Dysfunctional, resentful, unresponsive and overstretched

Jenni describes the situation correctly, but it is too late for Mr Hunt to be “fixing these urgent, practical, systemic problems”… it is the longer term which is disenchanting the doctors and leading to them being “Dysfunctional, resentful, unresponsive and overstretched”. 

Russell opines in the Times 6th Jan 2016: Better a decent 5-day NHS than this shambles

When the present service is practically on its knees, it makes no sense to stretch it further

I am totally in favour of a seven-day NHS. I have sat in a hospital bed in the dead zone from Friday afternoon to Monday morning, waiting, waiting, waiting — for a consultant who can make a diagnosis, for an obstetrician to decide that my baby can go home, for a scan to happen, for a critical blood test to be read and understood. I have watched old ladies throwing up all weekend with nausea that no one is available to diagnose. That grey anxious limbo is deeply unnerving, and sometimes life-threatening.

But I’d also like to see a home for every family, a job for every voter, a bicycle for every child who wants one. What I want, if it’s to matter, has to have some relationship to what the country can afford and is prepared to pay for. And we don’t have the money or the willingness to pay for a fully functioning seven-day health service, rather than the weekend skeleton we have now.

As everyone who works in it or deals with it knows, the NHS is barely managing to cope with doing what’s expected of it for five days a week. It has had five years of an unprecedented squeeze with more to come, it’s often infuriatingly, carelessly, structurally inefficient, and many of its staff are already exhausted and disheartened.

The idea that Jeremy Hunt can conjure up an excellent week-round service by forcing already-stretched junior doctors to work longer for less is a delusion. It can’t be done, and if it’s forced through, it will make the NHS even shoddier than it is now. British doctors will walk, to be replaced by cheaper ones from Europe and the third world. Instead the health secretary should be focusing on what voters really care about: making the Monday-to-Friday NHS work well. Because it is, to a degree he doesn’t seem to recognise, already crumbling under the strain.

I don’t assume that doctors’ interests are synonymous with patients’ wellbeing. I was outraged at Tony Blair’s over-generous settlement with GPs and consultants when, by common consent, he stuffed their mouths with gold. But that was long ago.

Now pay has plateaued, pensions have been capped and departments have been given budgets running far behind medical inflation, and yet the NHS is dealing with increasing numbers of patients who are also living longer, getting sicker and have more complex conditions than before. The staff can’t endlessly bridge that gap, and they are enraged by the realisation that their fight to make it work isn’t appreciated by their political bosses. That’s why the junior doctors’ unprecedented strike is so widely backed by their NHS colleagues. Most people working in it know they can’t carry on like this.

Last weekend I talked to five doctors I know, all dedicated people who went into medicine despite long hours and terrifying responsibilities because it was fiercely satisfying. They’ve worked for between ten and thirty-five years, and every one of them is now resigning or wanting to get out.

A consultant psychologist in the southwest says her department can no longer see any but the most psychotic, disturbed or suicidal patients because staff have been reduced, senior staff not replaced, buildings sold, and office space rationed so severely that everyone hot-desks and no one has space to call their own. Emergency clients can’t be seen because the few private rooms are all booked in advance. “Psychologists don’t provide an effective service to clients when they’re so stressed and distracted themselves,” she says.

A consultant surgeon in the Midlands says the strike is just the tip of an iceberg of dissatisfaction. His senior anaesthetist is resigning, with remaining staff ordered to take on his job as well as their own, and fed-up experienced nurses are being replaced by inferior agency ones. Consultants once had teams of doctors they knew and could rely on. The teams knew every patient and felt responsible for them.

Now, he says, no one feels in charge, unknown housemen pass through in shifts, nurses are behind desks filling in forms rather than actively nursing, and the only point of contact for information about patients is the ward clerk. Critical details are missed and things go wrong. He feels powerless. He recently tried to get a patient fast-tracked through A&E by ringing the sister on duty, but failed: “I have the status of a cleaner in my own hospital.”

Then there’s the registrar I know, a London junior doctor whose department is currently 25 per cent understaffed and who was working 15-hour days in the weeks before Christmas to compensate. Already on antidepressants from stress, and unable to sleep, she was given lithium to help, which sent her into a rare, life-threatening psychosis. Discharged after a week and sent home to her parents in the country, she became suicidal and was interrupted while trying to hang herself from the banister with a dog lead.

When her shaking mother rang the mental health crisis intervention team, they refused to visit or help. The cuts, they said, meant that they couldn’t deal with anyone who wasn’t registered with a local GP.

It’s fixing these urgent, practical, systemic problems that must be Hunt’s priorities, rather than the seductive, headline-grabbing illusion of a seven-day operation. The NHS is still one of the cheapest, best value-for-money health services in the world, but it is also increasingly dysfunctional, resentful, unresponsive and overstretched. It needs shrewd analysis and intelligent nurturing, not further impossible demands. Step back, Jeremy, before the NHS is carelessly pulled apart.

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About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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