“I enjoy improving the lives of others, but no one considers how junior doctors are supposed to afford to survive here. It’s ironic.” Olly Rose is a fifth year medical student, completing his training at Charing Cross Hospital in Hammersmith. Despite being an integral part of the medical team within the hospital, once his training is complete Olly will not be staying in London. He simply can’t afford it. “I might go to Wales, or back up North. I could even go to Australia- it might actually work out cheaper”. Olly isn’t alone in making this decision. Hospitals in London, including within Hammersmith and Fulham, are facing crippling staff shortages as junior medical staff who can’t bridge the gap between their low pay and their high rent, decide to leave.
There can be no doubt that London’s rapidly increasing population is putting an enormous strain on a health service already under serious stress. Chris Ham, the chief executive of health think-tank the King’s Fund, believes that the high cost of housing in the capital is one of the major contributors to the current NHS crisis. “The money is running out, demand is increasing, hospitals are under pressure, there aren’t enough GPs and nurses. One of the biggest issues is recruiting the workforce for the future given the high cost of housing in the capital. It’s a very explosive mix.”
Jim Grealy, press officer for the campaign group Save our Hospitals, reported figures from the group’s research team showing that 80% of junior medical staff hired by the hospitals in the borough leave within eighteen months. Grealy said that some leave medicine entirely, others leave London, and increasingly many workers emigrate and work abroad. A UNISON report – entitled Undervalued, Overwhelmed – found in October of this year that 65% of NHS workers were seriously thinking about leaving their jobs, with two in five saying they are considering a move beyond healthcare. The report also showed that 58% of staff listed “low pay” and “staff shortages” as reasons for considering leaving.
The problem seems to be especially apparent within Hammersmith and Fulham, however, and Grealy cites house prices as one of the key reasons for this: “The reason for that is the cost of housing in West London is such that most junior medical staff can’t afford to live there, and even junior doctors have bigger debts coming out of university, and move to places where they can afford to start a family”. He added that as property prices go up, the problem increases further. This is a huge concern for Hammersmith and Fulham residents, especially as recent closures have increased pressure on the hospitals still open, but the problem is not contained to West London alone.
Startling statistics released in September show the General Medical Council (GMC) received 1,644 requests for Certificates of Current Professional Status (CCPS), which are issued for people who wish to work overseas, in just three days. The GMC usually receives between 20 and 25 requests each day. In 2014, 4,625 applied in total, but by the end of August 2015’s figure has already reached 4,800 and is likely to climb further. This rise in applications came just a day after the Government confirmed it would seek to impose a new contract for junior doctors, which is no coincidence. Junior doctors are being expected to increase their productivity by 40% whilst not receiving pay to reflect that work. UNISON’s report found that 55% of workers were doing unpaid overtime each week, and 25% of those were doing six hours or more. The biggest reason for all this unpaid overtime, according to 50% of the survey’s respondents, was that the job would be impossible to do without it, while 41% said they did it because they wanted to provide the best care possible for patients. It is hardly surprising, given these conditions, that so many junior medical staff are thinking about leaving.
Upon analysing the Care Quality Commission (CQC) inspection reports across the country from 2014 and 2015, it becomes clear that staffing shortage is becoming a serious problem. Of 89 hospitals, 68 had issues raised about short staffing on wards, and in many cases these staffing levels put patient safety at risk. West London Mental Health NHS Trust was told that it needed serious improvement following its inspection, and the CQC noted especially that the trust had a substantial problem with staff recruitment and retention. A similar report came from the inspection of Charing Cross, Central Middlesex, and Hammersmith Hospitals. Figures from the UNISON research showed that 64% of respondents reported frequent staff shortages, and 67% said there just were not enough members of staff to do the work required. Almost half (49%) of the respondents reported relying on agency staff, which should come as a concern during a time of austerity. Agency staff are far more expensive than permanent members.
Hammersmith and Fulham has recently been named as the worst performing borough in London for year on year growth of house prices, and campaigners and medical staff alike have pointed to this as being a major factor in the staffing shortages. According to analysis by the Office for National Statistics, the average house now costs twenty times the average local income. Average earnings in the borough have been recorded as being around £35,000, and the mean house price starts at around £564,500, although the majority of junior medical staff will earn far less than the average income. The average percentage of income being spent on rent in the borough is 54%, which is a very worrying statistic, and the problem shows no sign of slowing down, as average rents for a four-bedroom home have jumped more than 50%, from £2,815 to £4,312 since 2011.
Dr Rupa Huq, Labour candidate for Ealing Central and Acton, said in an interview with the Guardian: “With people now paying more than half their income on rent, many will soon be forced to leave our area – leaving only the rich able to live here. It would be a scandal if teachers, nurses and other professionals were forced out of the constituency.” However, the problem is quickly changing from a threat to a reality for some.
“I only got into the politics of it to help my students”, said Aysha Raza, an anatomy and neuroscience teacher at UCL. Aysha is a member of the Socialist Health Organisation, along with many other health campaigners and retired medics. She is also a regular campaigner for Save Our Hospitals within the borough, and witnesses first hand how changes within the hospital system is affecting healthcare. “The system is disintegrating, and there are definitely many more conversations about alternatives, especially amongst the nurses”, she explained.
There has certainly been anger within healthcare campaign groups as figures published by the Evening Standard revealed the staggering difference between the salaries of hard working junior medical staff and those of the managerial ‘fat cats’. Dr Tracy Batten, chief executive of Imperial College Healthcare which runs the hospitals within the borough, was paid £342,500 in 2014/2015. Aysha described this move towards a more business-model style of hospital organisation as a “bad habit” picked up from the US. “The senior staff are more managerial now, and less on the coal face”, she said. “There is too much business and too little actual medicine going on. It is very sinister, this systematic attack from the top”.
As for Aysha’s students, the future junior doctors, she describes their concern about their futures. Junior doctors struggle hugely, and they are all worried about how they will finish their training, with many talking about going to Australia or the U.S. “The work-life balance there is better”, she explained. “A lot of staff are hanging on just because they love their job, but that can’t go on. The numbers of people leaving are definitely going up”.
A report by the London Health Commission has suggested a possible way to improve the health services in London could be to provide affordable housing for junior medical staff. The commission is an independent inquiry, launched in September 2014 and chaired by former health minister Ara Darzi. According to Darzi, in order to improve recruitment and retention of the NHS workforce in London, trusts with surplus land should use it to provide affordable housing for nurses, radiographers and other junior medical staff. The research for the report came from consultations with health workers, and findings clearly indicated that the lack of affordable housing and high cost of living in the capital are major issues contributing to staff shortages.
Other attempts to tackle the problem have included high-cost area supplements to provide additional payments to staff, dependent on salary and location, although the Health Commission’s report has described these as “insufficient to bridge the cost of living gap”.
“I was born in London. I trained there,” explained Clare Fudge, a surgical registrar. “The cost of renting is astronomical. I wanted a family, so I had to leave”. Clare emigrated to Australia over a year and a half ago, and hasn’t looked back since. When asked if she or any of her UK colleagues in Australia would think about coming back, Clare laughed, “We left because of a failing system. We had no money, no time, and no hope. Why would any of us want to come back?”