Why we need to stand by our junior doctors
It has been an inescapable facet of recent news that all is not well with the NHS. Health Minister Jeremy Hunt has made some controversial comments in the past few months — a personal favourite of mine is when he made the misinformed assertion that doctors “must work weekends”, as though they don’t already. It was an irresponsible claim that led to reports of acutely ill patients presenting late to hospital through a misguided concern that there would be no one available to treat them at the weekend. It is scaremongering, at the cost of the credibility of what is widely acknowledged to be one of the best healthcare systems in the world.
It’s easy to forget what a privilege it is to have the NHS but, having lived abroad for four years, I can truly say it is a phenomenal thing: can you imagine, say, having to pay for a loved one’s ambulance to A&E? Or not being able to afford a life-determining organ transplant? But I digress, perhaps: I am writing specifically in order to address the issue of junior doctor contracts.
For all that Mr Hunt attempts to re-dress the situation at hand, he has essentially proposed unreasonable contracts for junior doctors — hence the protests taking place in London last weekend. Currently, if medical trusts make junior doctors work for more than 91 hours a week (as part of a rota), they are charged financial penalties. Under the proposed changes, however, the cap on hours that junior doctors can work would be removed. Although Hunt claims the intention is to reduce working hours to 72 rota hours per week, this is simply not enforceable — if there are no penalties, there is nothing to stop trusts from overworking their junior doctors.
Under the European Working Time Directive, junior doctors are not supposed to be working more than 48 hours per week. However, this is averaged over six months, meaning doctors are still legally able to work for up to 91 hours per week, provided they get a few days off three weeks later. With this in mind, the proposed removal of penalties seems all the more questionable. And this is all without even considering the amount of unpaid overtime these doctors are doing on top of their rostered schedule.
As many signs and banners at this month’s protest pointed out, “tired doctors make mistakes”, and these changes will have implications for patients as well as doctors. We should not be jeopardising patient safety by allowing the implementation of a system where junior doctors can and will be more overworked than they already are. What is more, it will have repercussions for the NHS itself — last week, a survey suggested that as many as 70% of junior doctors would leave the National Health Service if the contract were to be pushed through. Even if a significantly smaller fraction than this 70% were to leave, the damage to the health system would be irreversible. Indeed, one has to wonder if this is in fact Mr Hunt’s plan, further ushering us into an age of privatised healthcare.
In his book Do No Harm, brain surgeon Henry Marsh lamented the initial reduction of hours for his junior doctors, whom he felt became disengaged and unreliable due to a loss of the so-called “regimental spirit” that came about from working long hours together. He found ways of countering that though, whilst allowing his junior doctors more sleep than he himself had once been privilege to. Indeed, older doctors will often speak of this new batch of medical practitioners having it a lot easier than they did, and there is some validity in this sentiment because yes, of course times and expectations have changed. But an older generation can hardly begrudge junior doctors a (comparatively) better quality of working life, and nor can they dispute that the implementation of the proposed changes would be unfair in today’s entirely different working environment. Indeed, it might well be catastrophic for the way our healthcare system now runs.
Junior doctors — along with anyone in the medical profession at all really — do not have an easy time of it. They are not the odd stereotype of rich, lazy doctors — in fact, they are paid quite poorly for the amount of work they do. This is especially salient when considering that a lot of their earning goes back into paying off the huge student debt accrued by the significantly longer duration of their initial qualification, as well as the constant necessary training the profession requires. Then there are the monthly payments to be made to the General Medical Council and the British Medical Association. This is not a path one goes down for the money, but it must be disheartening for junior doctors to learn that under the new proposals they might be facing salary reductions of up to 30%.
These doctors work tirelessly throughout the year, missing birthdays, Christmas, New Year, the weddings of close ones, working long days and nights because that is what needs to be done. I am not a doctor myself, but I have seen in friends and family how strenuous this can be: tearful phone calls after a week on-call; constant skipped meals; even getting so run-down that they themselves become ill. Having patients vomit on them is hardly glamorous, but this is their chosen vocation — if nothing else, I can only imagine that it might be nice to be shown some appreciation and understanding rather than being impaired by the non-negotiating government.
So, while getting to London for a protest might not be feasible, we can still stand with our junior doctors by petitioning our MPs to fight for the cause in Parliament. Mr Hunt says that the British Medical Association is misleading junior doctors over government plans, but junior doctors have been specifically trained to critically appraise research and papers: they are perfectly capable of reading the contract without having the BMA spoon-feed them. It is not fair to remove the current safeguard of the financial penalties for overworking, and it is certainly not safe.
The NHS provides us with something quite wonderful, and we are so fortunate to have it. Mr Hunt seeks to undermine it with his misrepresentation of facts and his scaremongering. Let’s help preserve one of the best healthcare systems in the world, and come to the aid of our ailing, under-appreciated junior doctors.