meI have continuously worked for the National Health Service since October 1994, and this is the week I finally leave. I’ll spare you the math: that’s 28 years and two months. Like marriage, it’s an institution that I joined when I was twenty and thought it would be my whole life. And, in truth, leaving is almost as bad as getting divorced.
I’m leaving because I can’t anymore.
It’s not the patients; I really love most of them. I really hold them dear to my heart. I work with mentally ill teens, and over the years when I fought hard to get them to open up and trust me, they would scoff and say, “You only care because you’re paid to care,” and I’d say, “No. you can pay someone to really care. I get paid to work with you, but I care because I know you.” This is not just one line: I love a rebellious, damaged, difficult teenager, me. So, it’s not the teenagers who have pushed me. In fact, it is the patients that have kept me there for so long.
Neither are their parents; I learned a lot from them. They have taught me about patience and love and how to be a parent. They have been desperately and desperately sad. I have guided you with the wisdom gleaned from those who have gone before, with a dash of what I have learned from theory and research. I’m not saying they’ve all been charming, some were abusive, but overall it’s been a good bunch.
In the end, it was the “B’s” that got me: the bean counters, the bureaucracy, and the BS. They are the ones who have worn me down and spit on me.
First the bureaucracy. When I started in my current job, more than 20 years ago, I could walk into a room to see my patients for their 50-minute therapy session, one after the other, every hour. There were paper notes, which a receptionist took out and refiled for me, and in the 10 minutes between each patient, I was able to write my notes and have coffee. My seven and a half hour days would include two hours of clinical meetings, five patients, and 30 minutes of administration.
We now have digital notes which, in theory, are a better idea; but in practice for the last five years I have not had a consistent room to work with a computer. We have “hot desking” and “clinical rooms” mostly without computers. So in practice, I have to set aside time away from patients to log into a computer, which takes at least 20 minutes each time to log in. Note systems are clunky and unwieldy – it takes twice as long to do anything. The result is that I see one less patient a day to begin with.
Now the bean count. Our lovely administrative staff have been cut to the bone – they are not supposed to help clinical staff like they used to. They are largely paid to enter data. Patients must be checked in when they arrive, checked in as being seen by the doctor, and checked in again, all in hugely complicated, slow, and poorly designed systems. Recently, the health secretary, Steve Barclay, promised more transparency. But every time a politician promises more transparency, he promises that he will spend NHS money, which could go on nurses and doctors, ambulance teams and medicines, on an administrator who will sit at a computer entering data all day. An administrator whose salary could be spent on one more nurse to attend that ambulance with the pensioner who has fallen.
In theory, of course, it would be great to have that data; I am not against transparency per se. I’m just against it when we don’t have and can’t hire clinical staff.
And there’s the BS: the constant negative rhetoric from politicians about “efficiency” savings. I bet there hasn’t been a single month in my 28 years in the National Health Service when a politician hasn’t made that kind of negative implication, they will save the NHS by putting clinical staff to work a little harder. There has been an explosion in the number of managers during the same period, and the message is filtering from the health secretary through the endless layers of him. They hurl that rhetoric relentlessly at clinical staff: “Do more with less!”; that is what has really broken my spirit.
I could go on for hours and hours more, from poor recruiting systems to endless “essential” training.” But perhaps worst of all is the nonsensical internal market of England’s NHS, where, again, thousands of employees are employed so that one part of the system can pay another part of the system. It’s like Tesco is buying the food from farmers and then selling it to its own stores.
NHS staff are human too and it’s obvious to most of us that we could work less and earn more in the private sector, but many of us don’t out of a sense of loyalty to the system. We do incredibly difficult and emotionally draining work, under stressful conditions, but it usually doesn’t break us. We get our kicks from that job. The relentless scrutiny, the lack of practical support, working systems and negative rhetoric, that’s what gets us. This is why we end up exhausted, nervous and choosing between the NHS and our mental health. And that’s why I’m part of the NHS brain drain.
And to the future patients I won’t see: I’m sorry. I did the best I could, but I couldn’t take it anymore.