Brexit, NHS pressures, homelessness, and the crippling pensions tax – a look back at the issues faced by the profession in 2019 and how we covered them
35 – The percentage of doctors who qualified in other EEA (European Economic Area) countries who are thinking of leaving the UK, according to a BMA survey.
Doctors who qualified in other EEA countries make up almost a tenth of all those licensed to practise in the UK. Without them, the NHS would surely collapse.
Brexit’s many and corrosive tentacles have reached far into the health service. They included in September, the bizarre spectacle of David Nicholl (pictured below), the consultant who advised the Government on no-deal Brexit planning, being told by Jacob Rees-Mogg that he was ‘irresponsible’ for raising concerns about drug shortages.
Often overlooked is the effect it has had on individual doctors. Since the Brexit vote in 2016, the BMA has been consistently lobbying for them to be given guarantees on their future statuses in the UK. While there have been some assurances, many doctors have been left feeling that they were not welcome.
Greek-trained Michael Kalogirou told us in March that Brexit ‘makes it feel like you’re not accepted now’. Italian junior doctor Federica Ceroni said that after the Brexit vote, ‘I did not feel as welcome as I had before… it felt as if all that I had done while in the country had not been appreciated’.
80,092 – The number of patients in England in October who waited more than four hours from the decision to admit to admission.
‘Trolley’ used to be a neutral kind of word, just a name for a mundane piece of hospital equipment. Now, in the NHS word-association game, it’s inevitably paired with ‘wait’.
The number of patients waiting more than four hours for admission in October was up 63 per cent on the same month the previous year. Back in October 2010, the figure was 6,932. There are now enough people waiting each month to fill Manchester United’s football stadium. Nine years ago, they wouldn’t have filled Cheltenham Town’s.
By any indication, the NHS is facing unsustainable pressures. BMA modelling of trolley waits, emergency department attendances and emergency admissions has already established that an NHS summer is now as pressured as the worst of previous winters. For this winter it predicts that even the best-case scenario in most areas will be worse than last year.
One emergency medicine consultant told The Doctor: ‘I don’t think there’s an emergency medicine department in England or Wales that thinks patient care isn’t going to suffer over winter.’
The BMA, in its manifesto for the general election, set out enhanced investment by at least 4.1 per cent per year in real terms, and action on safe staffing, as key priorities.
462 – The number of days a homeless patient spent in a hospital in Nottingham.
Hospital attendances by patients with no fixed abode have more than tripled in three years. In our focus on homelessness we have looked at the effect on the health outcomes of patients, and the work being carried out by doctors around the country.
In this issue, a patient deemed medically fit for discharge faced the prospect of living rough on a housing estate. It is little wonder that hundreds of them have long stays in hospital while suitable options are found.
Fortunately, that patient came to the attention of a Pathway team at his local hospital. The teams address the complex issues in a homeless patient’s life and use their expertise in areas such as clinical care, occupational therapy, social care, or substance misuse to help address their problems.
Only 11 trusts operate Pathway teams at hospitals in England, when many more are needed. And that, like in so many other areas of healthcare, is a fundamental problem. Provision is patchy. Where it is there, it can be excellent – such as Rochdale GP Zahir Mohammed (pictured above), who not only hosts a drop-in surgery and stocks sleeping bags, but volunteers at a project for the homeless, too.
Homeless people have many needs, but one of the most fundamental is a truly national health service.
16 – Laura McManus’s age when she became pregnant.
Laura had been excluded from school at 15, was pregnant at 16, then lived in homeless hostels before doing a succession of jobs such as cleaning and serving in a chip shop.
She is now a doctor, having returned to education as an adult and been well supported by the teachers there.
It’s an inspiring tale but one that is all too rare. Only a minority of doctors come from working-class backgrounds, meaning there are whole sections of society barely represented by the profession.
Dr McManus told us: ‘It wasn’t that I was academically incapable, it was discrimination and the lack of support, resources and self-belief.’
The BMA has launched a new initiative called Aspiring Doctors, which invites medical students and doctors to visit schools and colleges and talk to possible applicants.
As the BMA medical students committee widening participation lead Brooke Davies said: ‘Widening participation, for me, is the concept that allows anyone to have a chance to be a doctor. Your background should not matter.
‘It should not matter if you have parents who are doctors, parents who are not, or you don’t have parents. It should not matter if you live on a council estate, live in care or live between homes.’
-£27,000 – Consultant psychiatrist Kate Lovett’s annual pay, effectively, once she has paid a tax bill related to her pension.
One of the greatest crises faced by the NHS is entirely of the Government’s own making.
Changes to pensions taxation have meant thousands of consultants have been hit with huge, unexpected tax bills, forcing them to reduce their commitments at exactly the time the health service needs them most.
Dr Lovett (pictured above) said: ‘This is terrifying – here I am at 52 having thoughts about cutting down the work I’m doing. We simply can’t afford for people even beginning to think like that.’
The BMA has been leading the campaign against the changes, lobbying successive prime ministers and other senior policy makers, surveying members to reveal the extent of the problem, and giving practical advice.
341 – The distance in miles between one NHS organisation and the private mental health facility to which it sends patients.
Research by this magazine found that patients with severe mental ill health are being routinely ‘warehoused’ in locked, private wards for want of NHS care closer to home.
Some CCG areas in England have no NHS wards at all for mental health rehabilitation, so rely on private hospitals and care homes. Such stays last twice as long, increasing the expense and the pain of separation from family support. And expenditure on them has gone up.
BMA mental health lead Andrew Molodynski (pictured below) said: ‘There are no positives at all here for patients, families, care services or the public purse – quite the opposite.’
The research attracted the attention of the Royal College of Psychiatrists, leading charities, and the doctor leading national efforts to improve the service.