Despite being bombarded by the music and advertising for seemingly months, it’s probably not too early now to start thinking about the festive period.
I very deliberately choose ‘thinking about’ rather than ‘looking forward to’ as for the healthcare professions, this can often be a tough time of year. The Christmas period itself often heralds a coming storm and signals the genuine start of “NHS winter”. And, while many others are gearing up for a well-earned break, in the NHS we go on delivering care “as normal” although at Christmas and New Year it often feels like an even more stretched and hectic health service.
And at this time of year we often see more of the very sickest patients, underlining the widening gap between the demands on our NHS and the resources we have in place to meet those demands.
The increasingly common long waits in emergency departments illustrate this, with waits over eight hours reaching historically high levels over the last two winters. We have also seen elective operations cancelled due to lack of capacity spike in recent winters. The decision to do that may in fact be the right one when faced with overwhelming emergency demand, but it again emphasises the utter lack of any slack in the system. I’ve written previously on the issue of delayed discharge – and the industry that has grown around even simply measuring these figures, rather than necessarily doing something about this, and boarding and delayed discharge sometimes seem to reach epidemic proportions by the first full week of January.
This is bad for patients and it’s not good for us. While we need to be mature and reasonable in our approach to targets, and question them when we think they may not be quite right, the failure to meet them does indicate pressure across the system. If you like analogies, then they are a warning light on a car dashboard that things are going badly wrong and breakdown is imminent. Except in the NHS it never feels like you get the chance to stop to fix things.
Beyond impacting on the people we care for these figures also clearly indicate the NHS workforce, which is already running on empty, is more likely to reach breaking point at this time of year.
I don’t use that term lightly. But I know the scale of the personal burden everyone bears when you are striving to deliver the best possible care you can, but the sheer scale of the workload just makes that next to impossible. Working in such high-pressure, unrelenting environments impacts on our own physical and mental health.
That’s why this year more than ever the BMA in Scotland will continue to highlight the fact that our NHS is understaffed, under resourced and creaking at its very seams, but more than that, we are going to focus on the impact this is having on you, on the frontline, doing your very best to care for the people of Scotland.
Our working lives will undoubtably improve if and when we finally have enough doctors and our NHS is genuinely properly funded. Even in my most optimistic moments (which are few and far between, but even I have them occasionally), we know that’s not going to happen overnight.
That is why I’ll be emphasising that much, much more must be done to care for the people who care for the people of Scotland. That means effective mental and physical support services from NHS employers, health boards and Health and Social Care Partnerships. It means being able to go to work without fear in a no-blame culture, where bullying is called out and rooted out.
It means actually sorting the pension tax crisis which means our most senior doctors are working less to avoid punitive tax bills, and where some are effectively working in a system where they can end up paying to go to work. And it means shifting the emphasis in healthcare away from a narrow focus on unachievable targets that simply add to the pressure.
It’s cliché, but fixing this isn’t just for Christmas, it is for life. Winter is often when we feel the pressure the most, but it’s there all year round. And it’s been there year in year out for far too long.
We desperately need the NHS to feel like a good place to work and look after those who work in it.
That’s why to help us really understand and highlight how this feels on the ground, we are asking you to take part in our pressure on the profession survey. It should take no more that 5 to 10 minutes of your time and it will seriously help us define the issues and push for change.
The link is here and we are keeping this open until December 14th.
You’ll also find loads of content on our social media channels across the festive period, reflecting on the last year, looking ahead to 2020 and emphasising the support we can provide you as your trade union. We know this is a tough time, but we want you to know that you are not alone, we are there to support you – as I am sure are all your colleagues.
And that’s the point I want to end on. We have such a tough job – and it’s even tougher at this time of year when we no doubt see friends and family having time off, when the nature of our jobs denies many of us the same break. Medicine is the path we have all chosen, and it can be incredibly rewarding, but I know that often doesn’t make it any easier. At the BMA we offer wellbeing support services, 24/7, to all doctors and medical students. It is confidential and free of charge. We are here for you. Never suffer in silence, there is always someone you can talk to.
Dr Lewis Morrison is Chair of BMA Scotland
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