In March 1974 I was a resident surgeon at Westminster Hospital.
As I watched the 9pm news in the doctors mess, a flash interrupted the broadcast: an attempt had been made to kidnap Princess Anne on her way to Buckingham Palace and her bodyguard, a police officer, had been shot and taken to Westminster Hospital.
I ran to the emergency room and the emergency room and I had barely assessed the patient, put intravenous lines on and ordered blood, when the senior registrar (12 years licensed and practically a consultant) and our boss, Professor Harold Ellis, arrived. They had also watched the evening news and had driven home within minutes.
These senior medics worked every day of the year (when not on formal leave, they were always on call), continuously supported and trained junior staff – and were available for any emergency. They had no overtime pay – this was the nature of their commitment to the job.
It is a mythology to claim, as the strikers do, that providing emergency cover (“Christmas service”) means that patients will not die as a result of this action (File Image)
But this is no longer the way consultants are hired to work. The world has changed, systems have evolved and look where we are now. The British Medical Association, the doctors’ union, voted advisers on strike action for higher wages ? and 86 per cent voted in favour. So, after a five-day strike by junior doctors, consultants will interrupt routine work for two days from July 20. That’s seven days of reduced activity in the NHS.
It is mythology to claim, as the strikers do, that providing emergency cover (“Christmas Day service”) means that patients will not die as a result of this action. Because there is no doubt that some investigations – such as endoscopy for rectal bleeding – are delayed, and that means that the diagnosis can also be delayed and the final result can be compromised.
Delays in the biopsy of suspicious nodules will inevitably lead to diagnostic delay as well. I have even heard of patients whose appointments have been postponed not just for a few days, but for weeks or months when there have been other delays in the system, and no doubt similar delays will occur after the strikes.
In my view ? and a view shared by many, I suspect ? doctors are well paid, although it is certainly true that years of inflation, poor government planning and financial tightness in the NHS have led doctors to fall behind in comparisons with the financial rewards of 15 years ago.
Yet few are willing to accept that this is in part the legacy of the 2008 global financial crisis, along with societal change in which the middle class ? the white-collar class ? has flattened in terms of income expectations.
Indeed, there was a time when NHS advisers could expect to educate their children in private schools – but not anymore.
It was also possible for a consultant to a London hospital to buy a family home nearby, but again, not anymore. Three times a consultant’s salary (the standard mortgage calculation) isn’t worth a mortgage, even for a two-bedroom apartment within reasonable reach of many hospitals.
On a more banal, but no less important level, when it comes to workplace satisfaction, the doctor’s mess, where we used to have our own dining arrangements, has disappeared – and, for many, a guaranteed parking space.
Striking Junior Doctors march from BMA HQ to Parlaiment Square on June 16, 2023 in London (File image)
Their working world has changed, as has the culture. What was a calling ? when consultants were revered as team leaders for their skill, judgment and experience ? has changed, relegated to a skilled but technical job, as managers make too many decisions.
The care is fragmented, so that the patient is treated by different specialisms per body part. The health service itself is fragmented and unstable under the weight of numbers and lack of resources, and endless top-down changes.
The earlier culture has been replaced by a new era of anxiety and, for many physicians, mental health issues. Optimism has faded into a sense of hopelessness that things will continue to go from bad to worse.
The loss of privilege and status, along with this pessimism, has fueled discontent and even anger, which is now fueling the resolve of the 86 percent of consultants who voted to strike. The intention is to give the government a nosebleed, but patient care will be the collateral damage.