Jonathan Segal: Good will—is it enough to keep the NHS alive?

It is probably evident more than ever, with the recent credit crunch and economic instability, that the NHS has less resources to play with than ever. More jobs have been cut, more training post numbers reduced, and rotas further squeezed. I began to ask myself how are these gaps being filled?

I take you back to the full introduction of the European working time directive in 2009. Staff were now only legally allowed to work an average of 48 hour weeks. For me this means that I am only paid for an average of 48 hours per week and anything I do over is done on good will. Having done a recent diary monitoring activity I was not overly surprised to see my average working week equated to 60 hours per week. A weekly good will gesture of 12 hours.

The reason I write this article is after a quality improvement lecture I had. In it a consultant of a trust went off unwell. He would be away for 3 months. A meeting was gathered to discuss with the remaining consultants what should be done. Two out of the three consultants agreed to do some extra clinics and work a few more hours. I suspect mostly on “good will.” One refused and said he wasn’t getting paid enough to justify the extra hours, much to outrage from the others.  In essence I can empathise with this consultant, good will can only get us so far, When does good will stop and taking care of yourself come in? A question I feel ethically is hard to answer.

Generally speaking those who do a career looking after other people do so due to a compassion for others, the will to help others, something the NHS in my view certainly acknowledges and some may argue abuses.

I am sure I am not unique in my field of work, certainly I know accountants, lawyers, bankers that work even longer hours, but why do they work beyond what they are paid for? Are there underlying motivators? Often I feel the answer is yes, perhaps a financial bonus later down the line, a promotion if you reach your targets, monthly prizes for employees of the month, for me, the thank you I get from my patients is enough. Also the worry that if I didn’t put in those extra hours would that “thank you” still be there waiting there for me the next morning.

Now I don’t mean to come across as a martyr, as I know most of my colleagues do the same thing day in day out. Certainly I would be in the wrong field if I put my own needs before others. Husbands, wives, and children get used to us cancelling plans as work kept us late. It’s not just us doctors I am confident I am speaking for. Nurses, porters, and technicians are all doing extra hours for free.  Why do they do it? Because of a moral obligation? Because we know the patient will suffer if we didn’t? In essence because we care.

The underlying point is this, how do we keep incentivising our staff to put in those extra hours? From a doctors perspective so many of our incentives have evaporated—there is no longer free hospital accommodation, it is true, there is no longer such a thing as a free lunch, pay has overall been decreased, college exams are getting more expensive, and we have to pay for them. Lastly with all the bottle necks at the end of all this will we all have jobs?

I admire everything in principle the NHS stands for. I acknowledge its financial, political, and clinical challenges. I also admire those who work for the NHS. I think Aneurin Bevan would echo my pride for the people of his organisation. Is it time for those who keep the NHS from flat lining a brief acknowledgement of their efforts? Some form of incentive? Some form of gratitude?
Importantly with the example of the consultant above, is our good will getting too far stretched?

Jonathan Segal is a CT1 trainee, London