I’ve been an intensive care consultant for 20 years and have worked in the NHS for 30. I am there for my patients in their most vulnerable moments and am responsible for life and death decisions daily. The stakes are high, and the stress is unrelenting.
Every day I see my consultant colleagues having to innovate under increasing pressure from lack of investment, putting in extraordinary efforts to keep delivering the service they know their patients need. So why now have consultants in England been compelled to go on strike?
Put simply, regardless of what we have achieved, consultants have not seen a pay rise since 2008. Successive pay awards at less than inflation mean we have seen a real-terms pay cut of 35% according to the BMA. We, along with the rest of the NHS, took it on the chin at first, thinking that we were all in this together. But that pay cut grew and grew over so many years. Then the pandemic came along.
I led our local intensive care service through the crisis, working 60 hours a week or more treating patients. We felt abandoned in our cobbled-together protective equipment – single-use gowns we had to carefully take off and send for washing, and plastic visors so overused and cleaned so often we couldn’t see through them. We lived with the constant fear that we would spread this frightening new disease to our families.
I have spent decades treating the sickest patients in hospitals and seeing so much suffering. Intensive care is brutal: we can save your life, but the treatment is hard and often we don’t win. Saving someone is amazing, but also helping someone have a good death and supporting their family through it can be just as important. Yet the demands of this makes consultants particularly susceptible to burnout. We do not have access to supervision and psychological support for staff is sparse, unlike in other countries where a full-time psychologist will often be based in larger ICUs.
Despite never having problems with this high-stakes clinical work before, I suffered from burnout after the pandemic. Burnout is not simply being tired. It took many months to stop the suicidal thoughts – and about a year to put my professional and personal life back together again. I think the problems I experienced were caused by taking on a clinical leadership role in such a new situation – and the pain of not being able to deliver the care I was familiar with. Phoning someone to explain that after 10 days without visits they could now come to see their loved one because they were dying was horrific. We will never forget the suffering we saw during that time.
I also worry about my retirement – although the health impact of working nights (I do 24-hour duty periods) and the continual emotional stress with no supervision may mean I won’t see much of one. In 2020, due to a pay award for clinical excellence, the complex pension allowance rules at the time and tax calculations based on likely future earnings rather than PAYE income, I had an unexpected £24,000 tax bill for the potential pension I might receive. I was forced to borrow from my mortgage knowing that I will have to work longer to pay this off. I sacrificed a lot of my youth for the NHS, working 100-plus hour weeks, but was told that at least the pension was worth it. That is now feeling like a false promise.
I am striking because I believe that the work I do is not worth 35% less than it was in 2008. We have achieved extraordinary things in the past 15 years, and all we ask is to be valued properly. We are highly trained, innovative and resilient, but every day we are taking life and death decisions in a system that is breaking. I want there to be a future for the junior doctors I train. They could earn a better salary if they moved abroad. I want them to stay in the UK and treat me when I need them.
Perhaps most importantly, we need a truly independent pay review system, free from government interference. If we had this in the last 15 years, we would not have reached the point where striking was our only option. I want the prime minister to stop saying talks are over. I want him to come to the negotiating table, so we do not see this kind of erosion happening again. I want an NHS I can be proud of, where patient care is safe, where staff are valued; not the battered and broken NHS I work in at present.
-
Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here.
