17 October 2019
They cost less than plumbers!
By Lynda Goetz
Last week my subject was the public and their attitude to vets. This week I turn to the public and doctors. Like most of the rest of the population, I am a user of the NHS, the existence of which we all have reason to feel grateful for. But, and there is a big ‘but’, our attitudes towards doctors appear to have swung from the very deferential, in the early days of the NHS, to disrespectful and demanding. Not always, of course, but enough for the general attitude to be one of ‘entitlement’ and a view that as the NHS is here to ‘serve’ us, the patients or prospective patients, we do not need to appreciate or recognise the knowledge and skills of doctors, not to mention the personal sacrifices made by many in the medical profession. (The early years in the profession can be extremely difficult and demoralising with it being almost impossible to have any control over location or speciality unless you are in the top percentile of graduates.)
Last Saturday a front page news item in The Telegraph was headed ‘Locums earn £3,500 a shift as hospital crisis deepens’. Dreadful! What is going on? How dare they exploit our precious NHS in that way? However, it seemed the indignation was misplaced. Reading the article, it transpired that the sums, described as ‘eye-watering’ by the Patient Concern group, were for consultants (so, highly trained and skilled in their fields) and that the ‘shifts’ in question were between 24 and 32 hours long. Even if, as the report highlighted, these payments were for being ‘on call’ and therefore not necessarily for continual working, the buck stops with the consultant who is responsible throughout that time. He/she can literally be called upon at any time of the day or night. If one quoted amount of £3,658 (paid by North Cumbria University Hospital Trust for an A&E consultant) is divided by the length of the 31 hour shift in question, this amounts to just £118 an hour. I am sure I am not the only one who has paid plumbers more than that for an emergency call out!
Given the length of time doctors spend training and honing their skills, taking endless compulsory exams (for which incidentally they have to pay) to get to the top of their profession, is £118 per hour really such an ‘eye-watering’ amount? A lawyer of the same seniority would be quite likely to be charging upwards of £200 and hour and bankers and CEOs can earn far more. Should those who choose the medical profession and public service be completely penalised for that choice? Without their expertise people could die.
I fully recognise that the arrogance of some consultants can be a problem and that in the past this has led to situations like the Bristol Royal Infirmary baby scandal, when the high mortality rates of babies operated on by two consultants doing heart surgery was not reported or picked up on, resulting in at least 29 unnecessary deaths and many more babies being left brain-damaged. The subsequent inquiry and report published by Professor Ian Kennedy QC in 2001 did lead to changes in the NHS, many of which we now take for granted. NICE guidelines were not in existence back in the early 90s when these deaths happened and at the time patients (or relatives of patients) were not given the information we expect to be given now. Continuing Professional Development (CPD) is now far more rigorous and ingrained in the system so that consultants cannot simply enjoy ‘jobs for life’ once they have reached a certain level.
Obviously most of the changes have been for the better and as ‘consumers’ we are more easily able to judge how and where we would like to be treated. The growth of the internet and social media has given us the tools with which to research and compare. The downside of this is that although we do not have the levels of knowledge or expertise of those treating us, it is easy to feel we have acquired a great deal of knowledge on the problems which affect us directly and thus feel able to challenge the profession. This can lead to medical professionals having to explain and justify all their actions even where those to whom they are explaining may not have the knowledge basis fully to take on board or process the information.
Hospitals at all levels are increasingly understaffed, which puts a massive burden on those who are working. Rotas are published which appear to take no account of requests for holiday, time off for CPD or such things as weddings or honeymoons. Junior doctors can simply be told by the HR department that they will ‘need to swap with someone else’. Such treatment and the feeling of not being in control of any aspect of their lives can lead to young doctors going abroad to see whether life as a doctor needs to be this hard. Many end up staying in Australia or New Zealand, both of which seem to have achieved a better balance between patients’ rights and doctors’ working conditions.
At the consultant level there has been much talk in the press recently about the problems arising from HMRC’s pension regulations. Few doctors, however much they enjoy their work or however altruistic, are going to want to work for nothing, or worse, pay to work. Although in August, the Government came up with some changes to encourage doctors to continue working, these would not come into force until next April. In the meantime, many consultants and GPs are indeed reducing their hours or retiring and thus contributing to what is already a staffing crisis in many hospitals and GP surgeries. In such situations it is impossible to carry on without recourse to the agencies, even though this may not seem like money well-spent. (The system of fining hospitals or Health Trusts for breaches of candour regulations or for leaving people on the waiting lists for too long etc are equally counter-productive and remove money from a system already acknowledged to be short.)
If one combines the dissatisfaction amongst many junior doctors with the tax problems of those at senior level, one is faced with a perfect storm. Everyone is overworked because of staff shortages, working conditions deteriorate, patients are increasingly disgruntled and upset in situations which for them are difficult and emotional and, in short, no-one is happy. We, the patients, need not only to recognise the many problems facing the NHS, but also acknowledge that we may have a part to play in helping to remedy these. Whilst not abandoning our right to question or to be involved in our treatment, we may need to be more understanding, less demanding and less ‘entitled’.
We are incredibly fortunate to have the NHS, but its status as a ‘sacred cow’ with all treatments free at the point of delivery and little public understanding of the costs of those treatments may need to be seriously reviewed. Unless doctors see their choice of career as rewarding and worth the sacrifices, they will continue to leave the profession early or choose to work in countries where they are more highly regarded. That will leave hospital trusts even more reliant on agencies (quite possibly increasingly staffed by foreign doctors) to which they have to make ‘eye-watering’ payments which are not even going to the doctors themselves. The NHS in turn needs to treat staff as well as patients with respect and seriously review wasteful practices (‘easier said than done’ my friends within the system will snort derisively). Perhaps one of these years we will have a government and politicians prepared to look at this long term and to grasp this particular cow by the horns. In the meantime perhaps the medical profession, like the veterinary profession, needs to educate the users of the service.