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

by Rachel Clarke

  Dagan, having spotted Hunt entering the building, walked alongside him, attempting to raise in measured terms, ‘the concerns we have about patient safety’. Unperturbed by Hunt’s brief attempt to explain that he was, ‘just on his way to do an interview’, Dagan accused him of, ‘taking a massive gamble with people in the NHS,’ stating that he had, ‘absolutely no evidence whatsoever that these [contractual] changes will have a positive effect’. Hunt then simply ignored Dagan, who continued to follow him down a corridor and up a staircase, asking, ‘Why won’t you sit down to talk to junior doctors – what if you’ve got this one wrong?’50

  The visual potency of the Health Secretary actively fleeing a member of NHS staff ensured Sky’s footage went viral immediately after being broadcast, watched online by hundreds of thousands of viewers. Afterwards, in an interview with the Evening Standard, Dagan commented,

  I was a bit worried I was going to look like a bit of a fool walking after the Health Secretary, but I think it is telling he is just walking away from the questions. I spoke to my mother-in-law last night. She said it looked a lot like one of those episodes of Rogue Traders where the guy is just running away.51

  Like Dagan, I too had strenuously endeavoured to engage Hunt publicly. Crucial to his efforts to position himself as the BMA’s nemesis, yet ‘ordinary’ junior doctors’ friend, was his repeated assurance that his door was open to doctors like me. The closest I had come to meeting the Health Secretary was when he appeared on the BBC’s Sunday morning political interview programme, The Andrew Marr Show. I had provided the producers with an anonymous written comment and, knowing Andrew Marr might read this out to Hunt, settled down to watch the interview. I had my Sunday morning coffee in my hand and my wriggly five-year-old on my lap when, to my astonishment, I heard not only my words but my name read out live on air to Hunt. Several things happened in swift succession. I spat hot coffee onto the back of my daughter’s head, she shrieked and writhed in indignation, I upended my coffee into my lap, and Jeremy Hunt blinked and gulped like an Amazonian python ingesting a small deer as Marr mercilessly read out yet more doctors’ comments.

  ‘Rachel Clarke,’ Marr stated, ‘is a doctor who says, “Mr Hunt has made me feel demoralised, insulted and cheap. He implies we are the problem. Well, I give my life to the NHS. It’s so grim on the front line now, I sometimes work fourteen or fifteen hours straight without a second even to eat. I have never felt so despairing or so close to quitting medicine.”’52

  Another doctor Marr cited said, ‘The profession is at absolute breaking point. I see doctors in tears because they are so despairing about what the future holds. Jeremy Hunt has done this. He is driving away a whole generation of doctors.’

  ‘Those are the voices of doctors right now,’ Marr concluded. ‘That’s what they feel.’

  Hunt, visibly uncomfortable, responded by blaming the BMA for our anger, specifically singling out the union’s irresponsibility in spreading misinformation about the contract. Later that day, invited by the BBC to respond in a live interview, I roundly dismissed this attempt to portray doctors like me as the hapless victims of BMA propaganda.53 I was perfectly capable of appraising the evidence for myself, I argued, and the central issue was one of trust. As doctors, we are nothing if our patients do not trust us. Yet the months of spin and statistical manipulation had left us feeling unable to trust the Health Secretary, and the more aggressively he played the media game, the more corrosive the Trust deficit would become.

  By now, the country’s 54,000 junior doctors were following and commenting upon every twist and turn of the dispute on our Facebook forum and other online platforms such as Twitter. The government did not like it. Sir David Dalton, the Salford Royal NHS Trust chief executive appointed by Hunt to represent the government in negotiations, claimed that frenzied social-media campaigns by junior doctors were destroying any chance of the two sides reaching a deal. The ‘goldfish bowl of people giving real-time commentary’ was a ‘huge impediment’ to talks, he insisted.54 The irony was lost on none of us that, while it was apparently acceptable for various mainstream media outlets to whip up antidoctor sentiment through fair means or foul, when doctors sought to counter misinformation online, this was painted as destructive hysteria. Talks, yet again, ground to a halt.

  In a frankly desperate effort to encourage Hunt back to the negotiating table – there was little to lose with an all-out strike fast approaching – I decided, at the unlikely age of forty-three, to organise my second ever form of direct action, the first being my junior school sit-in over swimming pool rights. Dagan and I hatched a plan to begin an indefinite peaceful protest on Hunt’s doorstep, camped outside the entrance to the Department of Health, immediately in front of his famously open door. We planned to remain in place in Whitehall for twenty-four hours, sleeping rough on a pavement outside the Department. After that, we would be replaced by our colleagues for twelve hours a day, seven days a week, until we had forced a breakthrough. When news of our protest broke, we were overwhelmed by hundreds of doctors from all over the country signing up to take part, some of them travelling down to London from as far afield as Leeds and Manchester.

  The aim was simple. There had to be a way of averting an all-out strike – an act of last resort that went against every grain of doctors’ instincts to care for our patients – through dialogue. No dispute is so poisonous, so intractable, that words cannot in the end defuse it. It was simply not good enough for a man who claimed to value patient safety to maintain tactical silence at this critical juncture, and we intended to highlight that.

  The reality was a little more complicated. First, having set up our collapsible table just outside the Department, its tablecloth emblazoned with the hashtag ‘#TimeToTalkJeremy’, we were approached by two burly officers from the Metropolitan Police.

  ‘Uh oh,’ I whispered to Dagan. We had checked the legality of our protest meticulously, but feared we were about to be ushered away on some kind of spurious pretext.

  ‘Hello, doctors,’ one of the officers said. ‘What’s going on here?’

  We explained who we were, what we were doing and why. There was a long pause. The two policemen glanced at each other. Then, one of them leaned in closely and said, in a low but firm voice,

  ‘Now you listen to me. You’re not doing anything wrong by being here, you’re not breaking any laws whatsoever, and if anyone – I mean, anyone – tries to tell you that you can’t stay here, you tell them you’ve spoken to the Met and we’ve told you that’s nonsense. And, if you have any problems at all, I want you get straight in touch with us. OK?’

  ‘Thank you so much,’ we said, smiling slightly incredulously.

  ‘No, thank you for taking a stand. You keep on fighting. We don’t want to see what they’ve done to us lot being done to doctors as well.’

  Again, the extraordinary solidarity from yet another profession who themselves felt equally beleaguered was astounding. It did not stop there. Throughout the day, as civil servants walked in and out of their Department, many of them came up for a chat. Some surreptitiously sneaked a BMA badge from our stash and furtively hid it in their handbags. Others were more vocal.

  ‘I can’t ever say this publicly,’ said one of Hunt’s own departmental employees, ‘but I think what’s being done to junior doctors is appalling. Well done for standing up to it.’

  Hunt himself was nowhere to be seen. A Department of Health employee tipped us off that there was an underground back route into the building, one that Hunt was forced to use for the duration of the protest. As night fell, we were overwhelmed by thousands of online messages of support from fellow doctors, so many of whom bought us takeaway dinners, delivered anonymously to the Department of Health by courier bike, that we simply could not eat them all and passed them on in turn to homeless shelters in London. The sense of solidarity was truly inspirational.

  That night, we crawled into our sleeping bags to try to sleep under our tablecloth, acutely conscious of the she
er absurdity of two doctors, both parents with young children at home, sleeping rough to try to persuade a Cabinet minister to talk to a trade union. It was bitterly cold. A drug addict appeared in the early hours, haranguing us for half the night. Direct action, I discovered, was not for the faint-hearted. Early in the morning, a member of the security team arrived who had been assigned to keep an eye on us when we had launched the protest the day before.

  ‘Did you really do it? Were you really here all night?’

  When we confirmed that, yes, we really had, he immediately offered to get us a coffee, as did many other early birds arriving at their Department that morning. Just before going inside, he told us, ‘You know you made quite an impression, yesterday?’

  Hunt, he explained, had spent a considerable time staring down at us while standing, arms crossed, at one of the Department of Health’s large glass windows that look directly across onto Downing Street. Apparently, his face was thunderous and the Department of Health press office had been in meltdown. For the next few weeks, twelve hours a day, seven days a week, two doctors remained doggedly stationed outside the Department. Hunt was forced to creep unseen into the back entrance of his own Department for the duration of the protest. For a man so protective of his public image, it must have been infuriating. But it was all to no avail. The government refused to return to talks with the BMA, and NHS patients in their thousands were subjected to the first full walkout of junior doctors in its seventy-year history.

  A few weeks after this bleakest point in the dispute, the BMA’s credibility was decimated when a vast cache of private electronic WhatsApp messages exchanged between executive members of the BMA’s Junior Doctors Committee was leaked to the Health Service Journal. Their impact was crushing. The committee’s chair, Johann Malawana, described a secret strategy of dragging out the dispute for eighteen months in order to ‘tie the Department of Health up in knots’.

  ‘The more I think about it, the more I love our plan,’ he messaged the group. ‘Basically five weeks of headlines about juniors strikes through January and February … The best solution may actually [be] to draw this right out into the Europe debate and leadership debate.’55

  Another member of the secret WhatsApp group claimed – contrary to everything I and so many other grassroots junior doctors had stated loudly and unequivocally for months – that weekend pay was ‘the only real red line’ for junior doctors.55

  I was incandescent. This was simply not true. My red line was drawn at the threat to my patients and, frankly, to my own sanity of the government trying to eke out a seven-day service from a workforce barely fit for five. To be misrepresented by the government was one thing, but to discover that my own union had so misjudged its members’ concerns was devastating. I had gone on strike in good faith – voiced my safety concerns in good faith – but now I felt undermined by my union, which had made its own members look untrustworthy. The leaks were the beginning of the end. The government and the BMA agreed on the wording of a new contract but, in spite of Malawana’s personal insistence that the new deal was better for doctors and patients, BMA members did not buy it. A clear majority of junior doctors, 58 per cent, chose to reject it.

  Ironically, given the government’s earlier claims that the dispute was the product of a small number of BMA extremists intent on toppling the government through whipping up gullible doctors into an irrational frenzy, it turned out that the union was willing to compromise on what the majority of its members regarded as beyond the pale. A contract that exacerbated gender pay gaps, left doctors with weakened protections against excessive hours and made it cheaper for hospitals to spread us more thinly, was unacceptable to the rank and file.

  The dispute swiftly degenerated into the unedifying spectacle of doctor turning on doctor, the 98 per cent mandate for strike action replaced by furious infighting and bitter disappointment. The BMA flip-flopped between various strategies for inaction, extreme industrial action and, ultimately, abandonment of any meaningful opposition to the contract. By the time the contract was imposed upon the first wave of juniors, hundreds of members had already quit the union in disgust.

  Far more significant for patients were the doctors now abandoning the NHS, feeling unable to carry on any longer. In the context of an already desperately under-doctored health service, Hunt’s ‘victory’ over the upstart juniors looked like a classic case of winning the battle but losing the war. I collated testimony from some of the individual juniors who made the painful decision, during the dispute, to quit their NHS training. One of them left the UK in June 2016 with twelve years of postgraduate medical training under his belt, a whisker away from becoming a consultant. In spite of having seven years of general training in obstetrics and gynaecology, a PhD and one year of subspeciality training in maternal and foetal medicine, he had decided to repeat all of that training from scratch in the US:

  The government shows so little respect to its junior doctors and consultant workforce … I’m now in my first year at NYU School of Medicine in New York, where I am treated like a fully trained professional, not a commodity to be exploited. In making this transition, I have taken a pay cut of 50%, increased my contracted hours by two thirds – from 48 to 80 hours per week – and persuaded my husband to completely give up his career to join me. As such, I hope it is abundantly clear that my motivations for making such a move are not related to finances or contractual terms and conditions per se. It is a response to the systematic degradation of my profession in the UK, which is being achieved through lies, misrepresented statistics and media spin.

  This government’s biggest mistake has been its failure to acknowledge that doctors are not driven by money or arbitrary work schedules but rather by their desire to practise their craft and do what is best for their patients. The NHS runs largely on good will and mine has finally run out, extinguished by the considerable stress of living and working through a damaging industrial dispute that has dragged on for over a year now. Imposition is simply not the answer, and will only drive more of my colleagues to join me by relocating abroad.

  Another trainee described her deep shame at now pursuing private-sector alternatives to the NHS career she no longer felt able to endure:

  Last Thursday was my last shift working as a middle grade emergency department doctor for the last four years. The hospital, and by extension the NHS, have had the best of me. I’ve had plantar fasciitis, sciatica and I have more grey hairs than black now. As a type 1 diabetic, I come home from 10 hour shifts feeling exhausted.

  I’m actively looking for a job outside medicine. I’ve asked my friends in the pharmaceutical industry to keep their eyes peeled and ears to the ground for me. I’ll be creating a non-medical CV and LinkedIn account to get myself out there for anyone who can use my experience to better the world of medicine outside the NHS. I’m ashamed and sad that it’s come to this.

  In my own case, a year spent locked in unsought-for conflict with the government had come at a heavy price. Inevitably, being embroiled for so long in a spin war had tarnished the love and wonder I had felt for medicine, and I had no way of knowing if this could be revived. During the dispute, I had applied for higher training in my chosen speciality of palliative medicine – caring for patients at the end of their lives – but increasingly I had begun to fear I was too disillusioned to do my patients justice. They deserved the doctor I had always imagined being on entering my chosen specialism: brimming over with pride and enthusiasm, not despairing at the future of the NHS. I chose to withdraw my application. It felt like the abandonment of my patients, my principles and the profession I had loved. I had no idea what I would do next.

  Something curious started to happen once the government had quashed junior doctors. Some of the most senior figures within the medical establishment, the ones who had so strenuously attacked us for striking, began to repeat in public precisely the concerns we had raised, unsupported, for over a year. Hot on the heels of parliament’s spending watchdog, the Public Accoun
ts Committee, condemning the government for making ‘no coherent attempt’ to assess how many staff would be needed for a viable seven-day NHS, Chris Hopson, the head of the organisation representing the country’s hospitals, NHS Providers, suddenly decided to speak out. When asked in late 2016 by the BBC’s Andrew Marr whether a seven-day NHS was deliverable, given the overstretched NHS budget, he admitted something he had steadfastly refused to concede throughout the dispute, namely,

  ‘It’s impossible to deliver it on the current level of staff and the current money we have available. If something has to give at the moment when we’re trying to do what we’re currently doing, it can’t cover important new policies like seven-day services.’56

  Sir Bruce Keogh, the medical director of NHS England, began writing soothing articles about junior doctors being ‘an important but sometimes neglected pillar of the NHS’,57 and even the GMC, which had been so critical of striking doctors, was at pains in its annual report to emphasise its concern at the depth of anger, frustration and alienation among junior doctors, urging that this, ‘should cause everyone to pause and reflect’. As it put it,

  There is a state of unease within the medical profession across the UK that risks affecting patients as well as doctors. The reasons are complex and multifactorial, and some are long standing. The signals of distress are not always easy to interpret but they are unmistakable.58

  It felt like too little, too late. If an entire generation of doctors – the ones who should be the profession’s most vivacious and keen, had become this disenchanted and cynical – then the price of the government’s trouncing of the BMA was one the NHS could ill afford.