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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
This month, some of the best and brightest 18-year-olds are attempting what I think of as the quadruple high jump — taking chemistry, biology, maths and a fourth A-level in the hope of getting into medical school. These students are the goody-goodies, the strivers with a vocation. But only a few years ahead of them, young trained medics are feeling unloved, angry and radicalised.
With public satisfaction with the NHS at a record low of 24 per cent, and the tax burden at a postwar high, the junior doctors’ demand for a 35 per cent pay rise has looked arrogant and naive. But they are our future — and they have been let down by everyone: the government, NHS England and the British Medical Association, the doctors’ union, which seems almost to want the NHS to fail.
In the past few months, I have spoken to a number of junior doctors at different stages of their training. Some are thinking of leaving the profession; two have gone to Australia. One is doing a business degree while deciding whether to stay; another has founded a health start-up and is off to America. They all care passionately about the NHS and have intelligent ideas about how to improve what they describe as a shambolic, out of date system. But they get the feeling that no one is listening.
“Drexit” — the doctors’ brain drain — is still at relatively low levels but that is likely to change, with a big recent leap in the numbers making firm plans to go. A system which used to run on people working overtime out of goodwill was knocked by the exhaustion of the pandemic. And before that there was the government’s cack-handed attempt in 2016 to reduce the toll of weekend deaths, which many junior doctors wrongly interpreted as an accusation that they were shirking.
Most of the factors behind the loss of morale are so obvious, it makes me want to weep with frustration. Trainees describe having no control over shift patterns; paying for terrible coffee and eating at night from vending machines; spending hours “documenting” training, while getting too little time to actually learn. One man who moved from Scotland to England told me that his records took six months to follow him. The NHS has 1970s-style IT and 1950s-style expectations about life outside work which haven’t adapted to the reality that many medics date each other.
Any half-decent leader could turn this situation around. The fundamentals are fantastic: medicine as a profession has a strong sense of shared purpose, good pensions and job security. But no one is actually in charge of the NHS as a whole. And when it comes to pay, a merry-go-round of underwhelming ministers is alternately frightened of, and angered by, a union which is stridently ideological.
A new deal is needed on pay and conditions to reassure junior doctors that they are valued. But on pay, both sides are dug in. The BMA insists that a 35 per cent rise is needed to restore junior doctor pay levels to what they were in 2008, since when it claims that average real pay has fallen by 26 per cent.
This is a heroic assumption, based on the most convenient measure of inflation — RPI. The Office for National Statistics, using CPI, calculates that average doctor pay fell by 11 per cent and 16 per cent between 2010 and 2022. The government has offered an average 3 per cent on top of an average 8.8 per cent given in 2023-24 — but the BMA is texting junior doctors urging them to hold out for the whole lot.
While the standoff continues, the service is in the grip of a vicious cycle. Strikes lengthen waiting lists and increase workloads. Staff absences put pressure on those who turn up. Patients are angrier and sicker. The government cannot cave in to the BMA’s demands without opening up other public sector pay claims. The shadow health secretary, Wes Streeting, has made clear that a Labour government could not meet all the BMA’s demands either, and certainly not overnight. Meanwhile, almost nothing has been done to improve working environments or reduce the burden of paperwork.
Almost every junior doctor I speak to says decent IT would improve their lives. Electronic rostering could give them control of work schedules. AI transcription of notes would save hours spent writing them up. Yet both the NHS culture and the BMA are strangely resistant to innovations which would reduce staff workloads.
The BMA has used GP data as a political weapon, repeatedly stalling attempts by the government, NHS England and the Royal College of GPs to let hospitals access patient medical records. Meanwhile, a few hospital trusts are forging ahead with new technology, but others are unenthusiastic about the federated data platform despite that software having slashed backlogs at pilot hospitals.
It sometimes feels as if everyone is waiting for a new government. Some in the current administration, scarred by years of being falsely accused of wanting to “privatise” the NHS, think the BMA is simply holding out for a better deal from the Labour party. But that’s a dereliction of duty. Hospitals like Milton Keynes have improved staff retention with subsidised meals, free car parking and rest facilities. That’s the least anyone should expect.
The true cost of being a doctor is not measured just in pounds and pence but in the emotional strain and the level of responsibility, in situations of life and death. Today’s applicants to medical school are our future. If we want them to take care of us, we need to look after them.
camilla.cavendish@ft.com