‘The joy of my job has gone’ Royal colleges call for national action to prepare for winter
As the Welsh NHS enters a second pandemic winter, 17 medical royal colleges and faculties have come together with a joint statement calling for national action on workforce shortages, health inequalities and the NHS backlog (attached).
As the Welsh government publishes its 2021 winter pressures plan, and on the first anniversary of the Welsh ‘firebreak’, thousands of patients, GPs and hospital doctors face growing waiting lists and a deepening winter care crisis. Royal colleges are calling on the Welsh government to:
- value the NHS workforce with a national recruitment, retention and staff recovery plan
- tackle avoidable illness with a cross-government strategy on health inequalities
- reduce the impact of the NHS backlog on patient safety and medical education.
Royal colleges and faculties are calling for a clear plan to end the unsustainable pressure healthcare workers face. The 17 organisations, which together represent thousands of NHS doctors, have joined to call for national action on workforce planning, including regular, transparent and detailed reporting on how national staffing numbers and patient demand are informing long-term plans.
The Royal College of Physicians (RCP) recently surveyed its members (October 2021) and found that almost half of respondents (46%) in Wales say their organisation is not at all prepared for winter. 37% feel personally unprepared, and almost two thirds (63%) are feeling tired or exhausted.
- A third (33%) are demoralised.
- 44% are pessimistic and 28% are worried.
- Only 9% are optimistic about the future.
Staffing shortages present a key barrier to tackling the NHS backlog and reducing waiting lists. The Welsh government should expand medical school places as soon as possible.
Earlier this year, the Royal College of Anaesthetists (RCoA) found that 55% of their members in Wales would support a national workforce strategy underscored by population-based needs modelling. Another recent RCoA UK survey found that 42% of anaesthetists who have left or retired from the NHS cite not feeling valued or well supported as their main reason for leaving and over one third (35%) say bureaucracy and leadership issues were the reason they left the NHS.
Dr Olwen Williams, vice president for Wales, Royal College of Physicians said:
‘It’s simple really. Workforce, workforce, workforce. The main reason we are struggling with waiting lists and the backlog is that we don’t have enough staff to cope. There aren’t enough doctors and nurses in the Welsh NHS, and those that are left are exhausted and demoralised. Morale is low. I don’t know how we’re going to get through the winter to be honest.
‘We’ve done the maths. To cope with the expected increase in patient demand over the next decade, we need to be creating an additional 350 medical school places every year in Wales – almost double the number of places available now. Phased in over 5 years, this equates to an extra 70 spaces every year for the next 5 years. However, in September 2020 we saw only 25 new spaces created at Cardiff university, and in September 2021, only 12 spaces.
‘An ageing population with long-term illness, growing obesity, advances in genomics and new technologies will all mean increased demand for doctors. Hospital activity – both emergency and elective – is steadily rising, and the backlog is not getting any smaller. It’s an incredibly difficult time to be working in medicine.’
Dr Abrie Theron, chair of the Welsh Board, Royal College of Anaesthetists and chair, Academy of Medical Royal Colleges Wales said:
‘Prior to the pandemic the NHS in Wales was already under huge strain, with an 11.8% shortfall in consultant anaesthetists, the largest in the United Kingdom. Across the nation we are seeing hospitals having to scale back, or cancel, elective care because NHS staff are simply not able to take on the burden of additional lists.
‘The Welsh government must recognise that the success of any recovery will hinge on the right number of staff, being in the right place, at the right time. In the short-term this means investment in NHS staff welfare and wellbeing and improving retention. In the long-term the development of a sustainable and well-funded workforce plan which considers the increased demand of an aging population with more complex needs.
‘Without investment in the healthcare workforce, the NHS will struggle to address the COVID-19 surgical backlog and meet the long-term expected increase in patient demand.’
Dr Mair Hopkin, Wales chair, Royal College of General Practitioners said:
‘GPs – along with the whole NHS workforce – rose to the challenge of COVID-19, putting their health at risk to help their patients. GPs were proud to play their part in a world-leading vaccine roll-out, but even before that began, RCGP data showed that Welsh GPs were working at 127% of their capacity. The profession is under serious pressure today and this is impacting on the well-being of GPs and their teams. As we approach what looks likely to be a challenging winter, we support this call for sufficient and sustainable resourcing.’
Dr Katie Fergus, policy and public affairs lead for Wales, Royal College of Psychiatrists said:
‘The past 18 months have had a profound effect on the way that mental health services provide care for individuals with severe mental health problems. A lack of access to community support has placed very high demands on NHS mental health staff to fill the gaps. This has become unsustainable.
‘Exhaustion and low morale are growing within care teams, many of which are already worryingly understaffed. When community-based support can’t be sustained, people end up being admitted to understaffed psychiatric hospital wards, sometimes many miles from home due to the lack of beds locally. Care teams are tired of not being able to provide the level of care their patients deserve.’
Other comments by RCP members in Wales (survey, October 2021):
‘I can't see an end to it. We’re treating more and more unvaccinated patients.’
‘I feel that the leadership of my organisation is out of touch with what is happening on the ground and that there is no communication about the organisation’s plans for the next few challenging months.’
‘I am so demoralised by the leadership in my organisation which fails to listen and has done nothing to address my personal workload or work-life balance that I have resigned and accepted a post in another organisation.’
‘This year has been terrible for morale and self-confidence. Dealing with acute COVID-19 was fine – it was challenging and interesting in a positive way. There was a high level of clinical engagement and cross-team cooperation. Since then, however morale has deteriorated. We are dealing with unprecedented demand from patients, a massive waiting list that is impossible to deal with, and no solutions as we go into winter. The hospital has been completely full since July and it has been a terrible summer – like a normal January with endless bed pressures. I am 4 years from retirement and any thoughts of staying longer have gone. I would retire now if I could afford to – I see no positives in working in the NHS over the next 4 years. It will be endless graft. The joy of my job has gone.’
‘I can't give any time to my family. I am always tired at the weekends and not able to enjoy my life. I am thinking more and more about whether medicine has been the right career choice as I don't have any personal life.’