Empathy is underrated in a political system that prizes economics over emotion. Ministers are locked in a battle of wills rwith junior doctors as the strike continues; patients are braced for weeks of disruption as operations are cancelled and treatments delayed. Although the British Medical Association has made clear that it is willing to be flexible over numbers, the government is still refusing to negotiate even as the NHS reels from the accumulated impact of weeks of industrial action.
But this dispute is about so much more than money. NHS staff are exhausted, demoralised and disillusioned after a pandemic that took many of them to hell and back. Working in the health service right now feels like living in a horrific version of Narnia where, as one emergency medic put it to me recently, it is “always winter and never Christmas”.
Doctors describe a sense of “moral injury”—by which they mean an overwhelming feeling that they cannot fulfil their duty of care to patients because of systemic problems in the health service. The psychological impact is enormous on clinicians who are taught to save lives and heal the sick but feel unable to do so because of circumstances beyond their control.
According to the latest NHS staff survey, more than a third of people working in the NHS feel burnt out and 32 per cent are thinking of leaving. The Institute for Government has calculated that 500,000 staff days are lost to mental ill health every month in the NHS.
Waheed Arian, an A&E consultant who came to this country from Afghanistan as a refugee, compares it to the trauma of fleeing a warzone. “There’s a sense of hopelessness,” he says. “You see there are people who are ill, you’re trained to treat them and you can’t do it.”
The tough talk in Whitehall shows no understanding of this mood of despair. The demand from junior doctors for a 35 per cent pay rise is clearly unaffordable. But now that the BMA has indicated that it is willing to move on this particular demand it is the government that is starting to look unreasonable. The “just say no” approach, combined with the highly political attacks on the militancy of the BMA, fails to grasp the emotional drivers of the dispute.
That matters because the NHS is haemorrhaging staff. Of course, more doctors need to be trained, but the real problem is the retention rather than the recruitment of doctors. Some are considering going abroad to work in countries where the stress is lower and the weather is better. There is a huge billboard outside one London hospital advertising medical jobs in Australia, including a photograph of an idyllic scene with somebody on a paddle board.
Others are quitting medicine altogether. I recently spoke to one elite surgeon who has left the NHS to run a waffle store. He tired of arriving at work ready to operate and finding that his list of patients had been cancelled because there were no beds for them in the hospital. The final straw came when he was in the middle of an operation and the lights went out in the operating theatre—he had to complete the surgery using the torch on his phone strapped to his head.
GPs describe a relentless anxiety that they are going to make a mistake in a day crammed full of 10-minute appointments for those lucky enough to get in to see a doctor. Meanwhile, surgeons’ training regime makes it almost impossible to balance work with family life. One junior doctor described to me how at one point she was spending £4,000 a month on childcare because of her irregular and unpredictable hours.
The health service needs to get much better at keeping the doctors that the country has already invested so much money in educating rather than treating them as disposable assets. Ministers should focus on drawing up a properly funded long-term workforce strategy rather than just promising to build shiny new hospitals.
Pay is only a small part of that. Junior doctors must be given more control over their lives, with a greater say over when and where they work. They should have greater flexibility, if they want it, and access to hospital crèches that actually cover the hours they are required to be there. At the moment, professionals who have in some cases already spent more than a decade in work say they feel as if they are being treated as children.
It is wrong that a medic cannot book a day off a year in advance to go to his own wedding, as one doctor described to me. It is unfair that some trainee surgeons have to spend four hours commuting every day to reach the placement they have been allocated. Training programmes should be reformed to take account of the modern world, including accelerated medical courses and more diverse entry routes into the profession. There could also be more support for junior doctors over the cost of exams and professional fees, which can add up to tens of thousands of pounds.
During the pandemic, the public clapped every week in gratitude to those working in the NHS. It is strange then that a health service, which exists to care for others, is such a truly terrible employer. If there is to be a sustainable settlement to the junior doctors’ strike, that must change. Ministers need to sound as if they understand how tough the last few years have been. There can be no agreement without empathy and compromise on both sides.
