Harmony Editorial – Of pay, colour, refugees and politics in Healthcare

This has been a strange week. We were barely over the heady celebrations, the fly past by the Red Arrows over London, the appearance of the Queen and her family in the balcony of Buckingham Palace, the elation that comes from being featured in the Queen’s Platinum Jubilee Honours list, then it all seems to be breaking through. The first event was the unsuccessful ‘rebellion’ by Tory MPs against their esteemed leader culminating in an embarrassing vote of no confidence in the Commons. The leader remained belligerent, victorious and belligerent, vowing that nothing and noone will come between him and ‘doing good for the British people’. Many pundits believe that the foundation has been shaken and soon, there will be more cracks appearing, a leadership contest and an election is not far behind.

NHS does not need more money

Staying for a moment on the political landscape, we have the Rt Honourable Sajid Javid, Secretary for Health and Social Care declaring that ‘the NHS does not need more money, it already has all the resources it needs, it now just needs reform’. Here we go again, is a thought that may have crossed the mind of many in the NHS.  The NHS is reeling with the highest waiting lists for all activities, the winter crisis which was one of the mantras of the last decade, have now transfigured to a state of perennial crisis. There are daily horror stories of queues of ambulances waiting outside emergency departments with high risk patients unable to be seen. The waiting time to see a doctor is now almost 12 hours in several A&Es. Workforce recruitment, retention, job satisfaction and morale is at an all time low. Most strategic or capital plans in the NHS have been shelved and every organisation is now looking desperately at cost reduction. The popular sport of ‘GP bashing’ now seems to be ever so in vogue. The recently appointed President of the Royal College of Physicians of London, David Oliver writes in the BMJ,

The UK has among the fewest doctors and nurses per 1000 people among the Organisation for Economic Cooperation and Development countries or the EU. Numbers of full time equivalent qualified GPs haven’t increased since 2015 and more recently have fallen. GPs are leaving the profession faster than people are entering GP training, and fewer international medical graduates now come to the UK or stay here. Yet annual recorded GP and practice nurse consultations have increased by 16% in that same period, now hitting record highs.

I was asked at the recent Queen’s Platinum Jubilee street party by some well heeled neighbours, ‘What is needed to solve the problem that is the NHS?’ The bars of the ever so popular song from the ‘Sound of Music’ reverberated in my ears, ‘How do you solve a problem like Maria?’ I thought for an instant, Pimms in hand, the grey clouds circling overhead, as a distant airliner positioned itself to land on terra firma, perhaps bringing people back from holiday, contented and raring to get back to work. I like working in threes…so I blurted out, ‘New money, workforce and managing expectations honestly’. By no means a strategy to write home about, but after 25 years in the NHS frontline I should know something. We then spent the best part of the hour debating how and where new money can be found, why politicians need to be honest about the apparently deliberate strategy to allow the ‘jewel in the crown’ to disintegrate slowly but surely due to chronic under-funding, overbearing bureaucracy and undeliverable expectations. Then we came to the workforce question, they were surprised that there was never an intention to be self-sufficient in educating and training a workforce that would meet our national requirements. That the strategy of importing ‘cheap’ talent from abroad was economically beneficial at least to the UK. Each doctor trained in the UK, cost the taxpayer around £250k, hence 47% of the doctors in the General Medical Council’s register were trained or qualified abroad. The story in Nursing and Midwifery was no different.

Workforce and Wellbeing

If educating and training healthcare professionals was so expensive, and the economical solution was to import trained individuals, one would imagine that the least the NHS could do is to treat them well. That they received, if not a golden handshake, at least a decent induction, guidance on how to navigate a new culture, to protect them from mistreatment, to support their families, to ensure that they felt valued, had access to opportunities to further their careers and felt included in the UK Big Society. The reality sadly continues to be of eye watering statistics of poor induction, unfair allocation of duties, limited or no access to training, discrimination in career progression or non-mandatory training, of exclusion, racism, bullying or harassment and unfair treatment both in disciplinary matters or when referred to the regulator.

The workforce is battered and bruised. The NHS is broken, some would want us to believe. The numbers of junior doctors willing to continue their training after their foundation years keeps falling well below the 50% mark, year on year. The attraction of the antipodes is a strong beacon for greener pastures, better pay and working conditions. One may even not consider the seeming advantages of the weather. The BMA junior doctors committee is balloting its members to consider strike action to counter the 22% pay deficit that exists due to the below inflation pay awards in the last decade. The Rail Maritime and Transport Workers Union (RMT) is going to strike nationally against an ‘insulting’ 2% pay offer. Do we believe that the Department of Health and Social Care would listen, in the backdrop of the aggression in Ukraine, the cost of living crisis, BREXIT fallout and the crushing debt from the pandemic years?

The pandemic has changed the world in many ways. There has been innovation and advancement in science, technology and global cooperation, yet the chasm in society has widened. There is increasing awareness amongst the ‘victims’ of systemic bias and discrimination that exists in big society and spills over into the realms of healthcare workplace. The work of the Medical Workforce Race Equality Standards group and the NHS Race and Health Observatory are starting to scratch at the surface of the abscess. What is needed is a firm and decisive ‘incision and drainage’ policy from the top. Is the Rt Hon Sajid Javid, the man to deliver on the promise of the right kind of reform, that the NHS now needs?

I guess the key question is likely to be, ‘Is there a stable government, willing to listen to the people, who are committed to work for a better Britain’. Finally, we are about to witness something that many did not feel was possible in modern Britain, which prides itself in being a flag-bearer for humanitarian missions – the imminent deportation of refugees and asylum seekers to distant Rwanda. A policy that the current Home Secretary, Rt Hon Priti Patel is particularly proud of and has the backing of the Tory PM with the most massive majority in the House of Commons. In a recent YouGov poll, Rt Hon Boris Johson was placed at no 13, just above John Major with a 99% ‘fame’ and 28% popularity rating. His idol, Winston Churchill sits at the top with 96% fame and 67% popularity. If one considers the popularity contest for current Tory politicians, Boris Johnson is pipped to the post by Theresa May, Rishi Sunak and Sajid Javid. If there is an imminent leadership contest in the offing, and the economic crisis and broken NHS are political football to play with, one wonders how the potential contenders to the coveted role may use the ‘reform’ agenda to their advantage. It is highly unlikely that the ‘football’ (in this case the NHS and the economy) are ever likely to benefit from being kicked around on the field. We wait with baited breath for more pronouncements from the UK Gov on these matters.

In the meantime, we keep our heads down and soldier on, saving lives as the only thing we are apparently good at or even been taught to do.

Editorial by Dr Indranil Chakravorty MBE

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