I DON’T think I can remember a time when the National Health Service wasn’t in crisis. If it’s not an impending flu epidemic then it’s a lack of consultants working at the weekend; or an overspent budget that threatens the continuation of routine surgical interventions; or a lack of GPs to provide patients with the kind of responsive service that general practice requires.
Presently the focus is on the change to the conditions of work and pay for the junior doctors and by all accounts they are not happy. The Health Secretary, Jeremy Hunt, does not appear to have made many friends among them and his handling of the whole issue can at best be described as clumsy and crass.
While the Secretary is of the opinion that he is offering them an 11% pay rise, the doctors argue that the reclassification of weekday evenings and much of Saturday as “normal office hours” will erode any pay increase or worse.
They also say that in the longer term the proposals will remove automatic pay progression in favour of a meritbased approach. The BMA is currently holding a ballot to gauge its members’ appetite for strike action and by the time you read this the result will be known and battle lines drawn (or not, as the case may be).
Far from perfect
I have some sympathy with the junior doctors. Vets have long had to (unreasonably in my view) work Saturdays and Sundays and late evenings as “normal office hours”, and while this has improved to some extent in recent years with the advent of emergency hours providers, it is still far from perfect. The junior doctors certainly don’t want to take a backwards step in this respect and there is plenty of evidence that they are not prepared to.
Already there are reports of a huge increase in the number of doctors enquiring about the opportunities for overseas working and one can see why. This very summer I spent three weeks in Australia and, on a tour boat sailing to the Whitsunday Islands, I got talking to a junior doctor from South Wales.
She was in her late twenties and had been working in the UK NHS specialising in A&E, one of the areas where the health service is finding it most difficult to fill senior posts.
Fed up with the long hours and poor rewards, she had taken a job in A&E at a hospital in Townsville on the Queensland coast. Her conviction that she had made the right choice was palpable.
She had a better salary, vastly reduced working hours with significant compensatory time off for antisocial hours, and a better and more relaxed working environment.
With the world an ever shrinking workplace for those with the right skills, that is what our NHS has to compete with.
With this in mind it is surely shortsighted of the Government to alienate such a mobile workforce that it simply can’t do without. And the evidence for that is clear to see.
Heavy reliance on locums
Many (perhaps most) A&E departments rely heavily on “locum” staff to provide anything like a decent service at the weekends. The cost of employing locums far outweighs that of regular staff with quite frankly eyewatering sums being quoted for locums doing 12-hour shifts.
How short-sighted to make it even more likely that the demand for locums will increase and with it the cost of funding them.
I have worked as a locum vet in my time and I know there are many vets out there who build a career and make a decent living doing just that. Many of the locum vets I’ve met have been excellent and there is no evidence to suggest that they are less competent than their salaried colleagues.
I’m sure the same can be said for medical locums with some excellent doctors among them. Indeed many of them may be in salaried employment and just be taking on locum shifts in order to supplement their regular income.
But I also suspect that some locum doctors do not have the same level of commitment to the organisation that a salaried employee might have and there is also the question of what checks are done on their qualifications and work experience to ensure they really are up to the job. CVs are sometimes more a work of fiction than fact and talking a “good game” is not always the same as playing it.
Indeed there have been a few horror stories in the press of late concerning locums who have made serious clinical errors (or in some cases have been fraudulent in gaining their positions), so value for money and public safety can very easily be compromised.
Improving their lot
Would it not be better to provide the junior doctors with the sort of pay and conditions (and the respect that they deserve) that create a work environment where they genuinely want to stay? Is that not what successful companies in the private sector are constantly striving to do? That is to keep hold of highly trained and valuable staff in whom they have invested much both in terms of time and money.
Private veterinary practice can also be neglectful in this respect. Too many practices have a large staff turnover and instead of stopping to ask why, the common response seems to be to complain about the commitment of this generation of veterinary surgeons and to plug the gaps with locums.
This has a negative effect both on client satisfaction and almost certainly continuity of patient care – which is highly likely to impact on the bottom line, the maximising of which is usually the driving force behind the shortsightedness that leads to the high staff turnover in the first place.
I will watch the evolution of the junior doctors’ dispute with the Health Secretary with great interest and I urge those of you who own veterinary practices to do the same.
You can only push people so far, and in particular those who have a very real opportunity to vote with their feet.