Your Life In My Hands--a Junior Doctor's Story

by Rachel Clarke

  The prospect of Hannah quitting the profession she had once so loved filled me with sadness. I tried to persuade her to stay.

  ‘Rach,’ she said, ‘you don’t understand. If I carry on like this, I won’t end up surviving it. I can’t keep pouring my life and soul into the NHS if I’m fighting against the system to do a decent job for the patients. Not when the managers don’t give a shit, the politicians are hypocrites and I get told I’m scum by the Daily Mail on a weekly basis. Why would I do that? It’s falling apart. Everything I do is in spite of, not because of, my employers, and I hate it.’

  One day, Hannah should have been a professor or groundbreaker of UK medicine. The NHS cannot afford to lose a single doctor or nurse, least of all its brightest and best. Yet, instead of addressing the gaps that blight doctors’ and nurses’ rotas, the government attempts to downplay and deny them. In contrast, Sir Robert Francis has been characteristically blunt about what should constitute a safe response to understaffing:

  ‘If you haven't got the right number of people to fly an aircraft properly, you don’t fly the aircraft. You should not be operating if you haven’t got enough surgeons on duty who are fit to operate [and] you should not be running a ward if you haven’t got enough staff on duty to feed people.’

  It is simply a fact that we don’t. We don’t have enough of anyone. In an NHS with too few doctors and nurses being stretched too thinly across too many patients, we increasingly fear a repeat of Mid Staffs, but the politicians choose not to hear this.

  CHAPTER 8

  MILITANCY

  In my world of princesses, heroines and unicorns, Margaret Thatcher was an unlikely addition. But, to my six-year-old self, there was something about her ascent to power that seemed to be tinged with magic. I’d had no idea certain jobs were for men. The thought hadn’t crossed my mind. Then, the morning after the 1979 general election, my primary school teacher held a newspaper aloft to the class in triumph.

  ‘Look!’ she cried ecstatically. ‘The Prime Minister is the most powerful person in the country and this lady, Margaret Thatcher, is the first woman in the history of Britain ever to have become Prime Minister. Listen, children. Every other Prime Minister until now has been a man. All of you, especially the girls in the class, should feel so incredibly proud. A woman can do anything a man can.’

  My eyes gleamed with excitement. Fired up by my teacher’s passion – and with my vision of Thatcher temporarily established as a kind of crusading female superhero, Wonder Woman in pearls and an electric-blue twinset – I must have fixed that day in my memory, because a couple of years later, now aged eight or nine, I decided to take a political stand of my own.

  Maybe if Henry Bone had not been so obnoxious – he liked to chase the girls round the playground and try to pull their knickers down – I wouldn’t have taken him on. But he was a thug and I hated bullies. Short, squat and prone to bashing the weedy boys, he was shaped like a dumpy torpedo. Perhaps it was this that gave him his edge in the water, because Henry Bone was some kind of swimming prodigy, supposedly destined for the Olympics, though I didn’t buy a word of his bragging. One of the very best things about my primary school was its decrepit old outdoor swimming pool, tucked away at the bottom of the playing field. Though the water was greenish and icy cold, usually blighted by weed and dead insects, our precious weekly ‘swimming lesson’ – an anarchic, overcrowded frenzy of splashing and squealing – was the weekly highlight of our summer terms. The chance to plunge into the stagnant water could never come round soon enough. The headmistress’s husband, a thin, stooped, browbeaten man known only as ‘Sir’, would stand on duty at the poolside, eyes glumly averted, while we unleashed merry bedlam in the water.

  In contrast to our strictly rationed pool time, Henry Bone had been granted special privileges. Being a swimmer of such prodigious talent, every lunch hour, five times a week, he was given the grace of the pool. Up and down he cruised, lord of the duckweed, gloating insufferably afterwards. Perhaps I really just wanted to cut him down to size – punish him for all the times he beat up the little kids – but the injustice of it festered within me. I couldn’t see why he should enjoy daily private pool time just because he happened to be good at swimming. If anything, the kids who couldn’t swim should be in there, learning how to improve.

  Somehow I rallied the rest of the children in my class to the cause, and for one entire lunch hour, instead of playing tag and scaling the climbing frames, we all sat cross-legged on the grass in front of the swimming pool, silently observing Henry Bone swim his lengths. It was swelteringly hot, itchy and boring. Our polyester shirts stuck to our backs with sweat, but I wouldn’t let anyone leave. The teachers, observing this unusual spectacle from the terrace where they ate their packed lunches, dispatched Sir to find out what we were up to. I stood up and spoke.

  ‘We don’t think it’s fair that Henry Bone is the only person in the school who’s allowed to swim at lunch just because he’s better at swimming than us. We think everyone should be allowed to swim even if they aren’t very good at it.’

  Sir reported back to the rest of the teachers. When the school bell rang at the end of lunch break, they all remained seated, curious to see what we would do next. None of us moved, though mutterings of unease spread through the ranks. Collectively breaking the school rules was unnerving.

  ‘Stay,’ I urged. ‘I’ll take the blame. We won’t get into trouble.’

  This time, the headmistress herself strode over to our protest. Notoriously fierce, she had a prominent wart on her chin that sprouted black hairs, which she would stroke unconsciously when not tearing strips off a miscreant. We all lived in fear of her temper. Sometimes I’d spend whole lessons spellbound by the wart and what it might represent, unable to tear my eyes from it. It seemed entirely possible that our headmistress was in fact a witch. Now, as she towered over us, glowering, I started to feel sick inside.

  ‘The teachers and I have discussed your protest,’ she announced with the utmost gravity. She paused. The wart was distracting me. ‘And we have decided that you are quite correct. If one child is allowed to swim at lunchtimes, then all children should be allowed to swim at lunchtimes. From now on, we will start a timetable and each class will take it in turns to swim.’

  The class erupted into shrieks of delight, the concept of a gracious victory meaning nothing to a bunch of nine-year-olds who weren’t even sure what a protest was. Justice felt sweet, even if we couldn’t spell it. It was a triumph for mediocre, underaged swimmers everywhere and our cheering seemed to last for ever. Though Henry Bone never stopped tormenting me afterwards, it was deliciously, magnificently worth it.

  I’d forgotten all about the children’s stand against Henry Bone until, as the junior doctor dispute got under way, the press started branding junior doctors as ‘militants’. The label was clearly a tactical smear aimed at delegitimising campaigning doctors, but – who knew? – perhaps I’d had a dormant militant tendency all along, having acquired a taste for it in childhood.

  A slew of similar insults followed. Doctors who backed going on strike against the government’s new contract were labelled ‘radicals’ and ‘extremists’, as though the behaviour of the country’s doctors in some way echoed that of terrorists. Jeremy Hunt apparently approved of these insinuations, retweeting some of them on his personal Twitter account. Not once, in all those years of medical school, could I have imagined that one day my status as a doctor in training would become, for certain journalists, a term of abuse, nor how painful it would be to confront that.

  Since the Health Secretary had launched his seven-day crusade, relations between doctors and the government had imploded. Hunt had renewed his vow to impose the contract if negotiations failed and the BMA Junior Doctors Committee, in response, had announced a ballot of its members over strike action. Huge numbers of ordinary grassroots doctors – those, such as myself, with no formal role or involvement in the BMA – had been galvanised by Hunt’s speech into action. Pr
ior to this, like most of my colleagues, I was only dimly aware that doctors’ contracts were up for negotiation. I belonged to the BMA only to enjoy my copy of the British Medical Journal every weekend.

  Typically, doctors are not exactly renowned for our insurgency. We’re people-pleasers, not revolutionaries. We’ve spent our lifetimes obligingly jumping through hoops. When the rebels among our schoolmates went behind the bike sheds, we went to the library to swot up on our A levels. Then, after choosing five or six years’ worth of further exams at medical school, we accepted with passive subservience working conditions that in any other profession would be met with incredulity. I have friends who have asked their hospital a full year in advance for annual leave for their wedding and honeymoon, only to discover nearer the time that they have been rostered on call for that particular fortnight. I have begged in vain for a rota in advance of starting a new job in order to plan my childcare, to be told on my first day in post that I am in fact starting on night shifts and will be expected to be on call that evening. I’ve worked in a hospital whose doctors’ mess was infested with rats in the ceiling and cockroaches in the skirting boards, despite years of efforts by the juniors to press the hospital management to address this.

  We used to take this kind of treatment with remarkable docility. But Hunt achieved something unprecedented. He politicised junior doctors, turning us en masse from compliant NHS rota fodder into accidental militants. Some of us gave television interviews that went viral, viewed online hundreds of thousands, or even millions, of times after they had been broadcast. Others started to plan mass demonstrations in London, Leeds and Belfast. Five junior doctors would go on to fight Hunt in court, their judicial review becoming the most successful example of crowdfunding in UK legal history, receiving over £50,000 of public donations in less than twenty-four hours. Most successfully, we harnessed social media to counter the government’s narrative that this was simply a pay dispute. When a small group of non-BMA juniors set up a Facebook forum, word quickly spread and everyone started joining. At its peak, the so-called ‘Junior Doctors Contract Forum’ had over 60,000 members and, though infiltrated by the press and the Department of Health, the majority of these were doctors. We used it to share freely our opinions, ideas and reactions to the unfolding saga. For the first time, the country’s 54,000 junior doctors had acquired a common identity, a sense of solidarity and a strong desire for collective action.

  On a bitterly cold Saturday in mid-October, 20,000 doctors and their supporters marched on Downing Street in the London protest against the contract. I’d only ever been on one protest march before – when a million people demonstrated against the Gulf War in 2003 – but that was in order to film it for a documentary I was making about Al-Qaeda. So, technically, this was my first protest. The Metropolitan police were out in force as doctors in scrubs, pensioners and children all flocked to Westminster. There were family zones, an NHS choir, banners and placards, one of which was immortalised in the next day’s press, saying, ‘I may not be a gynaecologist but I know a Hunt when I see one.’

  I’d never seen police officers beaming so supportively. One of them made a point of coming up to me to say, ‘Don’t give up. You keep on fighting. We don’t want to see them doing to you what they’ve already done to us.’

  It made me feel humbled. As protests go, this was a frightfully polite one. Having arrived outside Number 10, chanted a little and brandished placards, the crowd peacefully dispersed, leaving a few stragglers, myself included, who felt duty-bound to retrace their steps, carefully removing any traces of litter. Clearly, even when driven to extremism, doctors’ innate obedience lives on.

  At home, Dave and children took a dim view of my ‘militancy’. I’d started setting my alarm half an hour early every morning to give me time respond on Twitter to the latest government spin before getting the children to breakfast club and myself to the hospital. I wrote blogs and newspaper columns in the early hours, and regularly caught the train to London to give live television news interviews. Occasionally, a film crew invaded our kitchen and, to my children’s delight, I would bribe them into silence with the family iPad. Once, my husband asked my five-year-old daughter whether she would like, as a treat, to stay up late at bedtime to watch Mummy give an interview on the news. She gave the matter some thought before delivering an uncompromising verdict.

  ‘Well,’ she said at last. ‘Will the news have My Little Pony in it?’

  ‘No, it probably won’t, I’m afraid,’ replied my husband.

  ‘Oh. No, then. I’d like it if there was My Little Pony, but Mummy’s boring.’

  She was right. I was. People in the grip of an obsession always are. The more aggressively the government spun the conflict as merely a pay dispute, the less able I felt to sit passively by. Hunt believed the wrath of junior doctors had been provoked not by anything he had said but by the BMA, which had maliciously duped its members into misplaced fury by claiming that he planned to slash our salaries, when in fact he had no such intention. He therefore set out to divide and rule the union from its members, reserving his attacks for the ‘politically poisoned’ BMA, while seeking to appease and flatter ordinary junior doctors:

  ‘Working on the NHS’s front line is one of the toughest jobs in Britain today,’ he wrote in the Telegraph, just prior to our strike ballot. ‘Our junior doctors are at the forefront of dealing with those pressures. They work the longest, most unsociable hours and staff our hospitals over the weekend – in short, they are the backbone of the health service.’18

  These soft words cut no ice, being undermined by the occasions when the Health Secretary said something in public that we knew to be inaccurate. Early on in the dispute, for example, he claimed on the news during the BBC’s Breakfast programme that a minority of doctors working over fifty-six hours a week were ‘paid what’s called colloquially in the NHS “danger money”.’19 The insinuation – that some among us were willing to jeopardise our patients for the sake of lucrative overtime – conjured an image of junior doctors as reckless opportunists. The trouble was, it was cobblers. Not once had any doctor, even those in retirement, ever heard of the fictitious phrase ‘danger money’, let alone been paid any. Hunt’s claim, broadcast live to the nation at breakfast, was entirely disingenuous – or what is colloquially known as a barefaced lie. He’d literally made it up. And, the more he spun to the public using fabricated soundbites, the more successfully he alienated the country’s doctors.

  More subtle versions of divide and rule were deployed by various newspaper columnists, who looked to separate grassroots doctors into two opposing camps, inviting ‘moderates’ to perceive themselves as different from and better than their more ‘militant’ peers. In his column entitled, ‘Moderate doctors must defeat the militants’, the Times’s chief leader writer and former director of the Conservative Research Department, Danny Finkelstein, claimed that ‘threatening patients’ wellbeing for the sake of overtime pay is typical of the BMA’s cynical rabble-rousing behaviour.’20

  He argued that no doctor with honour should be willing to contemplate striking, ending with the impassioned plea:

  Where are you, brave moderate doctors, to tell the leadership that this has gone far enough? When all your associates are in such a lather, of course it is hard to stand up against it. But it’s your duty. To harm patients over your pay is outrageous.20

  Ironically, even as his cheerleaders in the media urged us not to be motivated by pay, Hunt himself attempted to buy us off with financial sweeteners. On the morning the strike ballot opened, every front page was dominated by headlines about an extraordinary concession on his part, a whopping 11 per cent pay rise for junior doctors.21 It was a masterclass in political spin. Not only did it make him appear magnanimous but, if we voted nonetheless to strike, we really would be showing ourselves up to be the money-grabbing individuals he had implied all along.

  But, if his new-found largesse sounded too good to be true, that’s because it was. The 11
per cent increase was in basic pay only, offset by huge cuts elsewhere in pay for antisocial hours, and, since most of us worked a great proportion of those, the overall effect was likely to be a pay cut for many. Perhaps Hunt had hoped to avoid strikes by duping us with an apparent pay rise, but what he actually achieved with his engineered headlines was to reignite doctors’ fury. Trust, honesty, candour. Those values at medicine’s core were not, apparently, shared by the Health Secretary. Unsurprisingly, 98 per cent of us voted in favour of striking.

  Perhaps most frustratingly, in working so hard to present the conflict as a pay dispute, an objective he achieved with aplomb, Hunt had failed to grasp what really motivated many of us. It was fear, fundamentally, that stoked much of the anger. Not, primarily, fear of losing out financially – though the idea of being paid less for our work was clearly inflammatory – but of being forced to work longer and harder than we already did, of being stretched even more thinly. I knew my limits. They were already being tested. More than anything, I feared being driven out of the job I so loved by intolerable increases in my workload.

  Hunt insisted no doctor would work longer than currently. Indeed, the new contract would reduce overall hours from ninety-one to seventy-two per week, he claimed, so we ought to be embracing it. But his assurances were undermined by his insistence that the new contract had to deliver seven-day services ‘cost-neutrally’. The public were being promised something for nothing, seven days for the price of five. Weekends would be transformed, allegedly, without any additional doctors or resources. Yet the original Conservative Party manifesto commitment in 2015 had recognised that staffing was critical: ‘We want England to be the first nation in the world to provide a truly 7 day NHS … with hospitals properly staffed, so that the quality of care is the same every day of the week.’22