A4C Blog: what do you want to be?
As a profession we are trained to keep our heads down, work hard and expect all to come good in the end. This means different things to different people, but few would deny an ambition for professional autonomy and job security.
The reality though is that healthcare is facing huge challenges and as individuals within that system we have to understand those changes to have any chance of either of those ambitions.
The first challenge is that medicine is becoming industrialised. The conveyor belt of medical training is churning and has been doing so at an increasing pace for over a decade. As this surge in doctors starts to near the end of training it becomes clear that they are not so much the product, but are in fact part of the machine itself. As the population ages and the predictable increase in lifestyle disease takes hold, doctors will increasingly become ‘providers’ with usefulness measured by the number of lists, rounds or clinics that can be attended. Shift work has already become the norm and our working patterns will become dictated by the need to maximise patient volumes.
The second challenge is that the money is running out. After a decade of unprecedented growth, investment into the NHS is now flat. £15-20bn in annual savings have to be found by 2014/15 and funding is unlikely to rise until 2022 at the earliest. As the figure shows (taken from the Nuffield Trust’s ‘A Decade of Austerity’) the main pressures come from pay, chronic diseases and population growth.
The third challenge is public expectation. A year on from the Francis Enquiry we face a public and press astounded by the apparent lack of care and compassion in clinical staff that led to the scandal at Mid Staffs. As the public becomes better informed and better served by other sectors they expect the NHS to care about the service it provides and we are increasingly being judged on the experiences of our patients.
We have a choice when faced with challenges like this. We can roll our eyes at the word ‘scandal’ and wonder if this has all been blown up a bit too much by press and politicians. We can say that lapses of care and patient experience are inevitable given the funding crisis and the relegation of doctor to ‘service provider’. We can leave this to the managers and the politicians and blame them when they get it wrong.
The alternative is that we face up to this. Have you ever walked away from a patient in distress or pain? Did you ever try and find a reason not to see a referral at 4am that you wouldn’t have questioned in the day? How many ways did you justify it? These are not things we would like to admit, but it’s our responsibility to admit they happen and to understand why they happen. Then we can learn how to shape the system we work in to make it easier to do the right thing. The truth is nobody knows how best to balance the expectations of world class care with the pressures we face, but more than any other time since I started training there is a will to listen to doctors in training, to invest in them and to equip them for the challenges ahead. Once you accept that you have a voice and you are as qualified as anyone to comment on the system as it stands you find that you can start to influence and improve it very quickly.
True job security and professional autonomy in the old fashioned sense may be a privilege that few can still be guaranteed, but for those who are prepared to take a risk, who stand up to be counted, there is a world of opportunity out there. Be an agent for change.
Rob Fearn
@robfe4rn