On Saturday the 10th of August, the Nobel-prize winning physicist Steven Hawking, addressed an audience at the Royal Society of Medicine. Over his illustrious career Hawking has become used to taking in public about his work in mathematics and physics. On this occasion however, he ceased the opportunity to draw attention to his lifelong experience of the NHS. His address, which was also published in a daily newspaper the day before, raised concern about recent NHS reforms and the “political decisions” that have brought it to the point of crisis. He listed underfunding, public sector pay cap, new junior doctor contracts, removal of student nurses’ bursary and ceaseless drive towards privatisation as hindering the NHS from providing high quality care. In response, war of words and statistics ensued with Jeremy Hunt accusing Hawking of “pernicious falsehoods”. Where facts and figures can ping-pong between opposing sides and become political instruments to justify particular actions, personal experiences of the reforms can help elucidate the reality behind the numbers.
In 2016, with funding from the Wellcome Trust, we began research on the experiences and views of austerity from frontline healthcare professionals (doctors and nurses) in A&E departments around the country. As the thermometer for any signs of sickness in the rest of the NHS, A&E Departments are often described as the ‘shop-floor’ and the ‘public face’ of the NHS. Our research is ongoing but early findings are striking. We found that although A&E funding has remained relatively unchanged, cuts in other sectors (e.g. mental health, social care), staff shortages in primary care, hospital closures and the more general austerity measures imposed on the NHS since 2010, have had significant effects on A&E departments. A&E staff are reporting changes in the demographic of patients (more psychiatric, substance abuse and geriatric cases) and great increase in their number. Yet, staff numbers have remained the same (in some cases reduced through a ban on agency staff), resulting in doctors and nurses buckling under the strain of longer and greater shifts to meet demand. These conditions have shaped A&E doctors and nurses experiences of NHS reform.
Many on the frontline report long shifts in overcrowded and understaffed departments, with strict four hour consultation times or government imposed penalties. Pay caps and the new junior doctor contracts have left nurses and junior doctors feeling disregarded and undervalued. For nurses, scrapping student bursaries and funding for continuous education was reported, in our research, as a major issue. Many described that despite hard work and long hours they are unable to make ends meet (some nurses reported having to use food banks), and they are left with no options or opportunities to continue their training and improve their skills and knowledge.
Pay caps and funding cuts for studentships and training was also raised by consultants and other healthcare professionals with managerial roles as one of the reasons driving recruitment and retention problems, especially in areas with high living costs. Working in A&E is highly stressful and demanding, yet the recent changes are putting even greater strain on staff’s physical and emotional resources, without leaving time to recuperate. Feelings of exhaustion, burnout, demoralisation and ethical conflict are common amongst A&E staff, and are becoming the sad everyday reality of many healthcare professionals. These effects do not feature in Jeremy Hunt’s assessment of NHS reforms, leaving a ‘black hole’ in his accounts. Yet, our research on the experience of austerity reforms from frontline healthcare professionals suggests that the staff, and judging from Prof Hawking’ account, also the patients, are experiencing the crisis.