The Doctor, issue 44, June 2022 by The BMA

The magazine for BMA members

thedoctor

Issue 44

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June 2022

‘We shouldn’t talk about throwing things away, because there’s no such thing as away’ How COVID fuelled the NHS addiction to plastic

Kabul calling A doctor’s plea from an oppressed country

Words of wisdom What’s the best advice you’ve ever received?

Putting up barriers Visa rules discourage much-needed GPs

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In this issue 3 At a glance Pensions are complicated enough even when they’re accurately worked out – and thousands weren’t

4-7 A plastic pandemic

Billions of single-use plastic items were made during the pandemic. How can the NHS become more sustainable?

8-9 Words of wisdom

What’s the best piece of advice you’ve ever received?

10-13 On the mend

How a ‘car crash’ of a hospital is aiming to turn itself round by treating staff better

14-15 Whistleblower under ﬁre

A medical director who raised concerns was subjected to ‘vindictive and demeaning actions’

16-17 Tackling racism

A high incidence reported, with little conﬁdence that employers will take action

18-19 You’re welcome

When the UK is desperate for GPs, why is the Home Oﬃce putting up unnecessary visa barriers?

20-21 Standing up to the Taliban

An Afghan doctor risks all by speaking out

22 Your BMA

Getting the most out of the annual representative meeting

23 On the ground

A serious accident at work 02

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Welcome Chaand Nagpaul, BMA council chair This will be my final editorial column in this magazine as my time as BMA council chair comes to an end at this month’s annual representative meeting. It has been a great honour to represent doctors during my time in the role. The profession has given so much to our patients and communities during years of unprecedented and extraordinary difficulty. It has also been a tremendous privilege to introduce the content of this magazine each month. The Doctor launched during my tenure as council chair and, since the very first issue, we have been at the forefront of the debate on many issues around health and care. We have won awards for our in-depth investigative and analytical journalism and we have amplified the voices of doctors working across the country. The NHS desperately needs more doctors. And general practice, like so many parts of the service, is under increasing strain. In this context it is remarkable that doctors desperate to work here and contribute to society are finding punitive and complicated immigration rules and bureaucracy standing in their way. In this month’s issue of The Doctor magazine we speak to Adewale Saka, a GP trainee from Shropshire, who may be sent home to Nigeria with his six-month-old son if he cannot secure a Tier 2 visa. Separately, we also hear from Muhib Shinwari, a doctor in Afghanistan, who discusses the country’s collapsing healthcare system, losing his job for speaking out against the Taliban and his desperation to leave. We speak to doctors promoting low-waste working practices and ask how the NHS can lead by example on cutting the use of plastic. It comes after the World Health Organization recently declared COVID-related plastic waste a threat to human health. The June issue of the magazine also includes the experiences of doctors at a hospital trust in Norfolk who reflect on service improvement and rebuilding culture in an organisation which was in special measures for years. And we also report on the story of a whisteblower who was subjected to ‘a pattern of disgraceful behaviour’ at work but has now won an employment tribunal case with the support of the BMA. Read the latest news and features online at bma.org.uk/thedoctor Keep in touch with the BMA online at twitter.com/TheBMA

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AT A GLANCE

FIGURE IT OUT: Even with advanced accountancy skills it can be hard to work out the tax on your pension

Obscure rules, poor information, punitive taxes

hen medical students decide to take an intercalated degree one of the provisos tends to be that it’s in a subject related to medicine. Yet today’s doctors may well be wishing they could turn back the clock and instead go for a qualification in accountancy – in very, very specialised accountancy at that. The revelation last month that nearly 3,000 members of the NHS pension scheme had been sent erroneous pension statements is a reminder that the wise doctor should be keeping a close eye on all aspects of their pension. The mistake – which the NHS Business Services Authority acknowledged – was reported on Twitter by NHS pensions expert Graham Crossley, who had spotted that a pension with estimated growth of £33,000, with no annual allowance charge, was instead down as £77,000 growth carrying a £16,000 annual allowance charge. Other specialist accountants then added similar instances that they had spotted in their clients’ statements. The problem, however, is not only that such specialist accountants are thin on the ground (and rightfully charge for their expertise) but also that the whole topic of pensions still doesn’t figure on the radar of a lot of doctors. In this case, there was a clear operator error, but in other instances, many of which have been reported in The Doctor, the stunningly high pension tax bills have been entirely accurate, although completely unsuspected by the recipients.

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And who can blame them? It seems that on top of doing the day job and all the medicine-related ‘stuff’ that goes along with it, doctors are now expected to be experts in their own pensions – pensions that are not private arrangements, but that are part and parcel of their work for the NHS. In many cases a lack of reliable information also makes this much harder. The BMA has been pushing for the NHS Business Services Authority to improve the information available to doctors with their pension savings statements, but even an online portal – promised two years ago – which might go some way to addressing this lack has not yet materialised. This all means that individual doctors are having to spend precious hours of their spare time poring forensically over their earnings and their potential pension tax liabilities to try to avoid making costly mistakes – to prevent the ridiculous situation that in some cases they are paying more in tax than they are actually earning. It’s not easy. Whether it’s debating whether or not to take on that extra session, or to turn down that additional responsibility, to accept a clinical excellence award, or even to cut hours or take early retirement, it’s another pressure that frankly doctors could do without. By Jennifer Trueland Read more about the BMA’s campaigning to address punitive pension taxes at bma.org.uk/pensions thedoctor | June 2022

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RESUME THE WAR ON PLASTIC WASTE Plastic is a vital weapon in infection control and has never been more so than during COVID. However, the World Health Organization warns COVID-related plastic waste is itself a threat to human health. Have we reached a tipping point? Seren Boyd reports

S STABLEFORTH: The pandemic has shown that the NHS can innovate

‘The statistics about COVIDrelated plastic waste are shocking’

uspending the war on plastic waste was seen as a necessary evil to tackle a global health emergency. PPE (personal protective equipment), testing kits and vaccine syringes were essentials in the fight against COVID: how to dispose of all that plastic was a question neatly sidestepped. Yet, two years on, the statistics about COVID-related plastic waste are shocking. Globally, an estimated 129 billion face masks and 65 billion gloves have been used each month during the pandemic – 75 per cent of which will end up in landfill or the ocean, says the WHO. The NHS alone used an estimated one billion surgical masks in the 12 months from February 2020. In March, Dutch researchers detected microplastics in human blood and tissue for the first time. Plastics have been a defence in this pandemic – and some remain essential – but could we do things differently?

Many doctors insist we can and must do much more, starting now, to end our reliance on single-use plastics – and switch to more sustainable practices and systems. It will take creativity, innovation and big-picture boldness, but alternative solutions are possible, they believe. Bill Stableforth is a consultant gastroenterologist in Cornwall and climate activist. ‘If the pandemic has shown us anything, it’s that given a bit of space to innovate, we can make changes fast,’ he says. ‘NHS staff and others can turn a service on its head, this afternoon even, with a little help.’

Set a target Some of these steps are relatively straightforward – yet many large NHS organisations are still not taking them. The BMA has called on trusts and health boards to have ‘policy and an ambitious target’ to reduce single-use plastic waste and

to explore re-use options for medical equipment, such as sterilisation. It’s also called on the Government to help the NHS achieve these and other sustainability goals. Almost a quarter of the NHS’s waste in England and Wales is plastic, says NHS Supply Chain. Yet, BMA research in 2020 found that the nearly six in 10 trusts in England reported having no policy to deal with single-use plastic. Even recycling of noninfectious waste is poor. Studies vary but it’s estimated that as much as half of the NHS clinical waste stream – mostly bound for incineration – could be treated as domestic waste. Marina Politis, a medical student on an intercalated degree in Scotland, voiced her frustrations about the lack of waste segregation in healthcare settings at the BMA annual representative meeting last year. ‘So often everything is shoved in the same bin: there’s no sorting,’ she thedoctor | June 2022

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POLITIS: Sort out the mess

‘The least we can do is recycle: that’s a very small step’

‘People want to do the right thing but hospitals and the NHS have to facilitate that’

says. ‘The least we can do is recycle: that’s a very small step.’ Abi Carey, a specialty trainee 5 registrar in geriatric and general internal medicine on Merseyside, has regularly taken recyclables home to add to her household bin and even provided an informal recycling bin at work. Where recycling facilities do exist, she says, they tend to be poorly labelled or misused. But Dr Carey, who is passionate about low-waste living at home and had a lowwaste wedding last month, makes an important point. ‘It’s currently very difficult to uphold or promote more sustainable practices in the NHS, because many staff are burnt out. It feels like there is no brain space for people to take on new challenges and changes.’

Re-use revolution Some trusts are ‘making it easy for people to care’, as Ms Politis puts it. Royal Cornwall Hospitals NHS Trust, where Dr Stableforth works, is a pioneer in this space. During the pandemic, the trust invested in a Sterimelt machine to divert plastics away from incineration. It uses heat to turn face masks and other plastics such as theatre tray wrap into polypropylene blocks. The trust has worked with a local firm to turn these blocks into litter-pickers, donated to every local school and college. Win-win. RCH is also part of a national trial, across several NHS sites, of the world’s first net-zero clinical laundry service for gowns, aprons,

coveralls and surgical masks. An early study found that it had the potential to save the NHS an estimated £9m a year. ‘We shouldn’t talk about “waste” and “throwing things away” because there is no such thing as “away”: these are valuable resources,’ says Dr Stableforth. ‘People want to do the right thing but hospitals and the NHS have to facilitate that.’ Other initiatives are coming on stream. Recycling schemes for clean PVC medical devices such as anaesthetic masks, oxygen masks and tubing were being trialled in several trusts before the pandemic. Some manufacturers are starting to use biodegradable materials such as compressed hemp for medical textiles and masks. In Australia, trials have even seen face masks combined with processed building rubble to be used in road construction.

Gloves are off To reach the NHS’s sustainability targets, the war on single-use plastics needs to resume, with urgency. As recycling and reusing need infrastructure in place for repurposing or sterilising, the ‘reduce’ mantra is gaining traction. Part of this offensive will have to include tackling ‘unnecessary and overuse of PPE’, says the WHO. The Royal College of Nursing’s recent Glove Awareness Week, which the BMA supports, encourages healthcare professionals to be more discerning in their use of plastic gloves. A pre-pandemic campaign at Great Ormond Street Hospital encouraged staff

to stop using non-surgical gloves where handwashing would suffice. This saved the hospital 21 tonnes of plastic and £90,000 in just 10 months. With good hand hygiene, glove use is not necessary for vaccination, the WHO says, yet ‘this appears to be common practice’. Ms Politis, who campaigned in Glasgow during UN climate talks COP26 last year, was dismayed to see 300 medical student colleagues donning and disposing of plastic gloves at each one of eight assessment stations during recent exams. More joined-up thinking could help address other types of waste too, she says. ‘Intubation equipment on the resus trolley was being thrown away a month before its use-by date so I asked if it could be taken to A&E where it would be used immediately, but was told: “Policy means we can’t”. Perhaps policies need to change.’ Cannulations were routine in emergency departments at St Mary’s and Charing Cross Hospitals until it was discovered that more than 40 per cent of cannulas inserted upon attendance went unused. Education and awareness campaigns reduced cannulation by 25 per cent in a year, saving £95,000. As part of a ‘Green Surgery Challenge’ run by the Centre for Sustainable Healthcare, a pilot by Leeds Teaching Hospital NHS Trust focusing on laparoscopic appendicectomy found that simply inviting patients to visit the toilet before the

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The cost of COVID

About 97% of plastic waste from COVID tests is incinerated

Between February and August 2020, three billion items of PPE were used in the UK, resulting in 591 tonnes of waste per day

The ﬁrst eight billion COVID vaccines administered globally generated 144,000 tonnes of waste in the form of syringes and needles

Source: WHO (2022) Global analysis of health care waste in the context of COVID-19

anaesthetic room eliminated the need for urinary catheterisation.

Momentum for change

‘With good hand hygiene, glove use is not necessary for vaccination, the WHO says’

The future of plastics is uncertain, with the global fuel crisis threatening oil-based production. New technologies such as plastic-eating ‘superenzymes’ are causing excitement. Dr Carey insists that plastics cannot be seen in isolation from the wider climate crisis – and not just because solid waste treatment and disposal accounts for 5 per cent of global emissions. Human and planetary health are inextricable. As she puts it, ‘eventually, nothing will matter except the climate’. Dr Stableforth agrees: the plastic crisis cannot be allowed to detract from more pressing ‘big-ticket items’

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such as reducing emissions. ‘We need big change in big systems,’ he says. His trust declared a climate emergency two years ago and works with other trusts in moves towards sustainability. Building momentum for change is vital, says Dr Stableforth, with doctors using their position of authority and inﬂuence and the NHS leading by example. He’s keen to see healthcare settings becoming ‘anchor institutions’, large employers and procurers that model and encourage sustainable practice. ‘If a hospital divests from fossil fuels, procures in an ethical and environmentally friendly way, focuses on active transport, rethinks its food, all that has a ripple eﬀect throughout the local community. Hospitals need to use their leverage and it’s not happening fast enough.’

Ms Politis would like to see sustainability embedded into more medical schools’ curriculum – and into clinicians’ conversations with patients. ‘We should be talking to patients about their environmental practices as part of their health proﬁle,’ she says. ‘But how can we do that if they’re being treated in a setting which doesn’t care about waste and the environment?’ Dr Stableforth remains determinedly optimistic. ‘I think people worry about climate action, because they think they’re going to have to live in a mud hut and eat raw turnip. But by phasing out fossil fuels, having active transport for all, the ability to walk and cycle to places with clean air, car-free cities… the social, psychological and physical beneﬁts are just enormous. The solutions are beautiful.’ thedoctor | June 2022

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SARAH TURTON

What’s the best piece of advice that you’ve ever received? Jennifer Trueland hears about dogs and lamp posts, baby sharks and grandmothers, and the various sayings and hard-earned life lessons which are never forgotten

SELVARAJAH: ‘I change what I do every few years’

Words of wisdom O

‘Make sure you recognise the people in your life who are allies’

lamide Dada was a medical student when she met the then-president of the American Medical Association at a BMA event. But she believes the advice she received then will stay with her for the rest of her career. ‘She [Patrice Harris] was the ﬁrst Black female president of the American Medical Association, and we got chatting,’ says Dr Dada, who founded Melanin Medics, a charity that aims to improve diversity and representation in the medical profession by supporting Black doctors. ‘I was really inspired by her, and she said something that stuck with me, and that was to make sure you recognise the people in your life who are allies, who are mentors, and who are sponsors. ‘People who are allies have the ability to support you, to learn with you, and to amplify what you’re doing, and to be a helping hand. People who are mentors are able to give you something to learn from – they are invested in your progress. And you must also recognise sponsors, who you don’t have this closer relationship with, but they’re able to create opportunities for you because of the positions they hold or the spaces they have access to. All it takes is one recommendation from a sponsor for you to be considered for an opportunity you normally wouldn’t have had access to.’

This made an impression on Dr Dada, who is now a foundation year 1 in Kent, because she had previously focused on the mentor relationship rather than recognising the other people around who could oﬀer support. ‘I think sometimes we try to ﬁt people into one box as mentors, but there’s a lot more to it than that.’

Look after yourself Words of advice can be purposeful or incidental, and they can come from anywhere. They can also be unwelcome, especially if unsolicited. But sometimes – as with the case of Dr Dada – they can have a profound eﬀect, regardless of the source. At this time of year, when new F1s are about to enter the workplace, it’s common on social media and elsewhere for doctors to pass on their advice or tips to the newest members of the profession – but what about the advice that they themselves had received? ‘It might not sound like a great revelation, but the best piece of advice I received – from a GP colleague – is to make your own mental health and wellbeing a priority,’ says David Wrigley, deputy chair of the BMA and a GP in Lancashire. ‘I think that when you’re under pressure and stress at work, it can be hard to recognise that

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SARAH TURTON

sticks with him came from an endocrinologist, who would say they didn’t worry if a patient refused treatments, because it meant they learned the natural history of conditions.

Focus on goals

feeling or sensation of being overburdened, and it is important to take the time to look at what you could be doing to reduce that pressure. Talk to trusted colleagues about it, use the BMA wellbeing support services. Doctors are great ones for not seeking help and support when they need it, for just battling on regardless. But we owe it to ourselves – and our patients – to recognise when things are building up and do something about it.’

‘Grandma standard’ When The Doctor approached doctors to ask about the best piece of advice they had received, not surprisingly, some themes persisted. ‘For me, it’s always treat your patients like your family should be treated,’ says Shrilla Banerjee, a consultant cardiologist in Surrey. ‘That was from my mentor, Dr Howard Swanton.’ It’s a similar story for Helen Ribee, a staff, associate specialist and specialty doctor working in emergency medicine in Staffordshire. ‘Give every patient the care you would want for your own family, is one my first registrar told me,’ she says. ‘It’s sometimes referred to as the grandma standard.’ Reading GP Joanne Byfleet recalls a pithy piece of advice gleaned from Baroness Cumberlege at a leadership event, which was ‘don’t stand between a dog and a lamp post’. Dubai-based paediatrician Denis Hardy cites advice from an obstetrician, which is ‘before you take any action, ask yourself what would happen if you did nothing’. Another piece of advice that bma.org.uk/thedoctor

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MATTHEW SAYWELL

DADA: Recognise your allies

Selvaseelan Selvarajah, a GP partner in East London, is often invited to give talks to trainee doctors, and much of it is based on what has been said to him along the way. ‘The best piece of advice I’ve had is always to remind yourself that at work you are always replaceable – but you’re not replaceable to your loved ones. Because sometimes we get really focused on our careers, and what we need to achieve in our professional lives, that we lose focus on what our goals really are.’ This advice – which came from his own GP trainer – stays at the forefront of his mind when he is asked to take on new roles and opportunities, says Dr Selvarajah, and it helps him to sort out what he really wants to do. Another career-related piece of advice is to have a plan, but be flexible and prepared to change. ‘I change what I do every few years and – although I might jinx myself for saying so – that keeps me energised, despite having many roles. Being a GP gives me that flexibility. It’s about being adaptable and having a change mindset.’ Advice can come from all sorts of sources – Dr Selvarajah credits a GP Facebook group for one of his favourites, for example – and this is certainly the case for London-based orthopaedic registrar Simon Fleming. He is a high-profile campaigner against bullying and discrimination in health services, and advises being open to ideas wherever they occur. His first – that ‘failure is feedback and feedback is the breakfast of champions’ was heard in the queue for coffee at a conference in Canada in 2015. The second came from a meme sent by a registrar when he was an F1, and that is: ‘Never let anyone tell you you’re too young to do something – a baby shark is still a fucking shark.’ The third was a suggestion from social media when he was designing the #HammerItOut campaign and that was, ‘don’t be a dick’. Probably a lesson for everyone.

WRIGLEY: Make your mental health and wellbeing a priority

‘Give every patient the care you would want for your own family’

What’s the best advice you’ve ever received? Email thedoctor@bma.org.uk

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SIMON BOLTON

SWORDS: Communication is key

SIMON BOLTON

SUWAR: Senior staff engage well with the junior doctors’ forum

MATHIALAGAN: ‘Engagement has been very poor’

RAGHURAMAN: Culture was chaotic

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On the mend ‘A car crash’. ‘Absolute chaos’. How does a hospital in this much of a mess start to turn itself round? Peter Blackburn speaks to doctors in a trust which, by aiming to treat staff better, is seeing outcomes improve

‘I

t’s a car crash.’ good idea about this, but nobody ever listened to me. As descriptions of hospital trusts go, it is hardly Nobody ever got back to me.”’ the sort of ringing endorsement which might The culture in hospitals in England is often leave people flocking to the job vacancies list on criticised, with staff experiencing bullying and the website. But when endocrinology consultant harassment, racism and stiff and hierarchical Frankie Swords heard these words from a regional structures. Doctors at the Queen Elizabeth describe NHS manager asking her to take on a secondment these issues as being rife while in and out of special she wasn’t put off. measures, exacerbated by a The phone call had come during ‘revolving door of management’. the midst of a CQC (Care Quality ‘Over the past 20 years I have ‘I found some Commission) inspection which seen at least 10 CEOs, 10 chairmen really good people was not going well. And it wasn’t and so on – that is the story,’ who were profoundly the first of its kind. The Queen geriatric medicine consultant Elizabeth Hospital King’s Lynn Rajaratnam Mathialagan says. demoralised and NHS Foundation Trust had been ‘I felt they were using King’s disengaged’ placed back in special measures Lynn as a step in their career in September 2018, just three rather than committing their years after being removed from ideas and ambitions to long-term the category by the regulator. Inspectors had raised hospital benefit… Decisions were made which weren’t concerns about patient safety, patient records, necessarily in the interests of the long-term but might medicine management and maternity services among have saved some money short-term. Clinicians were other areas. very frustrated and the engagement has been very ‘I didn’t know what to expect to be honest,’ poor over the years.’ Dr Swords, who came on a secondment as a clinical leader but is now the trust’s medical director, says. Deeply rooted problems ‘The hospital had quite a poor reputation. But what Deputy medical director and critical care consultant I did find was some really good people who were Govindan Raghuraman adds: ‘I would give you a profoundly demoralised and disengaged. What I was metaphor. It was like the traffic in India. You have lanes delighted to find in the first couple of months was I in place but nobody follows them. Absolute chaos – that is how it was.’ kept meeting people who were really good and just On top of deeply rooted cultural problems, thinking “how did this happen?”. including racism and nepotism, the trust has struggled ‘They would all say: “I wanted to do this, I had a thedoctor | June 2022

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SIMON BOLTON

SHAW: Improved food, staff support, and incentive schemes

to attract staff owing to its geography. It also serves an recognition’ for staff, particularly after such a brutal older population with more complex co-morbidities period during the pandemic. and does so in 1970s buildings intended for a community half the number it now has. The hospital Respect for colleagues buildings are literally propped up with metal stilts and Ask senior staff at the trust how they have made wards are constantly decanted while remedial works improvements and they are keen to stress that culture to make them safe are carried out. – specifically engagement, encouraging kindness The special-measures process itself makes life between people and clinical leadership – is at the more difficult too, with enhanced monitoring of heart of everything. Many of the steps taken might services and lots more paperwork and bureaucracy be assumed as the norm in some workplaces, but in an NHS which is already ‘over in the NHS common sense and regulated’. decency are not always the norm. At the end of 2018 Caroline Ms Shaw’s list of changes she ‘Clinicians were Shaw, an NHS leader of significant cites as successful reads like the frustrated and the experience, was parachuted in – demands list from doctors working engagement has the latest in a long list of names in many hospitals: free parking, trying to turn things around. subsidised access to a local gym, been very poor Ms Shaw brought deputy chief hot food provided on evening over the years’ executive Laura Skaife-Knight with shifts, a juniors’ mess apparently her from Nottingham University considered among the best in Hospitals NHS Trust and assembled the country, increased access to a new senior leadership team in a bid to turn around a psychological support and three freedom-to-speak-up trust which needed to make urgent improvements in guardians. Ms Shaw also brought back staff awards and an incredibly difficult environment, a national health reward and recognition incentives. and care landscape starved of resource and staff, and For Dr Swords a few obvious changes stand out, with a global pandemic on the way. each aimed at addressing the sense that staff felt Three years after Ms Shaw’s arrival CQC inspectors ‘unloved’. The wooden boards carrying the names saw fit to remove the trust from special measures citing a of consultants in gold lettering at the doors to the hospital had been taken down some years prior to her ‘marked improvement’ on the issues of most concern. arrival while the hospital was decorated but nobody The inspectors singled out critical care for had ever bothered to put them back. particular praise, suggesting the service was ‘That is quite a message,’ she says. The board was ‘dedicated to improving patient safety and experience returned to its rightful place. Consultants also had a through innovation and research’. Critical care consultant Dr Raghuraman says that was ‘rewarding ‘shabby’ little room meant to be for them to take time 12

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SIMON BOLTON

The Queen Elizabeth Hospital King’s Lynn

At the last inspection, the trust was deemed ‘good’ out but it was being used for meetings for any staff just for being effective, caring and well-led, but ‘requires like any room. It was done up and given back to the improvement’ for being safe and responsive. As such, consultants. there is clearly still plenty of work to do. With huge Dr Swords also cites being at every junior doctor pressures on urgent care, social care on its knees and induction, reverse mentoring from a foundation a hospital site not fit for purpose further improvement year 1 doctor and regular forums, meetings and seems like a significant challenge. Ms Shaw says communications as being key. national leaders need to show ‘recognition of this She says: ‘All that stuff has helped to get people being a really torrid time’. on side, listening and involved. Then you can harness ‘We have a really tired workforce who feel devalued,’ their ideas and empower them but they also come to she says. ‘We have public me when there are grumbles so I expectations where the public can get in there early and act.’ don’t think we are very good and She adds: ‘There’s loads of ‘Happy staff equals that we’ve had a load of money… evidence. Happy staff equals happy patients, and We need the top teams to have happy patients, and happy patients happy patients equals sympathy and understanding. equals lower anxiety, lower pain I’m not political but we need a scores, less use of analgesia, lower lower anxiety and really reasonable focus on what mortality and lower length of stay. lower pain scores’ is doable in elective recovery and The evidence is it improves quality the management of the urgent outcomes for patients if you have pathway.’ Ms Shaw adds that longhappy staff.’ term training and workforce plans are vital. And, at the very top of the list is a new hospital. Ms Cultural improvements Shaw feels the trust is now being taken seriously over Osama Suwar, an F2 at the trust, was Dr Swords’s reverse appeals for urgent capital funding. mentor in his first year at the trust and now chairs the There is certainly no shortage of ambition at the BMA junior doctors forum. Dr Suwar says the people in trust. Dr Swords lists a litany of areas where she, and charge ‘do care’. He says senior staff have engaged well colleagues, aim to become a ‘centre of excellence’. with his forum, making improvements in departments And when asked whether progress is a reasonable where cultural problems were rife and junior doctors expectation in such a tough environment Dr Swords felt unsupported. Dr Suwar adds, however, that says: ‘That’s a difficult question but the answer has junior doctors don’t always feel appreciated and that to be yes. We have come out of special measures more effort is needed in this area. ‘We had an awards and made good progress but we cannot stop here ceremony recently and not one junior doctor was otherwise we will go backwards.’ nominated for an award. I was quite upset about that.’ bma.org.uk/thedoctor

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GETTY

A medical director who raised concerns with her area’s COVID response was subjected to ‘vindictive and demeaning actions’, and unfairly dismissed. Neil Hallows reports

Whistleblower under fire A ‘It was “reckless” to follow [Public Health England policy] because it would mean that the spread of infection would be out of control on the island’

medical director was unfairly dismissed and ‘suffered detriments’ after raising whistleblowing concerns about the response to and the failure to pass on medical advice in relation to COVID-19 and other matters, a tribunal has ruled. The Employment and Equality Tribunal found that Rosalind Ranson, who was supported in her legal action by the BMA, was subjected to ‘a pattern of disgraceful behaviour’ at work, and was undermined and misrepresented by senior colleagues when seeking to discharge her duties in responding to the COVID-19 pandemic. Dr Ranson was appointed medical director of the Isle of Man’s DHSC (Department of Health and Social Care) in January 2020. A new organisation, Manx Care, was being created in April 2021, to focus on the delivery of

services, and Dr Ranson began her role with the understanding that she would transfer to it as medical director, but she was told in December 2020 that this would not be happening. The tribunal in Douglas, Isle of Man, heard that at the start of the pandemic in March 2020, there was a debate about how the island should respond. Dr Ranson and her medical team considered that the advice of PHE (Public Health England) was flawed and, in particular, not appropriate for the Isle of Man.

Closed borders call The approach being followed by the Isle of Man Government and Public Health Isle of Man was to follow PHE on the mainland. Dr Ranson’s advice included closing the borders. In putting this forward, Dr Ranson was reflecting the view of the specialist medical group that Dr Ranson had formed

to advise on the pandemic response. The tribunal judgement, released last month, found: ‘The PHE policy had been to stop COVID-19 community testing and to concentrate on delaying the spread of the virus by strategies designed to buy time to be more ready for the later peak. Dr Ranson’s concern at that time was that it was “reckless” to follow that strategy because it would mean that the spread of infection on the island would very rapidly be out of control with exponential growth in infection if the public were to follow that advice.’ But her line manager, the DHSC’s interim chief executive Kathryn Magson, appeared to Dr Ranson not to welcome her approach and, the tribunal found, would have been displeased when Dr Ranson made a direct approach to the island’s health and social care minister David Ashford in March

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Douglas, Isle of Man

2020. The modelling done by Dr Ranson’s team had shown that, with an unmitigated spread of infection, the island would reach ITU capacity within six weeks of the first case. Later that day she received what she felt was a reprimand from Ms Magson. The tribunal judgement says: ‘It appeared that Dr Ranson had a duty to represent the views of the island’s medical profession and to do her best to ensure that politicians and others beyond [the Council of Ministers] had an opportunity to consider the advice being given.’

Vindictive treatment Dr Ranson convened an emergency meeting of the island’s senior medical leadership team and the group called for the reversal of the decision to stop community testing and to close the borders for all but essential travel. Unbeknownst to Dr Ranson, the advice she was communicating was not passed on to the Council of Ministers. In Dr Ranson’s view, had the bma.org.uk/thedoctor

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advice been followed it would have meant fewer deaths and a shorter lockdown on the island. This led to Dr Ranson raising her concerns with another minister, Dr Alex Allinson, telling him that crucial information had not been passed on. The tribunal, which was held earlier this year, heard that Dr Ranson had been subjected to a number of vindictive and demeaning actions as a result of raising her concerns about the failure to pass on information. Ms Magson made ‘unjustifiable’ allegations to the chair and chief executive of Manx Care that Dr Ranson needed performance management, and on that basis Manx Care did not employ her. In addition, she lost her office, and was given a new one with a broken chair and no computer screen. Dr Ranson said in evidence that part of the reason for the treatment she received was that she made a series of ‘protected disclosures’ – statements which under whistleblowing legislation

mean that the person who makes them should be protected from detriment.

Forced out She said after the case: ‘As a doctor, my duty is to put patients and public first and this was made almost impossible by the campaign that was waged to make my work life untenable, to undermine my credibility and professionalism and finally force me out of a role I had been so looking forward to making a success. ‘The financial and wellbeing support from the BMA has been absolutely crucial to me and to this case. Standing up as a whistleblower is extremely difficult, even when you know it’s the right thing to do.’ BMA council chair Chaand Nagpaul said: ‘It is shameful and unacceptable that doctors who speak out about patient safety concerns can suffer victimisation and detriment for their commitment to patient care.’ The full story can be found at bma.org.uk/medicaldirector

‘A campaign waged to make my work life untenable, to undermine my credibility and professionalism’

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GETTY

Doctors have reported a high incidence of racial discrimination, according to new BMA research, and victims often have little conﬁdence their employers will support them. Tim Tonkin reports

The patient was racist, the colleague just laughed...

acism can be found in every part of society, with the NHS no less immune to its pernicious eﬀects. A series of reports recently published by the BMA highlight the extent to which discrimination aﬀects doctors’ professional lives and personal wellbeing, while also attempting to identify solutions towards tackling inequality in the health service. With doctors from ethnic minority backgrounds now accounting for 40 per cent of all medical professionals in today’s health service, it is easy to see how the NHS could be held up as a model employer of good practice, one that champions diversity and inclusivity. Despite the NHS owing its continued existence to minority ethnic and international doctors, new research by the BMA 16

highlights how racial bias and discriminatory behaviour continue to have a corrosive presence at an individual and institutional level, across all parts of the UK’s health service. An in-depth survey of more than 2,000 doctors and medical students carried out between October and December last year, has revealed that just over threequarters (76 per cent) said they had experienced at least one incidence of racism in the workplace in the previous two years. Of this total, 17 per cent said they experienced racism on a regular basis. ‘I was looking after a Caucasian male patient who noticed I was taking more time than normal to do a particular task,’ a medical student of British Asian background told the survey. ‘He commented saying “come on, you monkey man”. Other members of staﬀ around

me heard it but said nothing. In fact, one of my colleagues, a female Caucasian middle-aged lady, laughed with him. I felt horrible and wanted to curl into a ball. No one stood up for me and I did not have the courage to speak up.’

Turned off While experiences of racism were found to be more prevalent among doctors from overseas, with 84 per cent of international medical graduates reporting instances of racial discrimination, 69 per cent of UK-trained doctors also said they had been targeted. Fifty-eight per cent of those responding to the survey said it had had a negative effect on them either personally, professionally or both, while 23 per cent said they had considered leaving their jobs because of racism, with 9 per cent saying they had done so. One overseas-qualified

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Black, African junior doctor told the survey how the constant need to prove his ability and justify his ‘right to belong’ had left him questioning his future in the NHS. ‘I have the fortune of passing as English due to my accent but … the second people find out where I studied their approach and demeanour changes regarding my competence,’ he said. ‘There are a number of colleagues that struggle more than me, but the experience is deterring me from pursuing a long-term career in the UK.’ Fifty-four per cent of doctors from Black backgrounds responding to the survey said they had had their clinical ability doubted owing to their ethnicity, with 46 per cent of doctors from Asian backgrounds and 37 per cent of mixed-race doctors saying the same, compared with just 6 per cent of White British doctors. ‘I have been mistaken for a taxi driver,’ a consultant of Pakistani origin told the BMA. ‘I have been mistaken for a junior doctor and the White junior doctor was assumed to be the consultant. It seems to be pervasive that White doctors are assumed to be better.’ As well as assumptions

made on the basis of ethnicity, many doctors told the survey they had experienced more direct forms of discrimination, from derogatory comments and behaviour to bullying. Thirty-seven per cent of doctors from both Black and Asian backgrounds told the BMA they had been bullied because of their ethnicity, with 22 per cent of those from mixed and non-British white backgrounds saying the same. ‘[A senior doctor] said “we don’t negotiate with terrorists” as a joke but I didn’t find it funny,’ a medical student of Arab origin told the survey. ‘You are constantly made to feel different, and you are reminded every day that you are not the same as everyone even though you are just there trying to do your job.’

Iceberg of abuse While exposing the prevalence of racism in the health service, the BMA’s survey also highlights the extent to which abusive behaviour is going under the radar, with 71 per cent of those targeted saying they chose not to report it. Fifty-six per cent cited a lack of confidence in any action being taken as their reason for not reporting, while 33 per cent said they stayed

silent for fear of being viewed as a troublemaker by their employer. One GP of Black, African origin told the BMA: ‘Patients have threatened me and called me awful names but when I complained to the management it was trivialised and I was told I could have managed the situation better and was told to do a reflection on the encounter for my appraisal.’ In addition to a report detailing the full findings of its survey, the BMA has also published Delivering Racial Equality in Medicine. The report, which recommends a range of actions around tackling racial bias in the health service including improving racial literacy, reporting processes and increasing accountability in NHS workplaces, builds upon previous work by the BMA such as the racial harassment charter for medical schools launched in February 2020. BMA council chair Chaand Nagpaul said the NHS was built on the principle of equity of care but it was failing on this principle for its own doctors. He added: ‘Racism is wrecking the lives of many doctors, affecting patient care and threatening services. The time for talk on this is over.’

‘No one stood up for me and I did not have the courage to speak up’

‘Patients have threatened me and called me awful names’

Demeaned in the workplace: quotes from the BMA survey ‘When I go to a ward, it is assumed that I am the porter, was sent to take out the trash – any lowskilled job that they are expecting someone to turn up for’ Black Caribbean consultant

‘I was constantly harassed and bullied by a patient in the hospital for my appearance, I was called a sheikh, I would be asked about my place of birth, and my name was ridiculed’ Arab junior doctor

bma.org.uk/thedoctor

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‘A patient said to me “your people have a lot to answer for with this COVID”.’ Chinese consultant

‘On placement, surgeon not speaking to me, only to my white counterpart. Wouldn’t even make eye contact with me. Went to the extent that I was getting curtains closed on me.’ Pakistani medical student

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ED MOSS

SAKA: An NHS future in the balance

You’re welcome The UK is desperate for GPs and should be greeting doctors such as Adewale Saka with open arms, but the Home Office visa system puts up unnecessary barriers. Peter Blackburn reports

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‘R

surgeries often seem confused by the process or put off by ight now I’m on the edge, actually. I’m on the the costs or administration involved. edge.’ ‘They have had to take jobs they didn’t want to, just GP trainee Adewale Saka will have completed because they were offering sponsorship and they feel they his GP training in August, with only his final exam results have to go with it; you feel like you are left with no options.’ outstanding. Dr Saka came to the UK with his family Last month, the BMA conference of local medical from Nigeria in 2018 – his partner also well on the way to committees passed a motion demanding action in this area. becoming a GP. GP representatives said they wished to celebrate and value Dr Saka has embraced the ‘difficult’ but ‘welcoming’ the contribution that IMGs (international medical graduates) environment in the NHS and is committed to making a future in Shropshire, serving thousands of patients in make to the UK workforce. They called on the Government communities where GP numbers are dwindling but there is to support the option of relocation of the close family of more need than ever before. NHS workers to the UK, facilitate sponsorship or skilledYet, as he says, Dr Saka is ‘on the edge’. With just weeks worker status funding for all practices across the country until his visa to remain in this country expires – because and mandate a five-year minimum visa award to doctors doctors in his position are only given visas which last until entering UK GP training programmes. their training is completed – Dr Saka The conference also demanded has no idea whether he will find a the extension of the duration of ‘The last thing you job. His hopes of contributing to his any existing health and care visa community are in the balance. (previously tier 2) before the planned want to be thinking Even worse than that, if Dr Saka is certificate of completion of training about as a trainee not given a sponsored visa his family date without trainees having to secure is visa issues’ will be split in half with his wife and employment for visa sponsorship, and three-year-old child allowed to remain said doctors leaders should lobby the and Dr Saka being forced to go back DVLA to prioritise IMG GP trainees to Nigeria with his six-month-old. Dr Saka’s wife is nearing who do not hold a UK driving licence for driving tests. qualification for ILR (indefinite leave to remain) having Vital workers moved to this country earlier and being given a sponsored Speaking in support of the motion, Northern Irish GP visa while working in private healthcare. The children’s Ciaran Mullan described any barrier to doctors helping futures are linked by brutal bureaucracy to their parents’ solve workforce and workload problems as ‘nonsensical’. paperwork. In response to the motion being passed, BMA UK GPs ‘The last thing you want to be thinking about as a trainee committee chair Phil White said: ‘If COVID-19 has taught us is that you have visa issues,’ Dr Saka tells The Doctor. ‘It’s anything, it’s how vital our NHS workforce is – and IMGs are extremely stressful already and adding that on top of your a key part of that. list of worries.’ ‘Anything to make it easier for IMGs to come and stay to Dr Saka’s story is personally extremely difficult but work in the UK should therefore be seriously considered becomes senseless when considered in the wider context. by the Government, and their input into our health service properly recognised and valued.’ A mountain of unmet need Dr White added: ‘Other countries have taken steps The NHS has more than 110,000 staff vacancies. The to recognise and support the contributions of their UK has among the fewest doctors and nurses per 1,000 international workers both before and during the people among comparator European nations. Numbers of pandemic, and as a result have retained an experienced full-time equivalent qualified GPs have fallen. And GPs are and talented workforce.’ leaving the profession faster than people entering training. For Dr Saka, the principles of the calls from GP On top of all this there are now 6.4 million people waiting representatives make perfect sense. ‘Anyone who is about for treatment as the backlog soars. And a mountain of to start their training should be given that longer visa so unmet need is growing in communities with doctors they would still have a lot of time to look for jobs positively fearing current assessments of the scale of the issue to be after training and then by the end of the five years you can conservative at the very least. apply for indefinite leave to remain,’ he says. Dr Saka, who has contacted local GP surgeries to ask And, in an appeal to the Government, he adds: ‘Make it for work and support with a sponsored visa, says friends easy – that’s all I would say. Just make it easy.’ and colleagues have found themselves in similar situations and have had to accept long, daily drives to work or look at Any doctors who are directly affected by this can consult giving up general practice and working in hospitals where the BMA immigration advice service for dedicated advice. support with visas is often already in place. He says GP Details are on the BMA website.

bma.org.uk/thedoctor

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Describing the horrors of life under the Taliban has led to doctor Muhib Shinwari (left) fearing for his safety and having to look elsewhere for work. Leaving the country may now be his only option. He speaks to Peter Blackburn

The cost of speaking up ‘W ‘It just feels like the future is more disaster’

e are all beggars in the making now – they erase our hope and our way of life.’ Cardiology trainee Muhib Shinwari (pictured above) is putting his own career and safety at risk to tell the world what the Taliban has done to his home country of Afghanistan. ‘I think people around me need to be educated,’ he says. ‘They need to know. It is risking my job. And it could be worse than that... But I don’t see any other way.’ Dr Shinwari, who lives in Kabul, feels that everything with value is being decimated in his country. ‘We are heading toward the very worst impacts of this regime,’ he says. ‘They are forcing people to not wear what they want to wear, forcing girls to wear hijabs, they check the colours of scarfs and assess beards. They are hurting Afghans.’ It isn’t just the rights of others Dr Shinwari is worried about. He and his loved ones have suffered directly. Dr Shinwari has been told he can no longer work at his local hospital because he is unwilling to stop speaking out. He is now trying to find work elsewhere. And Dr Shinwari says his brother has been attacked and taken away on two separate occasions by the Taliban. On top of that, his sister, who is in the 11th grade at school, is no longer allowed to continue her education. ‘It’s very confusing and scary, it just feels like the future is more disaster,’ he says.

Needless deaths Dr Shinwari had been training in Beijing until the COVID-19 pandemic hit. Having seen the impact 20

of the disease and the relationship with cardiac problems he decided to fly back to Afghanistan and to offer help in a hospital in Kabul. But then the Taliban came. In August last year Dr Shinwari spoke to The Doctor from a house in Kabul, in hiding, for fear of going to work not knowing what the Taliban might do to him. He eventually returned to his hospital. Dr Shinwari says it was a tough environment in which to work – with most patients unable to afford care and only the most desperately unwell coming through the doors. ‘The people who are going to hospital are dying. They are having acute myocardial infarction or heart attacks or brain haemorrhage or things like that. Only those people who are in real need of care are there otherwise they tend not to go to hospital because of the economy and all the problems in the country. They just don’t have the money to pay.’ Dr Shinwari adds: ‘Ten days ago we had a doctor who was suffering from an intracranial cerebral haemorrhage. He was a doctor admitted to our ICU but he could only afford to stay for two days. It was roughly 50 USD per night and then they took him to the public hospital because he couldn’t afford the care for more than two days. When he went to the public hospital, where there are real problems with care, he died there. He was only 28 years old. This is the situation of a doctor in a good profession – imagine the situation of everyone else, how they are struggling.’

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Trapped and ignored Despite multiple efforts, however, Dr Shinwari has been unable to find other countries and health organisations willing to offer him work and a visa. He says: ‘It is so hard for Afghans in the current situation to go to other countries. ‘If you have contacts with professors or universities or whatever they can help you, but you need to show huge bank accounts with maybe 30 or 40 thousand dollars which isn’t realistic in Afghanistan. ‘Nobody wants to put money in the banks, the economy is a mess and even if you fulfil all the requirements of getting a visa they often just ignore you, deny you a visa or turn you down. They are not wanting Afghans. It’s quite a bleak situation for us.’ There have been many obstacles beyond bma.org.uk/thedoctor

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Now, having told his hospital he isn’t willing to be made to be silent, Dr Shinwari is desperate to find a way out of the country – to use his skills to help patients in another country.

finance, too. Some organisations have requested proof of significant experience working in academia and Dr Shinwari has also struggled to find mentors who will help navigate systems and bureaucracy. Dr Shinwari says he had expected to find more ‘welcoming’ environments given the ongoing situation in Afghanistan but feels trapped. ‘The whole country is in a prison,’ he says. ‘People are trying to find illegal ways to get out of this hell.’ When The Doctor asks what Dr Shinwari would say to the UK Government and to health organisations not offering help, he says: ‘I would be a professional coming to the host country – not just there to take benefits. I would be there to help the economy and the health system. Many countries are struggling for doctors – and we saw in COVID times how important it was to have a strong health system – but we don’t seem to be welcomed anywhere. It is a position many of my colleagues are in. Whoever can, will leave – nobody wants to stay here by choice. ‘We just want a chance.’ The BMA has voiced concern with the passage of the Nationality and Borders Bill, which will result in the UK failing to support individuals fleeing desperate situations. It continues to push for the development of a single, fair, humane and effective refugee system, in keeping with its obligations under international humanitarian and human rights law. The BMA, through the refugee doctors initiative, supports asylum seeker and refugee doctors who enter the UK providing a range of benefits to help them get their licences to practise in the UK.

DAILY LIFE: Residents of Kabul suffer under a repressive regime and crippling sanctions

‘People are trying to find illegal ways to get out of this hell’

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Your BMA The BMA annual representative meeting is upon us – here’s how to make the most of it The BMA 2022 annual representative meeting takes place later this month – and I don’t think there has ever been a more important time for doctors to come together, get involved and be the strong voice our profession, NHS and society need. Your ARM is our main policy forming body. In total, 550 members of our profession – medical students and doctors – who were elected to represent their colleagues will be in attendance, voting on policy concerning the most important issues facing our profession. Between those 550 members all four nations are represented, the length and breadth of the UK is covered and we have doctors from every part of our profession – every specialty and level of progression from medical students right through to senior consultants, GPs and academics. These 550 people have been elected through conferences, divisions, branches of practice and regional councils and I believe you can be confident there will be people doing their best to represent you. However, if you’re not in the room that doesn’t mean you can’t be involved. You can still have a voice. You can still influence policy. You still help to challenge your BMA and change our direction. I would encourage anyone who can to watch live – there will, as usual, be a live stream available on the BMA website. It is important the profession hears the discussion and the debate so we can all understand both sides of each argument. If you are following at home or work you can use social media – Twitter, Facebook, Instagram, Reddit, whichever is your favoured method of communication – to make your voice heard. Our hashtag for this ARM will be #ARM2022 Your representatives are always keen to hear from you. You can go straight to your branch of practice representatives with your views at bma.org.uk/whatwe-do/committees. And if you are able to get involved more I would urge you to think about trying to become a representative in future years. Visit bma.org.uk/ become-a-representative The BMA is dictated to by policy set at ARM, other conferences or by our council. The BMA’s job is then to make this policy become reality. It can be through internal 22

@drlatifapatel projects, surveys, lobbying or working with stakeholders and government. Policy set at events such as the ARM can change our working lives, influence the Government and national NHS leaders and I know first-hand the things we say when we stand up to speak for or against a motion are heard. Our agenda is packed full of defining issues for our profession and our society. We will be discussing the pandemic response, how the workforce will deal with the backlog, core terms and conditions for doctors, pay restoration, pensions, doctors’ safety and moral injury. We will also be scrutinising the health and social care bill and holding the GMC to account. As well as looking across our profession, our NHS and our society we will also look inwardly. We will be making decisions about how the BMA can change internally to serve members better. This includes looking at where we’ve gone wrong in the past – for example in not representing minority groups, women, doctors from minority ethnic backgrounds and IMGs (international medical graduates), among others, as well as we could have done. We also have sessions looking at ethics and international issues and we will discuss Ukraine. High on this year’s agenda will be the situation with recent legislative change regarding asylum seekers and refugees and how we can value IMGs better. Our union is 163,500 members strong. We are a powerful voice for better for our profession, for our health service and for our society. To wield that strength as best we can we need to be the most representative voice of all members that we possibly can be. It is so important that you get involved if you feel you have something to say. Please do use all the methods I’ve outlined or contact me directly if you have something to say at RBChair@bma.org.uk I look forward to hearing from you. Dr Latifa Patel is interim chair of the BMA representative body

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on the ground thedoctor

Highlighting practical help given to BMA members in diﬃculty

A doctor suffered an injury at work. Her employer tried to blame it on her shoes. Only with BMA help did she finally get the response she deserved There are many ways in which doctors are at risk from injury at work. We hear much about needlestick injuries, and the deeply worrying trend of assaults on staff. But sometimes it’s more to do with an employer’s carelessness – which in this case was aggravated by its reluctance to do the right thing once the injury had been caused. It was a scene which would be familiar to many working in hospitals. Outside the doctor’s office, it was a mess. There was simply not enough space for the items haphazardly arranged there – the chairs, in what had become an impromptu waiting area, and the boxes of toys for younger patients. The floor was uneven. It was an accident waiting to happen, and happen it did, when the member fell badly and fractured her knee. She needed surgery, and it was months before she was sufficiently mobile to return to work. In total, she was absent for nine months. She still needs to use a walking stick and it is likely her disability will be permanent. What the member needed was an honest, compassionate response. What she got was an unnecessary and stressful battle to make up for the financial loss she had suffered. The initial report from the trust said it was the doctor’s choice of footwear which caused the accident. This was not true. A manager inspected the area, but only after it had been (conveniently) cleared up. The trust would not provide the DATIX incident report to the BMA, and said the CCTV footage had been automatically destroyed prior to the BMA getting involved in the case. Meanwhile, the financial burden on the doctor

grew worse. She was only in her ﬁrst year of employment, and so only due one month’s full sick pay and two months’ half-pay. She was paying for private physio sessions. But her employer was refusing to pay NHS injury allowance – a no-fault scheme for which it would not have even had to accept liability for the accident. The allowance pays up to 85 per cent of salary. The doctor took this to a grievance, which was not upheld, but the process was carried out incorrectly, without a hearing where she had the chance for a right to reply and to ask questions. With the BMA’s help, she appealed, the employment adviser supporting her through the online hearing. Finally, the trust relented, paying not just the 85 per cent of pay that was due under the injury allowance but her full salary, albeit still without admitting liability. The likely permanent nature of the member’s disability means she is now reluctantly considering a personal injury claim. The doctor said she would not have had this outcome without the BMA, and prior to it getting involved, the trust was not even responding to the doctor. When the employment adviser pointed out the procedural errors with the grievance, it took months to get a reply, and achieved after he escalated it to a senior manager. Agreement for the payment only came 10 months after the accident and it took further chasing and two further months to get the money. It’s a ﬁne example of the persistence and expertise of the BMA employment advisers who work to help members in situations such as this.

The Doctor

Editor: Neil Hallows (020) 7383 6321

BMA House, Tavistock Square, London, WC1H 9JP. Tel: (020) 7387 4499

Chief sub-editor: Chris Patterson

Email thedoctor@bma.org.uk Call a BMA adviser 0300 123 1233

Senior staﬀ writer: Peter Blackburn (020) 7874 7398

@TheDrMagazine @theBMA The Doctor is published by the British Medical Association. The views expressed in it are not necessarily those of the BMA. It is available on subscription at £160 (UK) or £225 (non-UK) a year from the subscriptions department. All rights reserved. Except as permitted under current legislation, no part of this work may be photocopied, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical or otherwise without the written permission of the editor. Printed by William Gibbons. A copy may be obtained from the publishers on written request. The Doctor is a supplement of The BMJ. Vol: 377 issue no: 8341 ISSN 2631-6412

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Staﬀ writers: Tim Tonkin (020) 7383 6753 and Ben Ireland Scotland correspondent: Jennifer Trueland Feature writer: Seren Boyd Senior production editor: Lisa Bott-Hansson Design: BMA creative services Cover illustration: Getty Read more from The Doctor online at bma.org.uk/thedoctor

12/06/2022 18:35

Medicine will always have new questions. We’ll find you the answers. For doctors and medical students who need to stay up-to-date with the world of medicine, BMA Library offers easy to use online services that support your career growth, clinical practice and research, and ultimately help you provide better patient care.

BMA Library offers you access to: Thousands of e-books and e-journals Information specialists for tailored literature search support for all your evidence and research needs ClinicalKey and ClinicalKey Student to strengthen your clinical knowledge and skills

bma.org.uk/library

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