One Profession: thoughts after Newsnight

Last night we watched Newsnight’s vague attempt to create a debate between two junior doctors on the same side. The interview set-up of course could never hide the glaring fact that The Department of Health and NHS England remained nowhere to be seen. In the run up to an unprecedented and desperate decision by junior doctors, their absence only confirmed their disgrace. Junior doctors have made it clear that they feel pushed into industrial action by a government who refuse to get back around the table. The point of course that seems obvious to the majority of people outside of The Department of Health is that forced introduction of working conditions that your frontline staff are at odds with was never an option. Mr Hunt will talk to you about time already spent talking, he will tell you that the people of the England need closure on this topic, for the sake of the NHS. The truth is that what the people who rely on the NHS need is an amicable resolution and that is something quite different. Talking remains the only option; for as long as it takes. There will never be a time when Mr Hunt’s ‘nuclear option’ becomes the sensible thing to do.

The absence of any government accountability on Newsnight last night, left two Junior Doctors in the hot seat; orthopaedic surgical Registrar Roshana Mehdian and registrar in palliative care Chris Kane. What I would like to point out today is that the problem was never that these two professionals have slightly different views on our upcoming industrial action. The problem lies at the feet of a media which seems unused to the concept of professional and honest discussion between peers and suspicious of the honesty required in medicine; where we admit to possible risks and discuss them openly, in the hope of coming to the best solution for our patients.

Participation in industrial action for a doctor is difficult and it requires two separate thought processes. First we ask ourselves do we think that a full strike by junior doctors has become warranted on the bases of our treatment and the proposed working conditions? The answer to that question by doctors in overwhelmingly yes. The BMA have triggered action in response to an overwhelming 98% mandate for it’s members. The second question is one that comes to every doctor multiple times per day, whether it is about if you can refuse emergency care within your department or what time you go to bed at at night; is this fair to my patient?

I am taking a liberty here, but I feel absolutely sure that both Roshana and Chris will have been through this exact same though process. At the end of it, they have come to different conclusions, but what we need to remember is that both these doctors can be right, at the same time. Their decisions are both moral and just, within the context of their specific work. The process of questioning the effect everything has on patients requires an honesty and professionalism that we simply do not see in mainstream politics. The politics of junior contract from a government point of view has thus far been about spinning statistics, repeating lines and mistruths and keeping up an appearance of unwavering self assurance for the public. I have said before, that is simply not our fight song, we were never going to sing like that. As medical professionals, our behaviour will always be different, and I am not sorry for it. We are not a political party trying to drag ourselves the top of the opinion polls by whatever means necessary. We are not afraid of honest discussion and we are not afraid to do this openly.

My personal view on the industrial action is that it is the responsibility of every single doctor not to presume safety will be maintained, but to actively check that their departments can cope. Similarly, despite their avoidance of public scrutiny on Newsnight, it is the responsibility of NHS England to take the move by junior doctors seriously and free up emergency and urgent cover as much as possible by cancelling elective, non urgent work. It is also the responsibility of our employer to speak up on a specific trust basis if they feel their own system will not be able to cope; because junior doctors and our consultant colleagues will listen and do everything they can to ensure safety is maintained. Let’s not of course forget that doctors have been coping with an increasing frequency of rota gaps, less than optimal staffing and over reliance on a carousel of locum doctors for a long time now. This is what we do. This is what we are used to.

Next week I will be on strike because I have assured myself that the consultants within my department are perfectly capable of maintaining a safe service. I believe that the majority of junior doctors will be able to come to the same conclusion but I also believe that we should listen to those who have concerns within the context of their work. Last night, Roshana and Chris refused to give Newsnight the standoff they craved and it was entirely the right thing to do.

Junior doctors remain united; one profession, we stand together and we stand with our patients.

This is Everything that is Wrong with the NHS

Being a member of parliament is an important job, being a Secretary of State more so. I’ve asked Mr Hunt before if he knew what it was actually like to hold a person’s life in his hands. Perhaps, were he to reply, he might answer yes, that he has spent his career making ‘difficult decisions’ and that of course it is his job to champion a safe and patient centred NHS.

He would be wrong.

The truth is that our Secretary of State for Health has absolutely no real experience of what it means to hold a life in his hands. Sure, he make decisions that have the potential to impact broad swathes of people. Sure, unlike me he has the power that comes with his office. Sure, his job is immensely important, but unlike me he has absolutely no responsibility for individual patients in real time. Contained in that statement is everything that is wrong with the modern NHS.

To the MPs of Westminister, as an individual, I am inconsequential. Indeed, you might say that the row over junior contract has taught us that even as part of a voice that is fifty thousand people strong, I am part of something unimportant to policy making. While I might be invisible to our government however, to the patient on front of me I am often everything.

When I stand on front of a patient and tell them not to worry, that I will give them the care they need, it this promise that is the most important thing in the world to that person, and it comes from me….and from every single member of the healthcare team. Promises from the ground up; that is what actually makes a difference to the individual patient.

Everyday, millions of NHS staff make millions of promises to patients. We promise Mrs Smith that we will get her treatment started and do our best to get her home in time for her grandson’s graduation. We tell Mr Clarke not to worry about his upcoming surgery, that he is in safe hands. We tell Mrs Brown that the lump in her breast isn’t cancer…or we tell her that it is, unfortunately, and that we will be by her side through her journey.

It doesn’t matter whether that is a promise to help a patient die where they wish to die or to push on somebody’s mother’s chest and do everything you can do to drag their soul back into a room. It doesn’t even matter if it is merely a promise to save somebody the ice cream that they like while they’re off the ward for a scan, they are all important. It is through these promises that the NHS delivers care to individual patients, every second of every day of the year and each one of these promises is one that the health secretary or even the Primeminister himself cannot make.

I am in the business of individual patients. Our government is in the business of policy.

And what happens when things go wrong? When you look at a patient or their loved ones and recognise that outcomes were not what you or the patient wanted them to be. Sure, the Department of Health may talk of ”learning lessons”, they might pat themselves on the back for the lessons they learned and solemnly promise to carry this forward into policy making.  But of what real value is that? What our modern NHS leadership seems to have forgotten is that without me, their promises are useless. Patient care is experienced from the ground-up and Mr Green probably doesn’t care if it is government policy to listen to patients because he is unlikely to every sit on front of the government. When he comes in to hospital what is important to Mr Green there in that moment is just if I actually listen to him.

I am of course not suggesting that the Department of Health is without consequence, but somewhere along the line, it seems to have been forgotten that they are there to support us in our care for patients.

Nurses, doctors, health care support workers, pathologists, radiologists, physiotherapists, porters……the Department of Health forgets that we are the NHS; we are the good, we are the bad, we are the agents for change.

The NHS will only ever be as good as it’s frontline staff and our Department of Health would do well to remember they are just passing by.

In an ideal world, it would be the corporate heads of services and government ministers who would be flat out trying to prove to us that listening to them is worthwhile; that their ideas are sound and their motives are honourable. It should never be the opposite way around and that is everything that is wrong with our NHS and everything that has pushed junior doctors into this mess.

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We will not move backwards

strong-woman.jpgMy maternal grandmother was born in 1923. In 1945 she worked as a laundress in Dublin. This was back breaking work, the sort of toil that makes Friday night on the floor in A&E look like an easy ride. In the Summer of that year she stood with 1,500 laundry workers on a picket line with the Irish Women’s Worker’s Union to demand not one, but two weeks paid holiday from her employer as a basic entitlement. The strike was monumental for more than one reason. Other working class unions identified with the laundry women’s struggle and offered support where they could, the power of the ruling classes, government and even the church hierarchy however rallied around the wealthy business owners and as a result the strike was dragged out over some fourteen weeks. For working class women in the climate of post war Europe, this hardship was not to be sniffed at; but they persevered.

Secondly it was a strike by women, who stood firm in their worth at a time when they did not have the luxury of being able to expect equality and when they won, they won a right which was extended to all Industry workers in Ireland.

In 1948, my grandparents married and over the next 15 years between 1949 and 1964, my grandmother had twelve children. When the youngest of her children was about 9 years old she returned to work as a cleaner in a hospital and continued this work until she was seventy years old.

In 2012, the British Medical Journal (BMJ) quoted Professor Jane Dacre, then medical school director of University College London as saying

“when the 2007 female cohort [of specialty trainees] become consultants, female consultants will be 55% [of the workforce]. So feminisation is a fact. There is a tsunami of women coming through” .

women docsPersonally, I take a little issue with an increase in female consultants being compared to a natural disaster (!) but 9 years later it is interesting to note that according to NHS employers current data, the proportion of female doctors employed as consultants is actually still just 32%. The interest in a growing cohort of female doctors at this time sparked the BBC headline ‘women docs weakening medicine’….a headline which has been be periodically dragged out since, perhaps most notoriously in recent times by Dominic Lawson in The Times.

My grandmother was a tower of strength. She was a giant and I have told you her story because it is one of the reasons I am lucky enough to have grown up knowing the truth; that feminine is anything but weak. To me, the idea that the association of female workers with weakness has continued to drag at the heals of female doctors, even in the twenty first century, is unbelievable. More than unbelievable though, it is just wrong.

You will understand now why, when I tell you that the idea that being female would ever be seen as a negative attribute when I became a doctor was not what I expected at all. Thoughts like that were just not part of my world. When I was half way through my medical degree however I was assigned a placement in intensive care at a district general hospital. As is the norm, I very much looked up to the male consultant we were attached to, but when I told him it was my dream even back then to do intensive care medicine as a career, he told me it was not a career for females. When I left the hospital that evening, my world fell apart. Dramatic as it sounds, I was honestly devastated. It was like I had been hit with a wrecking ball; all this time I had no idea I was inherently inadequate and what was I supposed to do with my dreams now?

Thankfully this was just a temporary break in my self esteem. I soon remembered who I was and where I came from and I have never encountered a similar attitude from any of my intensive care mentors since. In fact my experience since has been very much the opposite and I have some consultants at University Hospital Coventry and Warwickshire to thank for that.

Yesterday The Department of Health Published it’s own equality impact assessment (EIA) on the junior doctor contract they have lined up for imposition and we were reminded that the facade of support for gender equality in the workplace is depressingly fragile. As a female I read the words with absolute disbelief and perhaps simultaneously the most comforting and frustrating thing is that every single male doctor I have spoken to has shared the same reaction.

“We consider that any indirect adverse effect on women is a proportionate means of achieving a legitimate aim”

“…could give rise to inequalities implications…..but if this were the case we consider that any impact would be justifiably legally as indirect impact resulting from a legitimate aim”

“…while this may disadvantage lone parents (who are disproportionally female)….in some cases this may actually benefit other women, for example where women have partners…”

I will not linger on the point that the ‘legitimacy’ of aims are only as trustworthy as those in charge and that so far, The Department of Health have not at any stage proved that their association of the new junior doctor contract with a so called ‘seven day NHS plan’ is remotely justified. Their aims are far from legitimate and if you take one piece of truth from this writing I would like it to be this, that junior doctors have never been a barrier to improvements in NHS services.

The language used by the department of health in their EIA is both frightening and deeply concerning. But this time, I have absolutely no intention of letting my world fall apart, temporarily or otherwise.

The question of course is where do we go now? This is not something I know the answer to, but I know this much; we will not go backwards. We will not accept a contract that attempts to once again kindle the discrimination of female doctors in the medical workforce.

So let me be clear Mr Hunt, I am a female doctor, I am an asset to our NHS and I will not be collateral damage in your plans.