see a National Health Service that is creaking; it has been starved of real-terms funds and cuts in social care have left hospitals bulging at the seams, constantly patching up gaps in rotas and services.

It is hard, when standing on the inside, to see this state of affairs as anything other than a manifestation of this government’s ideological opposition to the welfare state, whatever lip service it may pay to it.

The NHS is bearing the brunt of austerity measures, despite repeated Conservative claims of increases in funding and of ‘the deficit being cut, not the NHS’.

In my own trust, it is no longer a shock to see patients waiting in trolleys in A&E corridors for several hours, or to see A&E become a ward due to a lack of beds. It’s no longer a shock to hear of massive gaps in the rotas or to have to carry several bleeps to cover for absent doctors.

Every day I receive e-mails from the trust desperately asking for people to cover the ever-widening rota gaps.

This government, and Jeremy Hunt, have deliberately conflated elective and emergency services in order to scaremonger. They want to distract the public so they won’t see what 53,000 junior doctors can see: that this contract is purely a money-saving enterprise and nothing more.

It is a means of introducing cuts into the NHS without calling them cuts, and it is just the beginning. Nurses, porters, consultants, lab technicians, admin staff, radiographers, physiotherapists, and all the other staff that make up the great machine that is the NHS, can expect the swinging knife of austerity to come for them next.

To redefine their weekends and their nights (up to 2am) as normal working days. To take away their safeguards, their breaks, and their private lives.

We have a seven-day emergency service already: if you come to hospital, whatever the time of day or night, whatever day of the week, you will be seen. And you will, despite everything, receive world-class care. If you want to improve emergency care at weekends, you can’t do so by stretching junior doctors any thinner. We need more junior doctors: not more tired junior doctors.

We don’t currently have a seven-day elective service: you won’t usually have a routine/planned hip replacement or an outpatient appointment on a Saturday or Sunday.

If you want to increase elective services over the weekend, it doesn’t take a great deal of thought to realise that this will require more than just the presence of junior doctors: you will need more receptionists, admin staff, consultants, radiographers, lab technicians and a host of other staff, to also work more weekends.

To do this requires more funding. Logically, at least two sevenths more funding than elective care currently receives. This has not been promised. This is an ill-thought-through, jumbled set of woolly ideas lumped under the heading ‘a seven-day NHS’. It has not been costed, tested, or approved by any of the royal colleges or major patient groups.

This imposed contract will take away safeguards, weak as they already are, which supposedly prevent me from working beyond my contracted hours. Theoretically, it promises to reduce the number of hours I can work in a week to 72.

But if the safeguards are taken away, and I and my colleagues are expected to man a seven-day elective service as well as a seven-day emergency service without any extra staff, it doesn’t take much to make the leap that we will be expected once again to take up the slack and will end up working many more hours.

This contract will stretch an already thin and tired workforce even thinner. There is a shortage of junior doctors already: this needs to be addressed before we can safely try to increase services.

I never asked for a pay rise. You may not believe it but I’m still naive enough to think of the satisfaction of helping people as the main reward for my labour.

That satisfaction will diminish in the nightmarish future this contract promises: a future of less safe patients, and dangerously overworked doctors.

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