This week on Channel 4’s new documentary series Confessions of a Junior Doctor, we’re in the paediatric unit of Northampton General A&E and the noise levels are off the charts.
If you haven’t caught the fly-on-the-wall series yet, it’s pretty essential viewing in this uncertain time for the NHS. Each week, camera crews follow young men and women at the beginning of their careers as they try their best to navigate the stressful world of a busy hospital. This week, we’re with Neeta, who has just been indoctrinated as a registrar, and Fahim, a third-year junior doctor.
"I actually like the sound of crying children!" Neeta laughs when we question her about the noise. "It's the ones that don't cry that worry me. If your child is making a noise, I'm happy."
Neeta is at the senior end of the junior doctor cycle. She has just become a registrar and, when she’s on shift, is in charge of the entire paediatric team. Sure, there are consultants above her but, essentially, she is the touchpoint. She is the person that junior junior doctors are meant to come to when they don’t know what to do, in order to make sure the children that come to them leave happy and healthy. How’s that for a big job?
Being a registrar is the second part of an eight-year junior doctor journey. After that (providing you didn't head down the GP route), you’ll become a consultant. When you’re a very junior doctor, Neeta explains to us, you rotate around different parts of the hospital. At that point, she says, the emphasis is just to “survive”. By the next stage, you’ve decided on which area to focus.
When you become a registrar, the workload goes up a notch. “The night before I started,” says Neeta, “I had this whole realisation that I was going to be in charge of every child that came into the Northampton hospital that day and that’s a really scary, overwhelming responsibility. It’s a big step up.”
The support network between the junior junior doctors and the senior junior doctors (to use non-technical terms) is essential. At one point in the documentary, Neeta is paged and called to a very sick child. It's terrifying. “When I get crashed it basically means a baby is very, very sick," she explains to me. "And the person who crashed me cannot keep that baby alive without me getting there. So I run. Because every single step that I do slower, that baby doesn’t breathe.” She isn't just running for the baby, though. Neeta is also running for that junior doctor because, when someone is that junior, she can only imagine how scared they must be.
Junior doctors must make decisions speedily, and with confidence, all the while knowing that their decision could impact whether a child lives or dies. Watching the series, it’s easy to see why doctors regularly rank among the most stressed people in the workplace. That level of pressure, day in, day out, must take its toll.
So I run. Because every single step that I do slower, that baby doesn’t breathe.
The key, Neeta says, is learning to trust yourself, but also learning to be humble, and realising when you might be wrong. “What’s instilled in you at medical school is confidence,” she explains. “You have to ooze it. A lot of the decisions I make, I probably look like I’m very confident and calm but actually my heart is racing and I quite often doubt myself.” Not that that’s a bad thing, she adds. “I think that’s the sign of a good doctor because if you don’t doubt yourself you’re never going to learn from that situation, and you’re never going to ask that question that might improve the patient’s care. I hope I always doubt myself.”
The Paediatric Assessment Unit is a sort of A&E for children. Around 20 to 30 children will come into the PAU each day, and Neeta will see at least half of them. Watching her prioritise and manage the patients and their families is stressful, even for a viewer. At one point during the episode she sends a boy home overnight (there are no beds) before he sees the specialist the next day. She tells the parents that he is still technically “in hospital” and can come back if his condition worsens during the night. She assures me that in this case, the boy was perfectly safe at home and that she has never let the bed crisis or the troubles facing the NHS impinge on her decision-making. “When I see a child and I think that child needs to stay in hospital then I will do my utmost to make sure that child stays in hospital,” she says firmly. “Someone will find a bed for me.”
“I don’t envy the bed managers’ jobs at all,” she says. “It’s a horrible place to be... I just make the decision about whether the child needs to stay in or not. The fact that I didn’t have enough beds in this case was a factor, but not the rationale for sending children home.”
Because the elephant in the room is, of course, the struggling NHS. The paediatric unit in Northampton hasn't upped its bed count in 20 years. Funding is getting tighter. Activist group Patients4NHS claims that, taking inflation into account, annual spending on the NHS has only been increasing by 0.9% in recent years, compared to the 3.7% it has been used to. Waiting lists are at their longest since 2007, and there've even been reports of hospitals "temporarily closing their doors owing to extreme pressure on beds and staff." At the moment, 24 A&E units are under threat of closure or downgrading.
Our boat is being rocked... they’ve chipped away so far that the core is being affected. That saddens and worries me immensely.
Added to this is the junior doctor crisis, which came to a head last year when junior doctors went on strike after health secretary Jeremy Hunt attempted to scrap overtime rates except on Sundays, while increasing doctors' basic pay. The union argued this could mean pay cuts of up to 40% in some cases. After further strikes, the dispute is still ongoing.
Neeta is heartfelt in stressing the importance of junior doctors when it comes to the ongoing survival of the NHS. “They are absolutely crucial,” she says firmly. “That is the be all and end all of that answer.” The reason she is able to do her job, she says, is because of the team, because of the support. “I physically couldn’t work without my juniors," she says, “I could not function without them. I would give an arm for them – literally – I couldn’t work without them.”
“It saddens me what’s happened and what’s happening,” she continues. “When I was very, very junior it was probably the end of a very different time in the NHS, when funding wasn’t as much as an issue and we were a stable unit. Now things have become a little rocky. Our boat is being rocked and with all the cuts it feels like we’re being chipped away at, and they’ve chipped so far that the core is being affected. That saddens and worries me immensely.”
The morale of her colleagues, although tested, will take much more to break, but she's keen to stress that it is struggling. “The morale within the team was based upon that time and energy we had to team-build and now, because of how stretched we are, we’re losing that morale and you need it. It’s the goodwill of the people that are working within the NHS that keeps the NHS going.”
Being a doctor is not always easy, she says. Everyone she works with will have missed out on some big life event – a wedding, a birth – because they were at work. Neeta planned her own wedding around the on-call rotas of both her and her husband, and her husband’s entire family. Her family moved Christmas Day so she could join them. “I can assure you that every single doctor you will see in this series has given umpteen hours of work where they haven’t been paid, or they’ve missed something.”
“It’s not just a job,” Neeta says. “It’s a way of life. They always ask you at medical school why you want to be a doctor and the bog standard answer is because you want to care for people, but you have to realise it’s not just about wanting to be a good doctor – it’s about what you are prepared to sacrifice in order to be a good doctor. Because everyone puts their heart and soul into their jobs. The humanity you see in this place is surreal.”
“We don’t want recognition," she says. "We don’t even want appreciation. We just want people to be aware of what we’re actually doing and how hard we’re working to keep other people safe.”