Hospitals are so chronically understaffed they have been hiking pay rates in recent weeks and bombarding doctors with urgent emails and text messages in a bid to ensure standards of care do not suffer.
Exceptionally, we approved a maximum hourly incentivised rate for our senior trust doctors. This will ensure safe medical staffing levels and enable the department to continue to give high quality care to all our patients, said Neil Doverty, the North West Anglia NHS foundation trust’s chief operating officer.
Hospitals often scramble to make 11th hour arrangements to fill rotas. Last Monday the Dudley Group NHS foundation trust in the West Midlands was forced to increase the fees for senior house officers in its A&E from £60 an hour to £70 an hour for shifts lasting 10 and 12.5 hours.
The Guardian has seen messages sent by dozens of hospitals across England and Wales to doctors which paint a picture of near panic as many of them struggle, often at the last minute, to have enough medics on duty.
Many hospitals have been struggling to find enough doctors to work over the Easter weekend, with some trying more unorthodox approaches to get staff in. West Middlesex hospital in London, which is facing problems staffing its rotas despite having a well regarded bank of staff and paying high locum rates, this week offered any doctor working over the holiday weekend an Easter egg as an incentive.
Faced with an acute shortage of A&E doctors last month, the John Radcliffe hospital in Oxford sent scores of doctors an email entitled “help!” which said: “I am sorry to be sending so many messages but I am in real need here. I am practically begging at this point. I really need some help.
“Can ANYONE help out for any length of the shifts needed this weekend? It really is a matter of keeping the department safe.” The email was sent on 16 March by Brigid Greaney, the medical staffing administrator for the hospital’s emergency department.
This week Lewisham hospital in London, in its search for doctors to staff its general medicine department, sent an email that said: “We are struggling with the cover for on-call shifts this week. Please let me know if you can help.” It offered to cover doctors’ day shifts if they agreed to work nightshifts.
Doctors’ leaders say the problem is getting worse, blaming NHS workforce planning and the pressure of coping with the growing number of patients needing care.
Hospitals should not be reduced to begging, but what other option do they have when the NHS is so chronically under-resourced? This should set alarm bells ringing right through the NHS, said Dr Liam Brennan, the president of the Royal College of Anaesthetists.
Dr Mark Holland, the president of the Society for Acute Medicine, said: “Rota gaps are common – very common. I would be surprised if any hospital anywhere has a full complement of staff. There are some trusts under huge stress and where putting a workforce in place is very challenging, I would be surprised if there wasn’t a sense of desperation to get doctors on the shopfloor.”
Hospitals are sometimes being forced to pay well over the normal rates for hard-to-fill shifts because “there is a pan-NHS workforce crisis. This isn’t about greedy doctors,” Holland said.
The emails and text messages show that almost every branch of medicine is experiencing acute shortages of doctors in at least some hospitals. They range from surgery to cardiac care, anaesthetics to A&E and general medicine to intensive care. For example, Manchester Children’s hospital last Tuesday solicited volunteers for 19 “long days” and 26 nightshifts this month in its paediatric intensive care unit “to be paid at the enhanced rate of £60 per hour”.
Some hospitals facing acute shortages are advertising scores of shifts at a time. Milton Keynes hospital this week notified doctors of 52 shifts over 20 days this month in its A&E. Worcestershire Royal hospital in Worcester has so far only filled five of the 69 shifts it is seeking to fill between now and early August.
A doctor at Chesterfield Royal hospital, who asked to remain anonymous, said: “The rota gaps problem here is insurmountable and, frankly, rather dangerous. The quality of my life has been greatly impaired by the busiest winter we had on record followed by no real drive by the trust to recruit more doctors to anticipate this deluge of patients. The biggest culprit is A&E which is almost entirely staffed by locums, most of them being long-term [locums], followed by the emergency medical unit, which is very short on nights and weekends.”
Despite hospitals’ best efforts some shifts are still going unfilled, which puts extra pressure on other staff. A trainee surgeon at a major London teaching hospital said: “I’ve had occasions where instead of having two on-call senior house officers to hand over to, I’ve had to cover both shifts, after already working 12 hours.
Working locum shifts in short-staffed departments often feels like juggling with your medical licence as your clinical decisions are affected by time pressures and bed shortages more than your assessment of the patient in front of you.
Hospital bosses warned that endemic understaffing is threatening patient safety.
Along with high levels of bed occupancy, gaps in rotas can mean patient safety is put at risk. Fewer medical staff on shifts create intolerable workload pressures for all staff. This is bad for morale which has a further impact on the quality of care, said Saffron Cordery, the director of policy and strategy at NHS Providers, which represents hospitals.
Workforce pressures are fast becoming the number one concern for many NHS trusts, including hospitals, mental health, community and ambulance services. These are particularly difficult over holiday periods. All types of trust are affected but we know that this can be very challenging in rural areas and in specific specialties. Patient safety is always the top priority and every trust wants to guarantee safe care. The steps described here are an indication of just how seriously they take this, Cordery added.
A Department of Health spokesperson said: Staffing is a priority that’s why we have invested in the frontline and there are over 31,400 more professionally qualified clinical staff including over 11,200 more doctors, and over 12,100 more nurses on our wards since May 2010.
With over 52,000 nurses in training we will continue to make sure we have the staff available to give patients high-quality care as part of a safer NHS seven days a week.