Pay rises alone won’t fix our NHS — but as a doctor I know what will

I was working a long shift which required me to be on the ward by 8am.

After doing the ward round with the consultant, listening to the needs of patients and families, the noises of random alarms, the bleep I am carrying and people retching, it reaches 1 pm by the time I have to carry out my morning tasks. 

The screen in front of me says that a patient has an acute kidney injury and, simultaneously, I realise I have not had a sip of water all day. My kidneys cannot have been far off similar function. 

I am exhausted and it is not even near the end of the day. It is a feeling that most junior doctors have multiple times throughout a normal week. I cannot help but feel the strikes are something we look forward to.

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The leading anti-assisted dying group Christian Action, Research and Education (CARE) used Christian reasoning to get its supporters to write to their MPs – but then omitted any Christian language at all from the default email that it got them to send. While recognising that it is essential that all sides are heard in the assisted dying debate, Humanists UK has urged religious groups to be honest about their motives for opposing assisted dying. CARE hosts on its website a ‘write to your MP’ tool that provides a default message that people can use to write to their MP asking them to oppose assisted dying. MPs Humanists UK has spoken to have reported receiving many emails from people using CARE’s tool. The default text doesn’t mention religion at all but gives as the constituent’s reasons for writing, ‘concern about the very rushed time frame’, inadequate ‘safeguards’, ‘coercive control’, and ‘feeling like a burden on others’. This stands in contrast to the emails that CARE has sent to its list to advertise the tool. The first, on 7 October, said: ‘As Christians, we have a high view of human life, made in God’s image. We are called to emulate our Saviour’s concern for the vulnerable, downtrodden, and powerless in society, opposing actions that will harm our neighbours. And we are equipped to articulate a better story: full of Gospel hope. The Spirit can help us to do this in love, speaking with grace and truth. … ‘I trust that you’ll join us in prayer about this issue, asking for God’s mercy on our nation, and powerful intervention. Whatever the outcome, we trust in Him. “Trust in Him at all times, you people; pour out your hearts to Him, for God is our refuge” (Psalm 62:8).’ A second, on 16 October, started and then finished: ‘Throughout history, the Church has strongly opposed assisted suicide and euthanasia. God’s word teaches us that human beings, made in God’s image, are to be protected and cherished. … ‘I trust that you’ll join us in prayer about this issue, asking for God’s mercy and powerful intervention. With Him all things are possible.’ The linked-to webpage from which people then write to their MP says ‘Please remember to: …Speak the truth in love. (cf. Eph 4:15).’ On Sunday the Observer published an investigation alleging that ‘grassroots’ campaigns opposed to assisted dying are in fact coordinated and financed by conservative Christian pressure groups. Humanists UK also published its own research into some religious groups’ influence in the assisted dying debate. That includes religious groups funding ostensibly secular groups, and using disability groups as a front for unstated religious views. At a Christian Medical Fellowship event, a speaker boasted that for a disability rally against assisted dying, Christian Concern ‘provided the financial support, made the placards, came along, got the disabled people along, and were completely invisible in doing it.’ Humanists UK Chief Executive Andrew Copson commented: ‘It’s clear that CARE’s religious beliefs are a motivating factor in its opposition to assisted dying. And this is a perfectly legitimate motivation to have. But the fact that it is using religious reasons to get people to write to MPs, without mentioning religion in their letters, is concerning. People should be up front about the reasons they are advocating for a certain outcome so that MPs can have all the information before forming their own views.’

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Over 28 days of strikes, the British Medical Association (BMA) has adopted a deeply draconian stance. Most of its argument is based around pay restoration, with only some scant whispers of working conditions. 

The net outcome of this? Virtually nil. And whilst yes, a substantial pay increase is warranted for doctors across the country — the same can and should be said about the rest of the public sector across the country over the last decade. It has been disheartening to read time and time again that, in an attempt to try and substantiate their own salary increase, I have seen doctors patronise the pay of others.

The strikes have been unsuccessful for different reasons. Partly because of the incompetence and ignorance of the Department of Health and Social Care. Undoubtedly, its inability to negotiate whilst regurgitating the same rhetoric about how they do appreciate doctors and other healthcare staff has done irreparable damage. 

After the trauma of Covid-19 and what staff put themselves through in the name of public service, there was a sense, maybe naively, that the NHS would not be taken for granted again, and that reward would be given. This has not been the case.

Likewise, the stalemate has also been caused by the strikes, somewhat ironically, has created a vacuum of temporary staff shortages which are filled by locum staff for extortionate rates. The staff who are filling these positions are the very junior doctors who are striking. It means the continuity of care is largely unaffected and that the strikes — conducted in the best interest of patient care — are causing less disruption than needed to force the government into making the offer doctors need.

However, even if by some miracle the strikes were successful, and the deserved pay was given, I believe the mass exodus of doctors leaving the country or changing profession would not stop. Many doctors I have spoken to, including myself, cherish the time off we (rarely) have and want better working conditions. 

After speaking to my colleagues, I have five suggestions I believe would tangibly improve the lives of doctors in this country and make the NHS an attractive place to work once more.

1. Fixing the rota system

As a junior doctor, most trusts across the country say you can only take annual leave on a normal working day (NWD). This sounds fine in practice, but on an average rotation, half of your shifts across the four months will not be NWDs. It means for those shifts you are not entitled to annual leave, unless you can find your own cover. And, as professionals who often work over 60-hour weeks, one simply cannot find the time to cover for your colleagues. An alternative system needs to be implemented which allows you to take annual leave on any type of shift — and it should not be the doctors who have to find the alternative cover.

2. Changing the volume of mandatory out of hour shifts (OOH)

Working out of hours is something which is inevitable as a doctor, you have to shelve whatever else is going on in your life and spend a week or so being nocturnal. Now, while these shifts can be enjoyable for a lot of staff, they are not adequately paid. The rate of pay for these shifts should be moved closer to that of a locum cover, which would make it more attractive for staff to work these shifts. This would mean the government would not have to focus so heavily on increasing base salary, and have a different way of increasing the salary of doctors. It should also be more flexible on whether a doctor should or shouldn’t work these shifts. 

The strikes have proven if the right pay is available, those gaps will be filled. Flexibility is the one thing which keeps a lot of doctors in the profession in the long run, and this should be increased, not reduced as it currently is.

3. Remove the bottleneck for training opportunities and training programmes

Despite what is being said by the government, with the increased numbers of doctors both graduating in and migrating to the UK, there are actually fewer training opportunities available than ever. The competition ratios are increasing year on year, and if we want to have a health service with highly qualified doctors specialised as GPs or consultants, then we need to increase the number of training places. It is counterintuitive to have increased numbers of junior doctors and not let them train.

4. Allow doctors to work privately earlier in their career

Another way of increasing the pay of doctors in the UK is to increase the scope of what private work they can do. This would require fundamental policy change in the UK, but if doctors really want the pay they deserve, this needs to be considered. It is currently the unspoken truth that a lot more doctors than it may seem are willing to work privately on the basis that the NHS is overworked and heftily underpaid.

5. Create a vision for the NHS which is hopeful and innovative – not toxic and depleted

The NHS was, at one point, the marvel of the world — and it still remains one of the things this country is proudest of. After all, it is no wonder it was used as the showcase in the 2012 Olympics opening ceremony. 

But that moment feels like a lifetime ago now. The Department of Health and Social Care needs to wake up to the fact that staff are leaving in droves, and a career which was once prestigious and rewarded is now a laughingstock. 

Opportunity, reward and respect should be the key messages in shaping the NHS for the future. Despite the negativity in working in the NHS currently, there is no reason why it cannot change and become the envy of the world again. It just requires the right minds and belief to get it there.

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