As the sun shone today and I am working from home I could not help but reflect back to three years ago, when the sun was blazing. In fact blazing so strongly that my choice to work in the garden proved erroneous: both my phone and computer shut down due to overheating. I think it was weather driven rather than over usage as this was the first few crazy weeks of COVID. My spirits during this time were lifted regularly by the unusually glorious weather, as we battled a terrifying enemy. Yet at this time the sense of social cohesion, the respect and honouring of the work of the NHS made the risk and pain lessen slightly.

Today feels so very different. NHS system long COVID drags on. We are not back to where we were with respect to productivity. Patients are frustrated by this, and increasingly disenchanted with the NHS. Worryingly, for I believe the pain and disruption of change outweighs any benefit (and there is almost no evidence that one system is better than another), I have started hear from even those who are committed to a free at the point of delivery system, that maybe we need to change our model to a social insurance model. Financially the NHS is struggling despite more spend, not just with respect to revenue. Capital programmes that are required e.g. building or refurbishing hospital environments are underfunded and electronicification of systems slowed by cost. Most crucially though staff are demoralised. Years of watching colleagues in other sectors see their wages rise and the gap between what healthcare workers can afford to do / buy grow is challenging. Alongside this there is the real impact of inflationary pressures that have driven many to leave and even more healthcare groups to strike.

For many the decision to ballot for strike action was difficult. The fundamental choice to work in healthcare is driven by a desire to care for others. Striking puts this on the line and even at risk. Choosing to strike was hard, walking out and striking even harder. Some groups choose to derogate areas to mitigate risk, others did not.

We now face an even more uncertain next few months, some groups who have amended pay offers on the table accept them. Will those who are still pushing for change up the ante or go back to the table?

Trying to staff rotas during the “junior doctor” industrial action has been incredibly tricky. Good will was used up the first time. This time with leave due to school holidays / Easter this has proven a nail biting affair. We are just able to cover skeletal rotas, with limited room for sickness or personal disaster causing absence. It is as ever the same people going above and beyond. Bravely stepping out of their professional areas of expertise and supporting other areas that cannot self-staff e.g. ED / acute rotas, grappling IT systems they rarely use and dredging their memories to remember passwords. It’s not just doctors who have stepped up. IT support staff have floor walked to sort out password issues and manage competency issues real time. Pharmacy and other clinicians have stepped into gaps to ensure patients don’t suffer. It has been exhausting gently nudging this process along again, whilst trying to sacrifice as little elective work as possible. Rolling day cancellations suggested by NHSE have proved tricky to do given the Easter bank holiday days.

So I am hoping the weather change, the spring flowers especially the bulbs and cherry blossom help again to assuage the sense of challenge that I and so many face at the moment. I fear that the sticky plasters we have had to use to ensure safe care over this strike will not be used for the last time. I worry that every strike drives the frustrations with the NHS and impairs our ability to fix waiting time issues, yet I know that the evidence is clear – content staff (and indeed staff at all) are crucial to ensuring patient safety never mind productivity.

Magical Meander

Magical meander is an anonymous blog series written by a medical manager working in the NHS and published on BMJ Leader Blog.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.