I’ve worked continuously for the National Health Service since October 1994, and this is the week I finally leave. I’ll save you the maths: that’s 28 years and two months. Like marriage, it is an institution I joined in my twenties that I thought I’d be in my whole life. And, truly, leaving is nearly as bad as getting divorced.
I’m leaving because I just can’t do it any more.
It’s not the patients; I really love most of them. I genuinely hold them dear in my heart. I work with mentally ill teenagers and over the years when I was battling hard to get them to open up and to trust me, they’d sneer and say, “You only care because you’re paid to care” and I’d say: “You can’t pay someone to really care. They pay me to work with you, but I care because I know you.” This isn’t just some line – I love a stroppy, damaged, difficult teenager, me. So, it’s not the teenagers who have pushed me out. In fact, it’s the patients who have kept me there so long.
Nor is it their parents; I’ve learned a lot from them. They’ve taught me about patience and love and how to parent. They’ve been desperate and desperately sad. I’ve guided them with wisdom gleaned from those who went before, with a sprinkling of what I’ve learned from theory and research. I’m not saying all of them have been charming – some were abusive – but on the whole they have been a good bunch.
In the end, it was the “Bs” that got me: the bean counters, the bureaucracy and the BS. They’re what have worn me down and spat me out.
First the bureaucracy. When I started in my current job, more than 20 years ago, I could go into one room to see my patients for their 50-minute therapy session, one after the other, on the hour. There were paper notes, which a receptionist would pull and refile for me, and in the 10 minutes between each patient, I could write my notes and grab a coffee. My seven-and-a-half-hour days would include two hours of clinical meetings, five patients and 30 minutes of admin.
Now we have digital notes which, in theory, are a better idea; but in practice over the last five years I haven’t had a consistent room to work in with a computer. We “hot-desk” and have “clinic rooms” mostly without computers. So, in practice, I have to book time away from patients to log in to a computer, which takes at least 20 minutes each time to get in. The notes systems are clunky and unwieldy – it takes twice as long to do anything. The result is I’m seeing one fewer patient a day, for a start.
Now the bean-counting. Our lovely admin staff have been cut to the bone – they aren’t supposed to help clinical staff the way they used to. They are largely paid to input data. Patients have to be booked in as arriving, booked in as being seen by the clinician, and booked out again, all in enormously complicated, slow, poorly designed systems. Just recently the health secretary, Steve Barclay, promised more transparency. But any time a politician promises more transparency they are promising that they are going to spend NHS money, which could be going on nurses and doctors, ambulance crews and medication, on an administrator to sit at a computer inputting data all day. An administrator whose wage could be spent on one more nurse to meet that ambulance with the pensioner who has fallen over.
In theory, of course, it would be great to have that data – I’m not against transparency per se. I’m just against it when we haven’t got and can’t recruit any clinical staff.
And there’s the BS: the consistent negative rhetoric churned out by politicians about “efficiency” savings. I would wager there hasn’t been a single month in my 28 years in the NHS when a politician hasn’t made that sort of negative implication, that they will save the NHS by making clinical staff work that little bit harder. There has been an explosion in the number of managers over the same period, and the message trickles down from the health secretary through their endless layers. They spout that rhetoric relentlessly to clinical staff – “Do more with less!”; that’s what has really broken my spirit.
I could go on for hours on more, from poor recruitment systems to endless “essential” training”. But perhaps worst of all is NHS England’s pointless internal market, where again, thousands of staff are employed so that one part of the system can pay another part of the system. It is as if Tesco were buying the food from the farmers, and then selling it to their own stores.
NHS staff are human too and for most of us it is obvious we could work less hard and earn more in the private sector, but many of us don’t because of a sense of loyalty to the system. We do incredibly difficult, emotionally draining work, under stressful conditions, but it usually doesn’t break us. We get our kicks from that work. The relentless scrutiny, the lack of practical support, working systems, and the negative rhetoric, that is what gets us. That is why we end up exhausted, strung out, and making a choice between the NHS and our mental health. And so that is why I am part of the NHS brain drain.
And to the future patients whom I won’t see: I’m sorry. I did my best, but I couldn’t do it any more.