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An open letter from a doctor to Jeremy Hunt

Your plans are neither safe, nor sustainable, nor morally okay. 

“Make the care of the patient your first concern.”

This is the cardinal rule of Good Medical Practice, the handbook issued to every medical student by the GMC at the dawn of their training. Ask any doctor: we have this rule as deeply ingrained throughout medical school as any physiological action or pharmacological mechanism. We probably mumble it in our sleep.

And we try to. We try so damned hard. Along with the nurses, the allied healthcare professionals, and all the auxiliary teams – we do what we can with meagre staffing levels and stretched resources pitted against relentless “efficiency savings“. We work and work and work, in a miasma of demoralisation that has only thickened over the past weeks and months as the true depth and breadth of the cuts has become horrifyingly apparent.

The patients are more numerous and sicker than ever before; partly due to the ageing population, but also because the patients getting admitted to hospital have been disproportionately disadvantaged by the decimation of health and social care provision both in hospitals and nationwide in the community. The estimated funding gap for adult social care this decade? £4.3 billion.Charity funding cut by £1.3 billionpersonal care cutmental health services cut disability benefits cutcarers in crisisbenefit caps inexorably tighteningall welfare increasingly inaccessible to the most vulnerable members of society: the unwell, the poor, the young, the disabled.

Given the above, it is indisputable that the actions taken by this government and the last have made the British population sicker.

The knock-on effect on healthcare resources is both predictable and inevitable.

Vulnerable, isolated older people are arguably the worst hit; the sterling work by Age UK shines a light on the shameful state of things for this demographic. These are the patients who bounce in and out of hospital and “bed-block“, often due to multiple morbidities and complex psychosocial needs.

Hospital admission should always be a last resort. Unfortunately, in so many cases, things are so bad in the community that last resorts are all we have.

Throughout my years as a junior doctor, I have become heartbreakingly familiar with the phrase “we don’t have capacity at the moment” from the various theoretically excellent community-based services designed to manage patients wherever possible in their own homes. There aren’t enough nurses, enough midwives, enough healthcare assistants, enough technicians, to safely run such services for as many patients as need them – so those patients stay in hospital. There aren’t enough GPs to provide enough emergency appointments to give everyone who requests one an urgent medical review – so those patients come into hospital as well. There aren’t enough days in the week or hours in the day to ensure flawless care for every patient who seeks help. There are never enough.

Healthcare professionals still strive to make the care of all these patients our first concern; far above our concerns for our own physical and mental health. In my first job as a junior doctor I unintentionally lost 8kg in three months, my BMI dropping to an unhealthy 17.2, because I was regularly working 14 hour shifts without a break. Any food grabbed was eaten whilst poring over blood results or typing discharge summaries with the other hand. I’ve lost count of the number of times my incredibly supportive husband has said “you’re too ill to go to work – take a sick day” and my first thought has always been: “yes if I worked somewhere else, but this is different – I’m not as sick as the patients, and they will suffer if we’re even more short-staffed”. Patients don’t want sick doctors, but most of them would rather that than no doctor at all, and that is essentially what it comes down to; short-notice cover is rarely arranged due to budget constraints, and instead the remaining staff stretch themselves thinner to try to cover the gaps. These examples are just from my early career – I know of countless others, because healthcare professionals make many larger sacrifices than these in the name of patient care and the public good every single day.

It is not safe.
It is not sustainable.
It is not morally okay.

You are correct that medicine is a vocation with myriad non-financial rewards; you are misguided if you think systematically disenfranchising the workforce won’t make people leave.

I’m referring to the move to change the definition of antisocial working hours, so that evening and Saturday work up to 10pm will be valued the same as weekdays 7am-7pm (the core hours many doctors work at baseline, albeit often involving multiple hours of unpaid overtime). I’m referring to the proposed stripping of the financial parity incentive from GP training – arguably one of the specialties in which recruitment is most in crisis. I’m referring to the recent toxic rhetoric surrounding weekend working, apparently designed to foster the attitude that doctors are at best lazy, at worst negligent. Summary of these proposals here.

Commonly heard from the most senior medical staff: “At least I’m retiring soon.”

Commonly heard from the most junior medical staff: “Have to admit I’m increasingly tempted by working overseas.”

I’m a born-and-bred British graduate of a medical school which regularly ranks in the top 5 in the country. I already had a BSc therefore didn’t get any help with paying my tuition fees; I took a loan and used the savings my father left me when he died, and I still amounted significant debt (I couldn’t have afforded to retrain if the fees had already been £9k per year). My university place was competitive, with approximately 8x the number of applicants than studentships available, and the cost of training me was approximately £300k. I was highly motivated, I worked very hard to get here, and I am devoted to both the NHS and to this country. And yet in the light of recent developments, I am considering working abroad. What an absolute waste of resources that would be.

It is in vogue at the moment to talk about “the patient’s journey“, to focus on how improvements could be made to the narrative of their illness: prompter diagnoses, minimising unscheduled care, maximising doctor-patient concordance in management; better outcomes, fewer recurrences and – as always – lower costs. “Customer satisfaction” will always vary, and the nature of illness means that disappointment, fear and anger will inevitably be factors in some people’s experience of the NHS. But the fact is, even if you make your journey from A to B via the smoothest possible route – in the shortest possible time – the experience of travelling in a creaking overcrowded bus running on low-budget fuel will always be more stressful than travelling in a well-maintained vehicle. At risk of labouring the metaphor, none of us are asking for the NHS to be a sportscar. But we wish for our patients to be able to make their journeys in a vehicle that promotes individualised care: that means more staff, more beds, more resources.

None of your proposals for 7-day non-emergency-care service address this unmet need. (We already run a 24/7/365 urgent care service, as you may remember from taking your own kids to A&E rather than wait for their GP practice to open after the weekend.)

As doctors, we are trained in the art of deduction: the ability to pick out important signs and symptoms from the background noise of normal physiology, to find a meaningful pattern in a group of data; to see not merely stars, but constellations. It is difficult not to look at your history, Mr Hunt, and to examine the statements you have made and continue to make, and come to certain conclusions:

1. You do not intend to keep the NHS free at the point of use
2. You intend to make this more palatable to the general public by systematically defaming and devaluing healthcare professionals – divide and conquer, if you will
3. You are willing to sacrifice the existing NHS workforce on the altar of “efficiency savings”, irrespective of the consequences

If I have come to the wrong conclusions here, please do not hesitate to correct me. My suspicion is that you would be unable to provide evidence to support a rebuttal of the above impression.

If this were about points-scoring, I would leave it there, but it is about so much more; so many people’s lives are being detrimentally affected, and frankly endangered, by the decisions you are making and the policies you are pushing through. I find it difficult to believe that anyone could lack compassion to such a devastating degree as it seems, from the outside, that you do.

So I will finish instead by making a request. I ask you to take a leaf out of our book, Mr Hunt: please, for all our sakes, prove me wrong, and make the care of the patient your first concern.

This article originally appeared on Left + Write

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Mumslink shows how online parenting networks are coming of age

Women online are changing the relationship between digital domesticity and digital independence. 

The habit of “speaking as a mother” came in for its fair share of criticism this summer. Andrea Leadsom’s insinuation of superiority over Theresa May, her rival for the Tory leadership, elicited widespread scorn – not least from those who have done most to strengthen the voice of mothers as a group: internet mums.

Over the past 15 years, the ten million users a month who log on to Mumsnet have been courted by politicians in webchats and speeches alike. The 2010 general election was even named “the Mumsnet election” in their honour.

From the start, parenting networks attracted users interested in comradeship, as much as those after information. 

For Jo Williamson, a mother-of-two, the trigger was the day her second child left for school, a jarring experience. “I went into a blind panic, thinking: ‘Blimey, I’m going to be sitting in an empty house just waiting for everybody to come back.’” In response, Jo and her business partner Jane Pickard came up with the idea for a new site that focuses on the fluid nature of many women’s professional and family lives.

The resulting network, Mumslink, uses carefully edited news feeds to introduce readers to ideas, businesses and charities that complement all aspects of their lives – from recipe tips to volunteering. “There are so many women out there with a plethora of talents but most of the time, because you’re with your children, nobody asks you to get involved,” Williamson says.

Similar feelings of isolation led Siobhan Freegard to found Netmums, one of the UK’s largest parenting sites. Back in 2000, she had barely heard of “social networks”, nor of Mumsnet, which launched around the same time, yet she knew that mothers needed a place “to share their stories and maybe meet up in the offline world, too”.

Such identity-building led to divisions over “the right way” to be a mother. A tense rivalry developed between the slightly younger Netmums and the more educated and affluent Mumsnetters (Tesco and Waitrose didn’t sponsor different networks for nothing). Within the sites’ pages, differences of opinion over working v stay-at-home parenting sparked allegations of hostility and bullying. Still, the media researcher Sarah Pedersen says there’s an argument that these sites have helped produce a reduction in depression and anxiety, as well as greater opportunities for women to negotiate “the tension between themselves and their role as mothers”.

There are signs that this online culture is growing up. The perception of mums as “a bit insular and thick” is more easily countered, says Justine Roberts, the founder of Mumsnet, “now that so many mothers are able to express their individuality, their interests and their expertise in the public domain”.

According to Freegard, the very act of online sharing has helped begin to repair the rifts within the parenting debate. “With social media, we see working mums and part-time mums, and we see mums changing roles as their children change ages, and we understand that there are different angles to things – that everyone has their story.”

This is more pronounced in the world of video blogging, Freegard says. On her YouTube channel, Channel Mum, people talk calmly about controversial subjects that would have been a “bloodbath” on Netmums, such as ear piercing for very young children. “With video, you can see the person in real life and that helps you feel for their story,” she says.

Perhaps the greatest effect, however, has been on how the internet allows parents to work from home. As many as 160,000 part-time ventures have been started by British women in the past two years alone, self-styled kitchen-table start-ups. Sites such as Mumslink (similarly funded by Williamson and Pickard and run out of the former’s front room in Hertfordshire) aim to help this home-based workforce with new clients. One Mumslinker visits the site to write about her own line of natural nail varnish, another to promote her hot-tub business. The company Digital Mums uses it to encourage women to expand their digital skills.

Commercial savvy is something that Freegard is also keen to develop at Channel Mum – equipping her contributors with financial advice and small stipends. “I remember looking at mummy bloggers and thinking, ‘You guys didn’t get properly organised,’” she says. Freegard points out that most early mum bloggers never grew their audience beyond those already involved in parenting online, and struggled to become more professional as a result.

Quite what the future relationships will be between the brands, businesses and audiences for information on parenting has yet to be established. Some users will baulk at being increasingly cast in the role of consumer. At the same time, the networks’ names – Mumsnet, Netmums, Mumslink, Channel Mum – suggest that parenting is still a woman’s domain.

Yet a better balance seems to be emerging in the relationship between digital domesticity and digital independence. Greater gender equality in the distribution of start-up funding, more job vacancies that allow flexible working, and increasing numbers of prominent women in the tech industry are just some of the things the community is striving to promote. In Britain, which has an ageing population and an ever-growing community of carers, the rise of these networks seems sure to be a net gain for us all. 

For more, visit: mumslink.com

India Bourke is the New Statesman's editorial assistant.

This article first appeared in the 25 August 2016 issue of the New Statesman, Cameron: the legacy of a loser