The UK is trapped in a “mental health crisis,” according to the Royal College of Psychiatrists, with demand for services soaring. This could be said about many other services in the NHS.
People are complex beings not uniform machines this is why medicine is interesting. Assessing ill people takes skill and time.
Skill is learnt and requires commitment to study, practice and perform. Traditionally medical students and junior doctors (resident doctors) assess patients and then present to their seniors. Senior doctors are part of peer groups that meet regularly and discuss the more interesting and complex cases together.
The NHS that is the health service that most people access when needed. It is also the education and training service for all clinicians, there are a few private providers, but deaneries and colleges approve training places mostly in the NHS.
The strain was visible in lack of training some years ago. Cuts in provision of funding for postgraduate training. Cuts to university funding for undergraduate training. More recently cuts in training posts. There are unemployed doctors in the UK, able and wanting to work in the UK, unable to find a suitable post.
As these doctors leave the UK or leave medicine, who is left to treat the ill?
When senior doctors retire, who will train the juniors?
Then we get to hospital beds. The acuity and severity of patients’ illness has risen as the numbers of beds have been cut. Many people are treated at home or primary care, a lot more pleasant for the patient to remain in their own comfortable environment but there has not been sufficient investment in clinical staff and infrastructure to do this adequately. Some patients are waiting days for a hospital bed.
The numbers of inpatient clinicians have not risen sufficiently to provide this increased acute service.
Doctors are paid much more in Australia. In New Zealand, a doctor can request annual leave with six weeks’ notice. In the NHS, doctors are expected to swap their shifts with someone and do them as extra before or after their holiday. If they cannot find anyone to swap with, they cannot take their leave.
The government have promised to recruit 8,500 more mental health workers. These are highly skilled professionals, where are they going to come from. With Nursing Degrees or training taking at least 3 years and nurses are the highest number of clinicians in the NHS, when will this happen?
The workload and long hours are compounded by rota gaps and staff shortages. Leading to burnout, fatigue and increased errors. A BMA survey found that many doctors experience depression, anxiety and burnout.
Maintaining a personal life while working unpredictable hours is a major concern. Many junior doctors find it difficult to engage in hobbies, spend time with family, or even maintain a healthy lifestyle due to the demands of their job.
The clinical responsibilities and training are complex and demanding. There is excessive paperwork, and duplicate digital systems are inefficient.
The burden of moving across the UK for suitable training posts, the difficulty engaging in social activities when they are so busy at work and the costs involved are great. The costs of postgraduate training not covered by the NHS study leave, the costs of accommodation away for courses and examinations and the cost of the postgraduate examinations are significant.
There needs to be an overhaul of staffing and rotas with support systems. The flexible training pathways need to be increased and improved. As well as fostering a supportive and compassionate culture.
Increasing the numbers of staff could reduce workload and the long hours.
We need investment in all clinical staff in the NHS to improve its service delivery so we can be confident of its continued excellent world leading healthcare.