Doctors at breaking point in underfunded NHS | Letters

Jill Jones says doctors, along with other overworked and demoralised health professionals, are paying the price for cuts; Stephen Smith says the wellbeing of medical staff is treated with indifference; John Hurdley senses a return to the ‘bad old days’; Dr A Sen Mukherjee offers support; and Martyn Thomas suggests legal action

Those of us with friends and relatives working as doctors in the NHS will have experienced no surprise on reading your article about the treatment of junior doctors (Doctor reveals ‘petty tortures’ that force colleagues to restrict their private lives, 29 March). We witness first-hand the toll that working in the NHS takes on their lives.

Along with the shocking situations described in the article, we know from personal accounts that the following are commonplace: 12-hour shifts with no break; demand for the doctor’s attendance at two life-or-death crises at the same moment; having to stay with a patient for two extra hours at the end of a 12-hour shift because there is no one to hand the patient over to. Plus, of course, they work nights and weekends on a regular basis. All this in a profession where if you make a mistake it could mean a patient dies.

We all know we have a badly underfunded health service. Who is paying the price for the underfunding? Our doctors, along with all the other overworked and demoralised health professionals. The cost of the underfunding falls on their physical and mental health, and it is no wonder they are leaving the service in droves.

If no action is taken, the service will go into a downward spiral of staff shortages, leading to more demoralisation, even more staff leaving, and the NHS, on which most of us rely, will be wrecked.
Jill Jones

• I was, until a few years ago, a BMA official who represented young doctors in circumstances such as those described in your article. Even when problems were raised at higher levels of management, the same lack of care was consistently shown, implying an institutionalised indifference to the wellbeing of medical staff.

The worst example I encountered concerned a junior doctor seeking to return from sick leave after she had attempted suicide. Hard though it may be to believe, before she was permitted to return, she was required to address, in a disciplinary context, the “theft” of the insulin that she took in a very serious attempt to end her life. The most senior manager in the unit concerned supported this approach, emboldened by the vulnerability of the young doctor who was not fit to go through the strain of the potential actions I discussed with her, and for obvious reasons did not wish public exposure.

It was only one compassionate HR manager, whom I involved as someone I could trust and who was as appalled as I was when he found out what was happening, who intervened and made himself unpopular with other managers by doing so. The doctor, as a compromise, was still required to endure a humiliating and distressing formal meeting in which her “offence” was discussed, noted and permitted to be subject to no further action.
Stephen Smith

• How depressing to read of the findings of Dr Joanna Poole concerning the experiences of her fellow “junior” doctors. The most outrageous aspect is that hospital administrators are congratulating themselves on providing lounges and bedrooms for junior doctors.

When I was a very junior doctor in the 1960s, any hospital that did not provide a lounge with a TV as a minimum would not have had any junior doctors and, since many posts were resident, bedrooms were also necessary. We felt that, despite limited resources, the management were on our side. That is unfortunately no longer true, as evidenced by your report.

The continuing sale or conversion to offices of decent residential facilities, which started under the Thatcher dictatorship, has left many hospitals with recruitment problems, particularly in London as lower-paid staff cannot afford rents. During the 1960s and 70s there was a realisation that junior doctors’ hours were not acceptable and some progress was made to deal with the problem: we are now seeing a return to the bad old days.
John Hurdley
(Consultant anaesthetist, retired thank God), Birmingham

• We owe our gratitude and thanks to Dr Joanna Poole for compiling and submitting her dossier of over 400 accounts of “petty tortures” that our colleagues have endured in their work environments. Although these accounts are shocking, they are sadly not surprising.

We stand in support of all colleagues today who wish to speak out about any mistreatment they have suffered in order to provide patient care.

We share concerns that these issues occur in hospital-based settings, and also in primary care. There are colleagues from all levels of seniority: trainees, salaried doctors and partners who anonymously voice concerns about culture and working conditions. Such accounts are not surprising. As a system, we are at breaking point and the numbers speak for themselves.

We are saddened by the volume of evidence that has been collected to date about the culture of bullying, inhumane treatment and disrespect for humanity that permeates throughout the NHS in both primary and secondary care. More is being done to promote and drive wellbeing initiatives, but without serious culture change we risk potentiating the recruitment and retention crisis.

We will support any colleagues who wish to come forward, either to share with us their story or who are in need of support. We are your college and we will endeavour to work for you.
Dr A Sen Mukherjee
Wellbeing lead, First5 committee, Royal College of GPs

• Your report on the treatment of trainee doctors describes treatment of employees that amounts to a serious breach of the employer’s duty under section 2 of the Health and Safety at Work Act (HSWA). In other workplaces, less serious breaches than those described lead to enforcement action by the HSE, including prosecutions of serious or repeat offenders, because breach of these duties is a criminal offence. If the NHS regulators lack the power to enforce HSWA, they should call on the HSE or the police to act on their behalf, before someone dies through their inaction.
Martyn Thomas
Fellow, Gresham College, London

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