A junior doctor described the scenes in hospitals as a "warzone" or "natural disaster", warning there won't be anybody to perform C-sections if the crisis continues.
More than 45,000 junior doctors could walk out on strike for 72 hours in March if members of the British Medical Association (BMA) vote in favour of industrial action in a ballot closing on February 20. Junior doctors are guaranteed an annual pay rise of 2%, far below the rate at which prices are rising.
This gap has seen the real terms value of junior doctors' pay fall 26.1% since 2008. Meanwhile, junior doctors have to fork out thousands of pounds to pay for mandatory training, exams and membership of professional bodies. The BMA is demanding the government restore pay to the level of 15 years ago in an attempt to retain "colleagues who we are haemorrhaging out of the system", according to Latifa Patel, chair of the BMA's representative body, and a junior doctor who trained in Liverpool.
READ MORE: Doctor describes 'warzone' hospitals where patients are 'nursed on the floor'
The Department of Health and Social Care (DHSC) describes NHS staff retention as one of its "key priorities", but Latifa, a paediatric respiratory doctor, has never worked a fully staffed rota since graduating in 2011. There are 133,446 vacancies in the NHS - including a shortfall of more than 47,000 nurses - accounting for roughly 10% of the entire workforce, according to the latest NHS data.
This means NHS workers take on the responsibilities of multiple people in buildings that are "basically falling apart", with outdated IT systems and a lack of equipment and bed space. Junior doctors rotate between hospitals working as many as four or five 13-hour, understaffed shifts each week for a starting salary of just over £14 an hour.
Latifa told the ECHO: "For someone who's done five or six years of training at medical school, who's coming out with £100,000 worth of debt, who's paid for a lot of their own training, you'd expect more than £14 per hour. For somebody who's looking after up to 300 patients a night, for somebody who's leading your child's birth, who's leading caesarean sections, who's doing life-saving operations overnight, who's performing resuscitation on your loved one in A&E, you'd expect them to be on more than £14 an hour."
For many, the pay is too low and the working conditions are too poor. Four in ten junior doctors plan to leave the NHS as soon as they find a new job, according to a BMA survey in December. A third plan to work in another country within the next year. Latifa said: "Overnight you can blink, and the person working £14 per hour has gone.
"You can blink and the person who was on £24 per hour has also gone because they can't do two jobs. And you can blink and that person earning £28 pounds an hour, the consultant, has gone due to pension taxation, they think, 'Well there's nothing in the system so I'm going'. And now you're left with someone needing a C-section and nobody to perform it."
Describing the conditions in the country's hospitals, she said: "We hear from doctors all the time, military doctors who've worked in crisis points across the world, who've worked for Médecins Sans Frontières in real crisis zones, say, 'I cannot believe this is the NHS in England, this does not feel like England, this feels like a warzone, this feels like a crisis zone, this feels like a natural disaster'.
"You look outside and you've got a mile worth of ambulances. You've just been told that somebody died on a trolley because they were waiting for 10 hours. You've just been told the patient you're looking for is in corridor C - that's right, there are corridors A, B and C, and they're in bed 10. Oh no, it's not a bed, it's a chair. You've just been told that the patient you're looking after, you're actually nursing them on the floor."
These problems - staff shortages, mounting waiting lists, and falling real terms pay - have been building for at least the last 12 years. The covid pandemic, and the below-inflation pay rises offered to doctors, nurses and paramedics who worked on the frontlines throughout, have pushed them over the edge.
Latifa said: "Junior doctors don't have the benefit of knowing a system that's any different. There are medical students who have medical school cut short, who've only ever known this NHS, who in 2020 were told, 'Right put your pens and paper down, go to join the NHS', who joined the NHS during the pandemic and saw patient after patient after patient die in front of them, who were told there are millions on a waiting list, who are repeatedly still being told the same, who are still wearing masks at work. They've never known any different."
She added: "Through the pandemic, we've realised how woefully unprepared we were, how, because we were propping up this system on a shoestring, it was so easy to snap. I think there is almost a sense of guilt amongst healthcare workers, that if we'd stood our ground and shouted earlier, we may not have lost those hundreds of thousands of lives."
The NHS wasn't just unprepared in terms of stockpiling personal protective equipment - the UK has fewer doctors, fewer nurses, fewer hospital beds and fewer scans per inhabitant than most other European countries. And it's losing them - to burnout, to higher paid jobs abroad and in the private sector, and now to strikes over falling real-terms pay and working conditions that make them "scared" for their own wellbeing and for patient safety.
Nurses and ambulance workers have already gone on strike in December and this month, with more days of industrial action scheduled for the coming weeks. Unions representing the two groups of NHS workers are co-ordinating strikes for the same day next month - February 6 - on what will be the biggest strike to hit the NHS.
More than 100,000 healthcare workers could participate. Latifa said: "It should be a real wake-up call to the government to say 'Look, we are doing something wrong, we have done something wrong for over a decade, and if we don't change direction now - and I mean drastic changes in direction - we're only going to get into get into more trouble'. And let's be honest, the people who are going to suffer the most out of this are going to be our patients. It's going to be society.”
Despite this, Latifa does have hope "because there are some real quick fixes that the government can do", like increasing pay to catch up with the last decade or more of inflation, and by investing in new equipment. Latifa said: "The government can invest in all of that stuff and instantly you would see the wellbeing of doctors, of healthcare workers, going up.
"You could see more people thinking, 'Well, okay, the system's awful, but I can see changes already, I know they've invested in more diagnostic equipment, I know that my consultants who were about to leave because of pension taxation are actually going to stay, I can see my pay has gone up to what it should have been if we'd followed inflation in 2008, I can see actually that there is light at the end of the tunnel'.
"All those doctors who were thinking of leaving, all those healthcare workers might stay, and then maybe we'll be in an NHS that's very different compared to the one that's predicted in five or 10 years time. There's lots the government can do. The first thing is to engage with unions. The second thing is to invest in the NHS. And the third one is to continue."
A DHSC spokesperson said: "We have been clear that supporting and retaining the NHS workforce is one of our key priorities, and that includes junior doctors. The multi-year pay deal with the British Medical Association is increasing junior doctor's pay by a cumulative 8.2% by March 2023.
"We have also invested an additional £90 million to provide the most experienced junior doctors with higher pay, increase allowances for those working the most frequently at weekends, and increase rates of pay for night shifts. The Health and Social Care Secretary wants to have an honest conversation with unions – including the BMA – about what is affordable in pay settlements for next year during these challenging times, and has invited them to discuss as soon as possible."
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