#nhs doctors

[ceevee5]

[newstfionline]

Where Brexit Hurts: The Nurses and Doctors Leaving London

By Katrin Bennhold, NY Times, Nov. 21, 2017

LONDON--Tanja Pardela is leaving London. Her last day is Nov. 26. She wells up talking about it. She will miss jacket potatoes, and Sunday roasts, and her morning commute--past playing fields, small children in school uniforms and a red telephone box--to the hospital where she has been a pediatric nurse for 11 years.

Ms. Pardela does not want to leave the country she came to over a decade ago. But that country no longer exists. On June 24 last year, she said, “We all woke up in a different country.”

Seventeen months after Britain voted to leave the European Union, many Europeans are voting to leave Britain--with their feet. Some 122,000 of them packed their bags in the year through March, according to the latest figures available, while the stream of new arrivals has slowed.

In London, a city long sustained by European bankers, builders and baristas--“a place that makes you dream,” Ms. Pardela said--the departures are beginning to hurt. Construction companies and coffee shops are struggling to recruit. Top universities worry about retaining talent. And nowhere are the concerns more elemental than in Britain’s treasured and already overstretched National Health Service.

Long before Brexit, the N.H.S. suffered from chronic staffing shortages, and today the country has 40,000 nursing vacancies. But recruiting nurses from the European Union had helped plug the gap--especially in London, where the share of nurses from the Continent is about 14 percent, or twice the national average. King’s College Hospital, the massive institution where Ms. Pardela works, is short of 528 nurses and midwives, and 318 doctors.

Brexit seems certain to make it harder and costlier to recruit from the Continent, assuming that people will still want to come from there. Even the legal status of European Union citizens already living in Britain remains unclear, entangled in the stalled Brexit talks between Brussels and London. Many fear they could lose rights, job security, pensions and access to free health care.

This uncertainty is one reason that some European health care professionals are either leaving, or thinking about leaving. In the year following the referendum, almost 10,000 quit the N.H.S. The number of nurses from other European Union countries registering to practice in Britain has dropped by almost 90 percent.

As yet, there is no mass exodus back to the Continent--the number of European Union staff in the health service even grew slightly in the year after the referendum. But the trends are unmistakable: The number of Europeans leaving the system is rising, and the number joining it is falling.

“With London in the grip of its worst ever staffing crisis, nurses are being pushed to breaking point on understaffed wards,” said Tom Colclough, regional spokesman for the Royal College of Nursing in London. “If those E.U. colleagues who have not yet left are not given an unequivocal right to remain, the very safety of the capital’s care settings will be under threat.”

The N.H.S., with its philosophy of free universal health care, is a pillar of postwar British identity, once described by a former minister as the closest thing the English had to a national religion. When London hosted the 2012 Olympics, a highlight of the opening ceremony was a dance performance by real nurses whose bodies eventually coalesced into three giant letters: N.H.S.

During the Brexit campaign, an argument about the N.H.S. helped tip a tight vote. Brexit advocates said leaving the European Union would allow the government to repatriate 350 million pounds a week from Brussels--about $463 million at current exchange rates--and spend it on health care. It was a powerful promise, plastered in bold across the side of a campaign bus--but it was false: Britain pays only about £166 million a week net into the European budget and there was little chance that even a lesser amount would go solely to the N.H.S.

“It was clearly the most effective argument not only with the crucial swing fifth but with almost every demographic,” the chief strategist of Vote Leave, Dominic Cummings, wrote in The Spectator earlier this year. “Would we have won without immigration? No. Would we have won without £350m/NHS? All our research and the close result strongly suggests No.”

Founded in 1840, King’s treated shell shock victims during World War I and victims of German air raids during World War II. More recently, survivors of London’s terror attacks and the Grenfell Tower fire were treated here.

The hospital is a complex of two dozen buildings in southeast London with Europe coursing through its circulatory system. Dutch workers built the state-of-the-art helipad on the roof. Eastern Europeans are helping to build a new intensive care wing and serving cappuccino as baristas in the four coffee shops. Of the 9,300 clinical staff, one in seven holds a non-British European passport.

Brexit is forcing a stark reassessment in every department. In the emergency room, Cyril Noël, a French doctor, is wrestling with how a country he loved rejected him. He describes the grieving process as the Five Stages of Brexit. In critical care, Georg Auzinger, an Austrian physician, has built a world-class facility but now worries about finding enough doctors and nurses.

Many worry that a health service they cherish may be existentially at risk. During a recent Sunday service in the hospital chapel, the priest said a prayer to guard against the “effects of Brexit.”

“The N.H.S. is in Britain’s DNA,” said Shelley Dolan, chief nurse and executive director of midwifery at King’s. “Europe is in the DNA of the N.H.S.”

When Dr. Noël, the French emergency doctor, started his shift early one recent afternoon, the department was already two dozen beds short. He surveyed the scene: seven stroke patients, two casualties from traffic accidents and a couple of stabbing victims. An elderly lady had been run over by her own car after forgetting to put on the hand brake. A toddler had swallowed a fridge magnet. A man had almost died after being punched in the face.

And the emergency room was four nurses down.

“Just a regular Friday,” said Dr. Noël, 45, as someone behind him mopped up the blood stains in Bay 4.

Working with Dr. Noël that Friday night were a Czech doctor and nurses from Ireland, Poland, Spain and Portugal. Several had spent their summer vacations scouting job opportunities in their home countries. “Everyone is nervous,” said Alexandra Cunderlikova, a senior nurse from Slovakia.

Ms. Cunderlikova came to Britain in 2003, a year before her country joined the European Union. She remembers lining up outside the Home Office at 4 a.m. for her work visa.

“I wonder,” she said. “Will it go back to that?”

There are still more Europeans migrating into Britain than leaving. But, as in the N.H.S., arrivals are slowing and departures accelerating, said Madeleine Sumption, director of the Migration Observatory at the University of Oxford, especially among Eastern Europeans like Ms. Cunderlikova.

The day before the Brexit referendum, feeling anxious and powerless because he was not allowed to vote, Dr. Noël did something he had never done before: He placed a bet.

Dr. Noël wagered £200 on Brexit. “That way, I thought, if it actually happens, at least there is one positive thing in it,” he said. To his dismay, he won. The £1,500 he made would roughly cover the fee for a British passport. But Dr. Noël is in no mood to become British--at least not now.

“I feel very strongly European,” he said.

He grew up as an Anglophile in the Jura region of France, near the German border, in a family badly scarred by two world wars. When he was 5, he paraded across the local market, pretending to speak English. At 30, he fell in love with a British student who had come to France on the Erasmus program, the European Union’s university exchange scheme. Twelve years ago, they moved to Britain and Dr. Noël instantly felt “at home.”

But now, when he works outside London in places where people voted for Brexit, resentment rises in his throat.

“I’ve had very torn feelings about helping people who expressed the wish to get rid of us,” Dr. Noël said.

“Psychologically Brexit has had a huge impact,” he said. “You feel rejected as a group.”

He talks about the “five stages of Brexit.”

First there was shock, he said. Then there was denial. (“Don’t worry,” he would tell the young nurses from Portugal and Spain in his department who fretted in the months after the vote. “Nothing is going to change.”) Eventually, Dr. Noël reached the anger stage, following a cascade of nasty news reports: about a government request for companies to compile lists of foreign nationals (later retracted); about a man being stabbed for speaking Polish; about a Finnish professor who, along with scores of other Europeans, was served a deportation notice.

The notice was a bureaucratic mistake. “But after Brexit, such mistakes are not easily forgotten,” Dr. Noël said.

If the N.H.S. has consistently managed to produce health outcomes comparable to countries with vastly more resources--like France, which has a similar population but more than twice the number of hospital beds--it is in large part because of the people, said Dr. Noël, who has worked in both systems.

“The N.H.S. is an incredibly resilient system,” he said. “People are so dedicated. When the system is squeezed, they work even harder.”

But Brexit has made many European employees reconsider. If anger was the third stage of Brexit, and depression was the fourth, Dr. Noël said he had now reached the final stage, acceptance.

For him, that means leaving Britain early next year. He has a new job at a hospital in Dubai.

Up two floors from the emergency room, down a warren of hallways and through a pair of locked wing doors is the liver intensive care unit.

Dr. Georg Auzinger, the clinical head of critical care, was checking on two patients who were recovering from emergency liver transplants on extracorporeal membrane oxygenation, a pioneering bypass technology. Their blood, liters of it, was being drained from their bodies, oxygenized in an external pump and then reintroduced. Anywhere else in the world they would have been kicked off the transplant list and have died.

The liver department at King’s is world famous. It is also very European. “The English are in the minority,” Dr. Auzinger said.

Dr. Auzinger, a lanky 51-year-old from Salzburg, Austria, has a clipped accent and speaks in Briticisms (“I was gobsmacked,” he says of the Brexit result). The liver department’s clinical director is Irish. Its academic director is Spanish. The hospital recently tried to hire a German as academic head of department, but he declined: He had been awarded a high-value European grant that he could not take to Britain after Brexit.

This worries Dr. Auzinger, who has to hire 407 nurses and doctors for the hospital’s new intensive care wing. Last month, not a single European applied for an advertised position as a senior consultant. “Before, at least a third of applicants were European,” he said.

Dr. Auzinger is happy to hire qualified Britons. “But there are not enough doctors and nurses in this country,” he said. “The numbers being trained do not cover the needs.”

In March, the government announced a plan to hurriedly train more British nurses. Yet in September, enrollment at nursing schools dropped, because the government also cut grants to nursing students. That is one reason Peter Absalom, associate director for recruitment at King’s, is now trying to replace one immigrant group with another. “We are looking to the Philippines, Australia and India,” he said. Three major recruitment drives are planned over the next 12 months.

Every time Mr. Absalom hires someone from overseas he has to pay for their visas and a collection of other charges, which add up to more than £4,000 per person over three years. It can take a year before the nurses start work. Europeans could be hired with no visa costs and no extra paperwork. Over the last five years, nurses from Portugal, Spain, Ireland and other European Union countries have accounted for about a third of the total intake.

Now King’s has stopped its hiring campaigns in the European Union.

“What is particularly difficult is that we cannot give candidates any certainty on their future status,” Mr. Absalom said.

Dr. Auzinger has been in London for 18 years. He, too, would consider going back to Austria if he could transplant his job there, but he cannot. He thinks the way Brexit is affecting the N.H.S. is symptomatic of a poor treatment plan. Britain is ailing. People are angry. Brexit was the treatment offered to them. What worries Dr. Auzinger is the lack of a diagnosis.

“If you think Brexit is the medicine, my concern is that you’re treating something blindly,” he said. “If you don’t have a diagnosis, you cannot treat the patient properly.”

Ms. Pardela, the pediatric nurse, still needs to stop by the post office so that her mail can be forwarded to Germany. She is keeping her British bank account open because she hopes that one day the pound will rise again. It has lost as much as 20 percent of its value against the euro since the referendum. So have her savings.

After the Brexit vote, a British colleague urged Ms. Pardela to apply for citizenship. Her skills were needed. No way, she answered. “I respect the vote,” she had said. “But I’m not going to bend to it.”

Last September, she called an old friend from nursing school and asked about job opportunities back in Germany.

“Brexit was a trigger,” said Ms. Pardela. “It makes you reassess your life. You find yourself thinking: ‘I’m working really hard. I haven’t had a pay raise in four years. Now they’re telling me they don’t want immigrants? Why am I still doing this here?’ “

“And then you think: ‘I’m 45. I better move now. It will be harder when I’m 55.’ “

In her small apartment, now filled with moving boxes, Ms. Pardela was packing photos of Big Ben and the London Eye, as well as a series of trashy romance novels that helped her learn English. Still on the fridge was a magnet featuring Florence Nightingale, the mother of modern nursing in Britain: an Englishwoman who was born in Italy and trained in Germany.

One reason Ms. Pardela thinks the N.H.S. is one of the best health care systems in the world is that it empowers nurses. “The range of opportunities and responsibilities is much greater here,” she said. In Germany, many of the things she has been doing--assessing blood results, adjusting treatment plans for transplant patients--would be handled by a doctor.

On Ms. Pardela’s ward, a third of the doctors are European. Twice a year they hold an International Food Day where everyone contributes dishes from their country. This year, Ms. Pardela brought sausage and sauerkraut. A Greek colleague made tzatziki. An Italian cooked spaghetti.

When the latest bout of cost savings required the department to cut one nurse from every shift, Ms. Pardela fought hard to win the role back. It took a year. In the end, she was successful.

“The irony,” she said, “is that now we can’t find anyone to fill it.”

The position has been empty since September.

[sleep-well-dearest]

If anyone live in England, contact local MPs about the NHS funding issues. My mother is a doctor, and has informed me that last moth her hospotal had to choose between paying thheir staff, and paying the suppliers. They chose to pay the staff, but that's not promised again this month.

there should be a law or order in place to force the government to bankroll the employees working in the NHS. My mother and her coworkers didn't go into thousands in debt and eight years of medical school to be unpaid labour, especially not for something as impotant as hospital care.

[ceevee5]

“The staffing crisis in the NHS in England is even worse than official figures suggest. NHS Digital figures suggest that the service has vacancies for 38,972 nurses and 8,016 doctors. However, the real figures could be as high as 50,000 and 12,000 respectively, according to estimates the Nuffield Trust prepared for the MPs. The trust’s analysis accords with the view of many frontline doctors and managers that some posts are not advertised, and thus not picked up by the statistical agency, because hospitals cannot afford to fill them, even if suitable doctors or nurses are identified.”

[chrissterry]

NHS facing 'unforgivable' workforce crisis as number of doctors stands 25 years behind similar EU nations | Yorkshire Post

NHS facing ‘unforgivable’ workforce crisis as number of doctors stands 25 years behind similar EU nations | Yorkshire Post

This is disgraceful, but it is what occurs when Governments are responsible for financing organisations, for the finance given is only what each Governments feels is sufficient, not whether it is sufficient or not. It is the same with pay rises, which is of course a matter of concern currently, as only a derisory 1% has been put forward so far. But even when a pay uplift is authorised, it is…

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[wemrixblog]

Kidney Donor Recipient Dorchester Hospital in Coronavirus Times.

[newstfionline]

Britain braces for an exodus of E.U. doctors and nurses feeling hurt by Brexit

By William Booth and Karla Adam, Washington Post, March 4, 2018

BETTYHILL, Scotland--From his wind-scoured bungalow, Andreas Herfurt overlooks the village cemetery, an end place in his line of work. For almost 20 years, the German has served as the town doctor here in the woolly wilds on the north coast of Scotland.

“Those are not just my former patients,” Herfurt said of the graves surrounding the old church. “They are my neighbors and my friends. I have learned the hard way the whole truth about cradle-to-grave medical care.”

Herfurt is the National Health Service’s family physician for 850 souls in a 400-square-mile rural practice. This is a place where the cozy village pub--the Farr Bay Inn, known with a wink as the FBI--has a public room the size of a walk-in closet, the only restaurant option in winter is a fish-and-chips shop, and sheep outnumber humans by thousands to one.

Herfurt, 53, who never became a British citizen, says he has loved his life in the NHS, the United Kingdom’s much-admired, oft-derided, state-run universal health-care system. He has made decent money, by European standards. And he digs living in the middle of nowhere, with his Scottish wife and their big, slobbery dog.

“But I don’t know how much longer we will stay,” he said recently, taking a break at his clinic in nearby Armadale.

“In the simplest, most emotional terms, because I am human, I wonder: Am I wanted?” he said.

The German doctor is not alone in such feelings--which could spell disaster for the British health service.

Like Herfurt, many of his European colleagues in the NHS say they were stunned by Brexit, the vote by Britain in a June 2016 referendum to leave the European Union. The exit, which was not backed by most voters in Scotland or Northern Ireland, is scheduled for March 2019.

In a survey at the end of last year, the British Medical Association discovered that almost half of the European doctors working in Britain were considering leaving following the Brexit vote, and that nearly 1 in 5 were taking concrete steps--selling homes, looking for jobs.

If Brexit was driven by strong emotions, so is the reaction to it by some European doctors and nurses in the NHS.

In interviews with The Washington Post, several of those who are thinking about leaving didn’t point to overt acts of xenophobia. They acknowledged that nobody is kicking them out of the country.

But they are taking Brexit personally, expressing indignation at the prospect of having to be vetted in post-Brexit Britain. Many said they would refuse to stand in line for a work visa or submit to a criminal-background check--not after years of overseeing life-or-death decisions and emptying bedpans for British patients.

They noted that when they came to work here, they were Europeans coming to a member state of the European Union. They didn’t see themselves as “immigrants.” They were Europeans exercising their right to free movement in Europe. They were wooed by the NHS.

Many never sought British citizenship because they didn’t have to. They assumed they could spend their careers, perhaps their whole lives, here.

Daniela Schulze-Henning, 43, an NHS psychologist, recently put her house on the market and plans to move back to Germany with her husband, a general practitioner, or GP, and their two children.

“We’re not the only ones. We have GP friends going back,” she said. “It’s everywhere.”

She said that 70 percent of the people in her London suburb voted for Brexit, including a neighbor who had a big “LEAVE” poster displayed in her window.

“I hated that, coming home, seeing the ‘Leave’ sign,” she said.

If the European medical workers do exit in large numbers, they will be missed.

This month, Parliament published new statistics on NHS staff from overseas, revealing that in Britain, about 139,000--or 12.5 percent of NHS staff--are from Europe and elsewhere. Europeans dominate in the most skilled jobs. About 10 percent of doctors and 7 percent of nurses are European nationals.

The study did not publish figures for Scotland, Wales or Northern Ireland because of differences in reporting, but health experts say the numbers are similar to England’s.

Brexit was propelled by disparate goals: Voters wanted to slash immigration, not only from countries such as Bangladesh or Ukraine but from the E.U., as well. They were also promised a windfall in NHS funding after payments to the bloc ended--$500 million a week, the Leave campaigners vowed, a claim that was later debunked and disavowed.

The NHS faces crisis-level staff shortages and relies heavily on Europeans to do the jobs that British nationals either can’t or won’t do.

European doctors interviewed by The Post say their fealty to the United Kingdom swings with the headlines.

One day, they read that Prime Minister Theresa May has promised Britain will always welcome “the best and brightest” from the continent. The next day, they see hard-line Brexiteers in her cabinet insisting that annual net immigration must be slashed from current levels of hundreds of thousands of newcomers to a post-Brexit goal in the tens of thousands.

Many wonder how their children will fare. They are unsettled, too, by the tabloid rhetoric branding Brexit opponents “enemies of the people.”

As a boy growing up in Majorca, Spain, Carlos Hoyos remembers being fascinated by British inventors. England embraced openness, he believed. When he visited London as a teenager, something clicked: “I thought, ‘This is where I want to live.’”

It has now been 27 years since Hoyos moved to the U.K. He lives with his British wife and their two teenage daughters in Southampton, on England’s south coast, where he works for the NHS as a child and adolescent psychiatrist.

“It’s emotional that these people I have admired all this time actually don’t want me here,” Hoyos said. “It’s a sense of rejection.”

Harry Quilter-Pinner, a research fellow at the Institute for Public Policy Research in London, said, “The influx of workers from the E.U. are vital to keeping the show on the road.”

He added: “If the government said, ‘Okay, let’s train up new doctors,’ you wouldn’t get any payoff for 10 years. The only way to fill that gap is through immigration.”

The problem, said Siva Anandaciva, chief analyst for the King’s Fund, an independent health-care think tank, is “the worrying trends emerging that show these staff no longer want to work in the U.K.”

He pointed to sharp declines in the numbers of European nurses and midwives coming to Britain at a time when the country needs to hire tens of thousands of nurses.

Joan Pons Laplana, 42, is from Barcelona and works as an NHS nurse in Chesterfield. He has lived in Britain for 17 years and has three children, all born in England.

“Despite my family, despite paying taxes, despite working hundreds of hours of unpaid overtime, like everyone else in the NHS, I feel like I don’t count for anything, that I am invisible,” he said.

“There’s the younger generation, who have been here for less than five years. All of them are packing up. A lot of colleagues are going,” Laplana said. “There’s the second group, like me, it’s not that easy, because of my family, my kids, my career of nearly 20 years, my mortgage, my friends--where do I go? I don’t have anything in Spain. I have my mom and dad, but Spain is not my home.”

The NHS has buckled under the strain during the current flu season, with hospital corridors crowded with gurneys and 12-hour waits in emergency rooms. Heart and cancer surgeries have been postponed.

Herfurt has continued his usual house calls, his visits to elder-care residences. He said, “I am a dinosaur,” and added with a flash of frustration, “Good luck finding my replacement”--someone who will work long hours in a remote rural practice.

If he stays, it will be because of his patients.

For 19 years, he has spent his days here giving howling 6-week-old babies their first checkups; seeing snotty-nosed kids through childhood vaccines; helping mums with pregnancies--then shepherding the older folks through the middle and final years of heart disease, diabetes, cancer and dementia to death.

“It has been a privilege to practice this kind of medicine,” Herfurt said.

Annie Hall, one of his patients, shook her head and said, “No, no, no!” when asked what she thought about Herfurt leaving.

“He can’t go,” she said. “He’s a local, almost.”

[yahoonewsdigest-gb]

NHS paid locum doctor £3,258 for one shift during winter A&E crisis

Health

NHS paid locum doctor £3,258 for one shift during winter A&E crisis

A NHS hospital paid more than £3,200 for a locum doctor to cover a single 24 hour A&E shift over the Christmas and New Year crisis, an investigation has found. So short staffed were some trusts between Christmas Eve and New Year's Day that more than half the shifts in their emergency departments were worked by locum medics, often at huge expense. Figures obtained by Sky News show that four hospitals paid more than £2,000 for A&E consultants to work a shift, with the highest bill being the £3,258 paid by United Lincolnshire NHS Trust for a doctor to work for 24 hours.

Market forces really are quite extreme currently, with the lack of permanent people to employ. It means hospitals are desperate to try to find people to fill these slots and are having to pay super premium rates for that to happen.

Dr Clifford Mann, president of the Royal College of Emergency Medicine

Leeds Teaching Hospitals NHS Trust paid the equivalent of more than £230 an hour for one doctor. Three hospitals paid more than £1,700 for nurses on single shifts, the highest at Royal Berkshire where one agency was paid £1,875 for a nurse to work 12 hours on New Year's Day, the equivalent of £156.25 an hour. Derby Hospitals NHS Foundation Trust paid £156 an hour for a nurse and North Bristol NHS Trust paid £144. At Airedale NHS Foundation Trust almost three quarters - 71% - of the shifts over that period were covered by a locum doctor. Experts said that competition between hospitals to fill shifts during what was the busiest Christmas period on record meant that the prices being charged by locum agencies soared.

It can be very demoralising to be working alongside somebody with much less experience, much more junior, who is earning a multiple income compared to you in terms of the pounds paid per hour.

Mick Corti, of the London Procurement Partnership