A doctor says the NHS’s priorities are all wrong: pettifogging rules are rigorously enforced, but the Working Time Directive is pretty much ignored
“I work at a district general hospital in the South-East of England: when I began my career as a hospital doctor last year, I made the decision to move out of London. My patients suffer from acute medical problems such as cancer – we see a wide range of illnesses and injuries, as we provide care for a majority of the health problems that GPs can’t tackle.
Personally, I think the biggest problems facing patient care at the moment are exhausted doctors and the over-zealous implementation of the ‘bare below the elbows’ policy by management. The former could be addressed if managers followed through with the European Working Time Directive, an EU regulation which specifies that workers must rest for at least 11 hours out of 24, and mustn’t work more than 48 hours in a week. This would ensure that doctors aren’t exhausted when they’re on duty, and thus improve patient care and safety.
Some hospitals do adhere to this EU policy: when I worked in London hospitals, doctors turned up for work when their shifts were due to begin, left when they were due to finish, and had time for a lunch hour. That required managers to pay more attention to staffing numbers and rotas, but it paid off. However, in my hospital we work without breaks, arrive before our shift formally begins and finish hours after we should.
This affects my ability to do my job, and I am worried patients may suffer. By deliberately understaffing, the local management have undermined this beneficial directive. Officially, I’m meant to leave when my shift ends – but no-one checks up on my timesheet, and if I observed my paid hours then the night team would be unable to cope. The directive only receives lip service, and managers rely on our goodwill to keep the hospital running. The strongest enforcement I have seen of the work directive was a letter that managers sent out to all staff, telling us we had to leave on time; but I believe that if I did so, people would die.
What’s more, managers have failed to staff the hospital properly when I have called in sick. The hospital has a policy of not hiring freelance workers to cover for regular staff who fall ill. So when I’ve phoned in sick, human resources have shrugged off my pleas to arrange cover. They say the team can manage.
Meanwhile, the blanket implementation of the ‘bare below the elbows’ policy has been fervent. In order to prevent infection, medical staff cannot wear long sleeves, jewellery or ties; the idea is that it’s easier to keep hands clean than clothing and jewellery. Staff have been forced to remove simple, un-engraved wedding rings by zealous infection control nurses – of whom there are a strangely high number, considering the woefully small numbers of nursing staff on elderly care wards.
An infection nurse can march up to you when you’re trying to put a needle in a patient’s arm, and demand to immediately see your hands and check your nails are the right length. Doctors and nurses have had to attach watches to their waists – though this can create greater health risks, as they can dangle into material on patients’ beds. Yet as far as I know, there has never been any robust research to demonstrate that keeping staff bare below the elbows has any impact on infection rates.
The government has big plans for NHS reform – but if the reforms are implemented by managers like those at my hospital, I don’t think the Department of Health will be able to improve things. You could have the best guidelines and policies in the world, but if they’re interpreted by an under-qualified management then the results are likely to be detrimental.
Also, I’m not sure that ministers have a really good understanding of what things are like in district hospitals like mine. I have seen Andrew Lansley at my hospital – but only because he appears on television screens at the end of patients’ beds. Most of our patients don’t have a spare £10 per day to put in the machine to watch regular TV channels, so they just have the health secretary on loop. The majority of them turn the TV away from the bed, though I wouldn’t blame that on Mr Lansley personally. Anything screened on a loop is awful.
The NHS is rotten to the core, and I’ll be surprised if it is still going in 50 years. Many of its managers are incompetent and its priorities are skewed. I am so disappointed with it that I intend to emigrate to Australia or New Zealand.
During university, I completed part of my degree by working in Australia. A greater proportion of their healthcare system is private, but patients are treated a lot better. For doctors, there is less paperwork and fewer bureaucratic hurdles. I will be moving there as soon as I can.”