Back in March 1974, I was the house surgeon on call at Westminster Hospital.
As I watched the 9pm news in the doctors’ mess, a flash interrupted the transmission: there had been an attempt to kidnap Princess Anne on her way to Buckingham Palace and her bodyguard, a police officer, had been shot and was being taken to Westminster Hospital.
I ran down to A&E and the casualty officer and I had hardly assessed the patient, set up intravenous lines and ordered blood, when the senior registrar (12 years qualified and virtually a consultant) and our boss, Professor Harold Ellis, arrived. They had also been watching the evening news and had driven from their homes in minutes.
These senior medics worked every day of the year (if they weren’t on formal leave, they were always accessible), constantly supporting and training junior staff — and available for any emergency. They had no overtime pay — this was the nature of their commitment to the job.
It is mythology to claim, as the strikers do, that providing emergency cover (‘Christmas Day service’) means patients will not die as a result of this action (File image)
But this is no longer the way consultants are contracted to work. The world has changed, systems have evolved, and look where we have now arrived. The British Medical Association, the doctors’ trade union, has balloted consultants over strike action for higher pay — and 86 per cent have voted in favour. So, following five-day strike action by junior doctors, consultants will stop routine work for two days from July 20. That’s seven days of reduced activity across the NHS.
It is mythology to claim, as the strikers do, that providing emergency cover (‘Christmas Day service’) means patients will not die as a result of this action. Because there is no doubt that some investigations — such as endoscopy for rectal bleeding — will be delayed, and that will mean that diagnosis may also be delayed and the final outcome could be imperilled.
Delays in the biopsy of suspicious lumps will inevitably result in diagnostic delay too. I’ve actually heard of patients whose appointments have been postponed not just for a few days, but for weeks or months when there have been other hold-ups in the system, and no doubt similar delays will occur after the strikes.
In my view — and one that is shared by many, I suspect — doctors are well paid, though it is certainly true that many years of inflation, poor government planning and financial stringency in the NHS have resulted in doctors falling behind when making comparison with the financial rewards of 15 years ago.
Yet few of them are prepared to accept that this is, in part, the legacy of the 2008 world financial crisis, along with the societal change in which the middle classes — the white-collar classes — have been flattened out in terms of income expectations.
Indeed, there was a time when NHS consultants could expect to educate their children at private schools — but no longer.
It was also possible for a consultant at a London hospital to buy a family house nearby — but, again, no longer. Three times a consultant’s salary (the standard mortgage calculation) doesn’t sustain a mortgage even for a two-bedroom flat in reasonable reach of many hospitals.
At a more banal, but no less significant level, when it comes to workplace satisfaction, the doctors’ mess, where we had our own dining arrangements, has gone — so, too, for many, a guaranteed parking space.
Striking Junior Doctors march from the 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 vocation — when consultants were revered as team leaders for their skill, judgment and experience — has metamorphosed, downgraded to a well-trained but technical job, while managers make too many of the decisions.
Care is fragmented, so the patient is treated by different specialisms for each body part. The Health Service itself is fragmenting 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 doctors, mental health strain. Optimism has faded to a sense of hopelessness, that everything will continue to go from bad to worse.
The loss of privilege and status, along with this pessimism, has fuelled the discontent, even anger, now driving the determination of the 86 per cent of consultants who voted to strike. The intention is to give the Government a bloody nose — but patient care will be the collateral damage.