Who wants to be Leader?

Health secretary Jeremy Hunt believes, rightly for once, that the NHS can only survive if more clinical staff become leaders. Yet most clinical staff don’t want to be lead by Jeremy Hunt or implement dangerous £22 billion austerity cuts, departmental closures and the private outsourcing policy of the government. Leading an organization where patients and staff are routinely harmed by the effects of unnecessary underfunding is a thankless task. The BBC’s week long exposure of the NHS crisis introduced us to the concept of ‘corridor nurse’ in scenes reminiscent of the nineties. Back in July, a Surrey woman died after being denied entrance to 3 hospitals and NHS England was warned of worse to come. Now many ambulance trusts aren’t able to fulfil their emergency response times, and staff are in tears in short-staffed departments that can’t cope with the demand. The service has always been glued together by goodwill but under Hunt, the goodwill has gone and staff are walking.

Under Hunt’s command, the number of junior doctors progressing directly into specialty training has fallen from 71.6% in 2011 to 50.4% in 2016, its lowest ever level (Eye last). This is sad, but unsurprising not just because of their work pressures, but because they feel undervalued and ignored by the Department of Health and NHS England. Many of the junior doctors MD has spoken to also believe that it is unsafe to blow the whistle about their working conditions and patient harm. As one put it: ‘It felt a lot safer when the BMA was behind us and 55,000 of us were united in exposing the dangerous understaffing in the NHS. But since the BMA capitulated over the new contract, it’s as if you’re on your own if you dare to speak up. And you have no legal protection.’

Junior doctors often take a career break after finishing their F2 training year, but the omens are not good for most of them returning to the NHS full time. ‘As a paediatric trainee, my workload was simply overwhelming. There were – and still are – rota gaps in every shift that we have to cover. Sometimes I’d be looking after 40 sick kids. I would worry about harming them when I was on duty, and then take it home with me and spending all my ‘down time’ worrying that I’d done something wrong because I was always multi-tasking very complex problems when, say, getting a dose of a drug wrong or missing the subtle signs of sepsis could prove fatal. Just driving past the hospital on my days off would make me feel very anxious. And before a shift I would sit in the car park and cry, and just wish I didn’t have to be there. I used to love my job, when the workload and stress were manageable, but they aren’t any more and I can’t return to the job until they are.’ Another junior doctor highlighted Hunt’s leadership; ‘You can’t blame Hunt for everything. The NHS has been underfunded for most of its 69 years, and that’s all of our fault. But I simply refuse to work in a system where I believe the leaders are both unwise and unkind. If Hunt had listened to junior doctors, instead of fighting them, we could have worked together to try to sort out some of the problems. To be blunt, I think the leaders of the NHS are either in denial about the true state of the NHS, or are deliberately running it into the ground so they can sell it off. Most of my friends aren’t going into full-time specialty training until the NHS becomes a safe and humane system to work in. And that needs a change of leaders as much as a change of funding.’

Some good news for Hunt is that people appear to have stopped living longer, at least for now. Researchers from the London School of Hygiene and Tropical Medicine have analysed the sharp rise in deaths in 2015 (30,000 more in England and Wales than in 2014) and linked to the ‘massive disinvestment’ in health and social care. If this is true, 2016 looks like being a bumper year for deaths. In the meantime, the corporate hoovering up of NHS services by the private sector continues apace. One senior NHS manager, who doesn’t wish to be identified, gave an alarming account of the process:

‘We lost our contract for community services – something we had run successfully for many years – to Virgin. I still don’t understand why, but I guess they made promises to the CCG that we realistically couldn’t deliver. We then had a meeting with representatives from Virgin to discuss handing over the contract. It was like an episode of the apprentice. These bright-eyed twenty-somethings were full of enthusiasm but clearly had no idea how to run the service. They wanted us to advise them, and to hand over all our knowledge and expertise. I thought ‘this isn’t how corporate take-overs work.’ If Sainsbury’s take over a Tesco branch you don’t expect the Tesco staff to hand over all their business intelligence to a competitor. But you do it in the NHS, because you don’t want to see patients harmed. I’ll be amazed if they make a success of it, but it’s the CCG who gave them the contract. It’s doctors doing the government’s dirty work.’ Clinical leader anyone?