The past decade has been difficult for all involved in healthcare with insufficient resources, increased demand and damage by the wrong drivers – targets vs clinical care, blame vs learning, work outcomes vs care for workers. This has led to the medical profession feeling overwhelmed and stifled. There is evidence, from many sources, of stress and burnout of doctors and a growing sense of professional disempowerment.
The recent recognition of these issues alongside an increased funding package provides an opportunity for change. Workforce issues are now being taken seriously – regarding both the numbers staff and their welfare. There is a move from competition to collaboration and recognition of essential learning environment/system failings. Added to this there is a need for change in the ways we deliver care and a call for clinical, especially medical, leadership due to evidence of effectiveness. Things are going to change and we, as a profession, need to be the architects of that change to provide new services, welcome new roles and technologies to help us to provide best, safest patient care.
Burnout is the effect of lack of control, no sense of belonging, lack of being valued, failure of teamwork and continuity of care – as well as overwork. These changes provide new opportunities for the medical profession to re-energise and support one another to ensure better relationships within the working team and with patients after a decade of being side-lined and ignored.
An engaged, happy workforce is a safer workforce. All doctors are part of the solution – incremental change from the most junior is as effective as the highest leadership roles. We must speak up for good and call out bad.
It has been too tough for too long – we need to rise to the challenge and own the solutions as a profession.
Professor Carrie MacEwen, Chair Academy of Medical Royal Colleges
The article in the Times 25/02/20 took some quotes out of context and drew conclusions which weren’t meant. The headline was sensationalist, sending out the completely incorrect message.
The message is better communicated in the BMJ article 20/02/20. The full text of both articles are copied below.
The chair of the Academy of Medical Royal Colleges says that the time is right for doctors to take the future of the profession into their own hands.
“We all recognise that the past decade has been particularly difficult for doctors. There have not been enough resources of any description, whether financial, workforce, or equipment. Add to that the increased demand, and we have got a workforce that has become overwhelmed and stifled. There is no headroom to deliver anything.
“Over the past decade we have also been sent along by the wrong drivers: targets rather than good standards and good clinical care; blame rather than learning; and work outcomes rather than caring for workers. These things all coloured a picture that is quite negative. There is evidence that people are burnt out and stressed, and there is a growing sense of professional disempowerment. Not having the ability to do what we need to do.
“However, we’ve now come to a new phase. We’ve got increased funding for healthcare, we’ve got an NHS People Plan [due to be published soon], and in all four home nations, for the first time, workforce issues are being taken seriously. This isn’t just workforce in terms of talking about numbers of people in the workforce, but also the need to care for staff.
“For years we’ve been banging on about the workforce, and governments have finally recognised that we need more doctors. Although it’s not going to be a magic bullet—it takes a long time to train a doctor—I think there is a feeling that at least they do recognise the issue.
“I also think there is recognition that people in the NHS have been ignored, completely. It’s not just about numbers, it’s about culture, and people are finally being recognised as the most important resource that the NHS has.
“For the first time in a long time there is also recognition that clinical leadership is important. If you look at NHS England, for example, there is a whole cadre of senior clinicians who weren’t there before. We now need to make sure that this clinical empowerment is not only recognised by organisations but also by individual doctors.
“Who is better placed to lead and make changes than the young doctor who’s just come out of medical school, seeing things for the first time? We need to say to them, ‘This is your chance; everyone is a leader, everyone matters.’
“I’m calling out to the medical profession to stand up, as part of a multidisciplinary team, to do the best that they can and feel that they are important. We, of course, need managers and politicians, but as doctors we’re in a stronger position now than we’ve ever been, and if we don’t take leadership and say, ‘We’re going to play our part; this is our job,’ then there is a risk that other people start doing it for us.”
Doctors need to stop moaning and take responsibility for improving the NHS, the leader of Britain’s medics has said.
Ministers have given the NHS a “substantial sum” of money and doctors must now stop blaming the government for all its problems, Carrie MacEwen, chairwoman of the Academy of Medical Royal Colleges, told The Times.
Britain’s 220,000 doctors have a professional duty to make the health service’s ten-year plan work and can no longer “sit on their hands”, Professor MacEwen said.
After years in which the loudest medical voices have tended to complain about government funding and staffing levels, she said that doctors should take advantage of a “golden opportunity”.
She said that the NHS had a clear plan, a commitment to increase the budget by £20.5 billion over five years and a government committed to solving a staffing crisis.
Doctors had been ground down for years by the “overwhelming” demands of an ageing population and became used to just getting through the day, she said. However, ministers had finally accepted the need to treat the NHS workforce better and to improve both morale and numbers.
Professor MacEwen said that taking more responsibility would improve morale as well as care, warning that doctors could face similar treatment to teachers and end up being sidelined by the government if they refused.
“Given the parallels in some other professions outside medicine, we know how this movie ends,” she said.
The academy brings together 23 medical royal colleges and faculties that define standards of treatment for the NHS and its words carry weight across the profession. Professor MacEwen is keen to use her influence to set a new professional tone.
“There’s an attitude and culture that needs to be addressed,” she said. “Everybody has to take responsibility. If we continue to blame government and only government then we will not get anywhere.
“Too often doctors will moan to each other in the mess room about things ‘They’ve done now’, not realising that it’s often actually in their gift to change the situation. They cannot simply sit on their hands. Things are improving, but change is piecemeal, the profession needs to unite and seize this once-in-a-generation opportunity.”
She said that doctors, as “natural-born leaders”, were best placed to solve the problems of the NHS. For example, if a doctor realised that patients were waiting four hours in a clinic because of an IT problem they should take responsibility for working out how to fix it.
Samantha Batt-Rawden, co-founder of Doctors’ Association UK, a grassroots medical group, said that doctors did speak up but that the biggest problems in the NHS were “simply out of our control”.
She said: “It’s clear that the solution is not going to be from clinicians, but those setting the rules. For doctors who have been working themselves into the ground to keep patients safe this winter a suggestion that they should take responsibility for the situation they have found themselves working in seems out of touch, and will no doubt be a further blow to morale.”
Boris Johnson has announced a £20.5 billion funding boost over this parliament. Analysis has shown that this increase is below the NHS long-term average, but Professor MacEwen said that the profession would not improve by complaining.
“The health service is being given a lot of money. It may not be enough, it’s never enough, but you know we have got to work with that,” she said. “We actually got quite a good settlement, considering how other people did. And we have to make sure that the money available is used to the best effect.
“I think it’s easier to persuade people to give you more money if you’re using the money you’ve got wisely and you can demonstrate that”.
Professor MacEwen said that doctors had began to be sidelined in the 1980s when the introduction of professional managers ended the culture of “what doctor says goes” in the NHS. “I think that initial reaction, that the managers should just take over and we’ll just turn up and do the doctoring, has actually softened over the years . . . [but] their leadership skills and their ownership has maybe still not fully recovered to the way that it should be.
“The long-term plan is talking about making lots of changes in the way we deliver care. There’s nobody better to lead that change and to be deeply involved in shaping change than the medical profession.”
© 2020 Academy of Medical Royal Colleges.