As the UK’s public service industries continue their industrial action for better pay and working conditions, THE FACE asked young people in each sector to keep accounts of their typical working weeks. These are the realities behind their picket-line demands.
Chiamaka is a 24-year-old first year doctor in the East of England. She took part in the recent junior doctor strikes in April, and is striking again this week with the British Medical Association, from 14th to 17th June.
After talks with the government broke down, the British Medical Association’s junior doctors’ committee has said it will continue strike action for at least three days a month until their legal mandate runs out in late August. “Four in ten junior doctors are looking to leave the NHS, and the health service staggers under a workforce crisis,” reads a statement from the BMA. “This is no time for the Government to play games on pay.” If the junior doctors’ committee renews its mandate to strike come August, it could result in more industrial action that lasts until early 2024.
This week, Chiamaka worked 58.5 paid hours.
My alarm goes off at 5:45am and I start the day like I always do: by completing one exercise on Duolingo. Then I get up and get ready, and begin my 50-mile drive to work.
I arrive at work around 8:30ish and head to A&E to sort through the list of patients admitted by the night team. I start reviewing the overnight patients with the consultant, spending the next four hours seeing patients with abdominal pain, heart failure, severe dehydration, brain tumours, gastrointestinal bleeding and more.
After each patient is seen, the consultant finalises their management plan and I make a list of “jobs” I have to do. Jobs include a variety of tasks, such as calling other medical specialties for advice and referrals, initiating treatment with the help of my nursing colleagues, updating patients’ family members and speaking to radiographers to get scans booked.
There aren’t many chairs in the department and standing up for four to five hours at a time really takes its toll. I go for lunch and teaching at 1pm; there’s an interesting talk about sepsis by one of the senior doctors. I get called back to A&E 20 minutes into my break because there are too many patients waiting. Recent rota changes mean we’ve gone from having five to 10 doctors working overlapping eight hour days to two to three working 12.5 hour days.
At 5:30pm, I manage to escape to the mess (doctors’ staff room) for half a cup of tea and a snack, resting my feet for another five minutes before I’m called back to A&E. I continue to see more patients until 8:30pm, when I round up my jobs and check there’s nothing urgent to handover to the night team.
I’m too tired to drive home, so I go to the switchboard to get the keys to an on-call room because I’m back again at 8:30 tomorrow morning. My Apple Watch says I’ve walked 6k today, even though the hospital is tiny and I’ve pretty much just stayed in one department for 12 hours straight. I’m exhausted with a sore back and legs, but feeling grateful for the opportunity to spend my time helping so many people with a wide variety of problems.
I wake up at 7:45am, grateful for the extra two hours that have been cut out of my morning routine. I’m back in A&E, so I start checking where the patients from overnight are, so we can prepare to go round with the consultant and see them.
Afterwards, myself and the other junior doctor split the jobs from handover, and then I prepare patients’ notes for the consultant review. I review blood tests, imaging (X‑rays and CT scans), medication that’s been started and their current vitals, noting all this down in the patients’ notes. I go to prepare a new patient, get their GP records and look at their bloods, open the curtains to say hello and realise the patient’s gone out for a cigarette so pick someone else to see.
I head to the canteen for lunch – unfortunately the coffee machine is broken. The other doctor and I are flagging, so I treat us to a drink from Costa.
At around 3:30pm, I realise I haven’t had a loo break all day. But I’m on a roll and want to keep up the momentum as there are still a lot of patients to see, so I push on. A couple of hours later, I treat myself to a wee, then head to the mess to sneak a Jaffa cake or two while resting my feet for a couple of minutes, as there are still no chairs to sit down on whilst we work in A&E.
At 8:30pm, I go to handover to inform the night team of some urgent jobs that will need chasing. Today I’ve seen patients with chest infections, patients reaching the end of their life, patients who are not coping at home with their current level of support, and a patient suffering a suspected heart attack, to name a few. When I work a long day I tend to get home around 10pm, have dinner and decompress from the day with my mum before heading to bed.
I get up and ready at 6:30am, pack my overnight bag and some food. At 8:30, I get to work and the night team has nothing to handover. I’m back in A&E so I start seeing patients with the consultant, finalising and actioning treatment plans.
In the afternoon the consultant kindly offers to observe one of my consultations so I can get a clinical experience signed off for my portfolio. At 5:35pm I go to sit down because I’m getting a headache – I haven’t had much to drink all day. At 6pm, I head back to A&E to check on my patients, follow up their plans and update families. By 8:30pm I’ve rounded up my jobs and have nothing to handover.
I wake up at 7:30am and get a handover at 8:30am. I’m carrying an arrest bleep today, meaning if anyone in the hospital goes into cardiac arrest, the bleep carriers are alerted and have to run to wherever they are to carry out their pre-agreed role. I have the bleep for IV access – taking blood tests from and inserting an intravenous line into the unwell patient.
I have a clinical attachment today, which means I’ll be shadowed by an overseas trained doctor who’s learning how the NHS works before they start work here. We go to the endoscopy unit to deliver a referral request for a patient who has a suspected bleeding gastric ulcer from overusing ibuprofen. A pregnant patient has come in with a medical problem, so she will need the input of the obstetrics team as well as us (the medical team).
The A&E environment can be very overstimulating – it’s very loud with alarms and call bells going off, lots of people talking, phones ringing. One of my jobs for the afternoon involves calling a local specialist hospital in a different part of the country, (literally) running to a different department, running back to A&E, finding out the patient has been moved, then finding out where they are and updating them and their family.
I go to handover at 8:30pm, giving my arrest bleep to the night team. Every time I think I’m getting the hang of it and my body is getting used to this kind of work, I feel absolutely shattered again. I know I’m pretty good at my job and I do my best for my patients, but even when I don’t feel like I’m pushing myself to the absolute limit, I come away feeling exhausted.
I get into work for 8:30am. I go to my base ward (currently cardiology) and get told I’m being moved due to another ward being short staffed. Luckily I’ve worked here in the past, so I am familiar with where things are and how things are run. I prepare the notes for all the patients under my care. I only have nine today which is something of a luxury.
The consultant and I go and see all nine of my patients, and I formulate a list of jobs that need doing. I go for lunch at around 1pm, then head back to the ward around 20 past so I can speak to the other junior doctor and divide our jobs so nobody is too overloaded.
I spend my afternoon taking blood from some patients, preparing discharge letters that are sent to GPs when patients leave hospital, reviewing a patient who fell on the ward, and speaking to the hospital pharmacist about some medication queries. I finish at 5pm and head to the staff room as I don’t have anything to handover.
I head home at 7pm. Today was a lot easier as there were actually chairs on the ward (!) and I had a much lighter caseload of patients that I was responsible for.
Why I'm striking
We’re striking for a pay restoration, bringing our pay in line with inflation as our salaries have been eroded since 2008. We are currently being paid 26 per cent less than our equivalent role 15 years ago, with more student debt and a drastically increased cost of living. Staff retention is at an all time low, with colleagues heading abroad in droves to continue their training with better working conditions and pay that’s more proportionate to our level of responsibility. Seeing the NHS collapsing under the weight of underfunding and short staffing, the most obvious way to start fixing this is a restoration of our pay to help retain staff.
Health is so important and it can be so daunting to face when things go wrong, but the human aspect of what we do is being a literal and figurative hand to hold as someone navigates difficulties with their health. The days can be long – working 50+ hour weeks isn’t uncommon – and the workload can be brutal, but at the moment I can’t see myself doing anything else. I love my job.