The future of the NHS is on a knife edge.
Cuts to hospital, community and mental health services, coupled with record patient numbers have pushed many services to breaking point. Rota gaps, which are now becoming commonplace, are beginning to threaten patient safety.
Paediatric services are being affected more than most, with a drastic decline in doctors applying to paediatric training and an increasing number of unfilled posts. Some departments have been forced to sacrifice the training of junior doctors to maintain the safety of our children and young people. However, these actions will have repercussions down the line and, if this trend continues, patients will suffer.
The response from the Government: scrapping the four-hour Accident & Emergency target and eighteen-week non-urgent operation waiting time target. But the problem won’t go away just because we stop measuring it. This sort of response has led many health professionals to question the direction in which the NHS is headed and the motivations of its leaders. It has decimated the morale of the workforce, worsening the recruitment crisis.
Although the cause of the affliction is apparent, a treatment is not as easy to identify. Jeremy Hunt has made it clear that his prescription doesn’t include a real solution. Until this changes, the solutions will have to come from within. While filling gaps in funding and managing patient flow require significant investment and resources, the process of healing morale and improving the recruitment and retention of staff can begin from within the system.
As doctors we train for years to treat our patients, yet we are surprisingly bad at looking after ourselves and our colleagues. Working in the NHS has never been more stressful – both physically and mentally and, if left unchecked, this can have tragic consequences.
With this in mind, we organised Passion for Paediatrics with one simple aim - to support the mental and emotional wellbeing of paediatric trainees and help them manage the strain associated with working for the NHS in the current climate.
First, we highlighted the services available to trainees finding it difficult to cope such as the Practitioner Health Programme and the Tea and Empathy movement that was formed in the wake of the suicide of a doctor during the implementation of the new junior doctors' contract. Professor Clare Gerada, medical director of the Practitioner Health Programme and former chair of the Royal College of General Practitioners, shared some of her experiences in identifying and supporting doctors in difficulty.
We then focused on examples of morale-boosting projects from across the NHS, such as 'Barnet Bopping', a project utilising dance lessons to improve the working relationship between doctors, nurses and patients, was demonstrated by Dr Guddi Singh and Karelle Evans. 'Balint Groups' led by Dr Lucy Fullerton and Dr Susannah Pye showed how peer-based discussions can help doctors work through difficult and emotional cases in a supportive and confidential environment. Finally, we heard about 'Learning from Excellence', a project by Dr Adrian Plunkett at Birmingham Children's Hospital, which has been introduced at Barnet General Hospital by Dr Dominic Fenn and Dr Patricia Lutalo in an effort to highlight and share examples of excellence in healthcare practice. The hope is that others will be inspired to initiate similar projects in their own departments.
To finish, we highlighted ways that doctors can protect themselves. Dr Michael Farquhar outlined the importance of sleep hygiene, especially on night shifts while Dr Caroline Fertleman, Dr Serena Haywood and Dr Reina Popat Shah showed the benefits of cultivating mindfulness and creativity in everyday life.
There is no indication that the underlying problems facing the NHS will be solved overnight. It will require sustained pressure from doctors, patients, opposition leaders and public figures together with a government that is willing to listen and create a long-term plan before any significant progress can be made. However, it is possible for healthcare professionals to improve their working environment, and offset some of the implicit burden of a career in the NHS. Pilots like this are one way we are working to improve morale of junior doctors, hopefully helping retention of NHS staff and therefore a safer service for our patients.