You can also see this article at The Guardian online
What's it about?
We all support the idea of a 7-day NHS. But we'd like the government to work with us rather than tell us what to do.
I am a specialist registrar who will be able to apply for consultant jobs in three years’ time. I am not alone in feeling unsure about what the future holds for me as a doctor in the NHS. And what appears clear from Jeremy Hunt’s seven-day proposal is that he has never directly worked for our world-renowned, precious institution.
There is no doubt that the medical needs of the public remain significant at weekends and that I, along with the British Medical Association, fully support the idea of more seven-day NHS services. However, focusing on the need for consultant presence at weekends is merely shifting attention away from bigger issues that are staring government in the face.
As a specialist registrar, I rely heavily on the guidance and experience of my consultants, most of whom have been practising medicine for more than 20 years. They, like most doctors I come across, are hard-working people. They work for the NHS, rather than for private firms, because earning lots of money isn’t their driving force for practising as a medic. Most of us actually really care about our patients, our colleagues and our communities. I’d be surprised if you could find me a doctor who hasn’t skipped lunch three days in a row or stayed two hours late because a patient has become acutely unwell, without receiving any time or monetary compensation and, quite often, no thanks.
All doctors have had to spend a good chunk of their lives working weekend and night shifts. And while this antisocial pattern was “what we signed up for”, there’s no denying that such working patterns can be emotionally and physically tough, often to the detriment of family, friends and personal health. Studies have shown that working night shifts can increase your risk of serious health problems and that divorce rates are higher in those working in caring professions and with unpredictable working hours. And on a logistical note, transport and childcare costs can soar at the weekend, further adding to time and financial pressures. So if doctors are expected to work within these parameters for the extent of their career, we need to feel that we are being considered within this decision, not just being told what to do.
Jeremy Hunt states that “timely consultant review when a patient is first admitted and consultant-directed interventions” will save lives. This is undoubtedly true. However, even consultants can’t do everything and if the health secretary wants consistent 24/7 care then he’s going to need to give them a hand. Doctors work as part of a cohesive team and rely on diagnostics in order to give patients the best care possible. So we need to know where the extra nurses, radiographers, laboratory staff, porters, administration staff etc are coming from too.
What he likewise does not acknowledge is that healthcare professionals have many roles. Clinical care is at the forefront but don’t forget that consultants have important managerial, educational and health improvement roles alongside their practising duties that require adequate time to fulfil. This may be alongside trying to have a personal life too. So while working weekends may improve standards of patient care on a Saturday and Sunday, what happens on a Monday when that doctor has accrued much-needed time off the shop floor? Again, something we need to know.
What Hunt’s proposals also painfully neglect are the issues of elderly care and social placement. Significant numbers of accident and emergency admissions are for elderly patients or those with other social and long-term health difficulties that do not require emergency care but present as they “had nowhere else to go”. The government needs to look at how these groups of people can be effectively supported on a day-to-day basis to improve their individual outcomes and remove pressure from already bursting-at-the-seams emergency departments. Hunt also neglects to mention his recent public health cuts, which are taking money away from preventative health strategies and stealing decision-making responsibility from the very people delivering care.
What our NHS needs now is more staff, adequate compensation and consideration during antisocial hours and sufficient budget to cover our expanding ageing population with ever increasing needs. It does not need stab-in-the-dark ideas to make it look like progress is being made. NHS workers are already working in low-morale conditions, demonstrated by the the high levels of stress and anxiety observed among staff and the falling numbers of new doctors wanting to train in general practice and accident and emergency medicine. The government’s unwillingness to propose any solid plan to implement a well-supported seven-day service for patients and staff alike is only further testing the goodwill and capability of its frontline workers, the consequences of which could be irreversible.