The green shoots of change

Wednesday 31 March 2021

One year ago today, I attended the first day (of two) of oncology national recruitment (and managed to be surplus to requirements – result). I thanked everyone for making the effort to travel to support the future workforce, despite the risk. I expressed uncertainty as to when we would be able to meet together again. There was no second day. From this has flowed so many changes to how we live and how we work.

The RCR is ripe for change too. Our governance structures are over 45 years old and while they have served us well, they are, like myself, slightly creaky. Council has charged a governance working party to undertake a thorough review and make recommendations on what needs to change. We will be seeking your views over the next 18 months on specific issues. However, feel free to have your say on our future governance arrangements at Part of that future, I hope, contains closer working with our medical oncology colleagues. A single voice is stronger for promoting the benefit of oncology for patient care.

The lack of definite support for the NHS in the budget was a disappointment to many, especially the double whammy of disappointing pay rise and poor handling of the pension question. The potential for a period of reduced NHS spending damaging services, coupled with growing backlogs, and heightened expectations to which the 'logical' action must be a new (privatised) funding option, is a definite concern. Universal healthcare, free at point of use, has given us a strong bedrock on which we could build. We need to ensure we do build back better, working to eliminate health inequalities and aiming to embed the public health benefits of primary prevention and healthy living that extend into all aspects of society including education, housing and employment rather than expecting the NHS to fully deliver the entire wellbeing of the nation. Health has multiple determinants and focusing completely on the illness aspect of the NHS rather than the wellness aspect of other areas in addition has never seemed a balanced response to me.

Many felt the budget did not sufficiently address the pensions issue to ensure there was no disincentive to the retention of senior, experienced (and incidentally expensive) staff. The government is well aware of the concerns of the profession around retention of those toward the end of their career (or insert whatever alternative euphemism you wish). Over the next few years staff retention will be and remain a significant plank of the plan to bridge the existing workforce gap, despite a welcome expansion in training numbers. Keeping as many of us (of all ages) at work (including less than full time) for as long as possible is what is needed for the health service. I agree with this aim, but I must admit it does fly somewhat in the face of the free will someone once explained that I could exercise.

The answer, as with all issues, is infinitely more nuanced than it appears at first glance. We need to ensure that we train future colleagues invested in developing and delivering the service needed by our patients. Training in medicine does provide transferable skills, but we need to try to keep that innovation and energy within the workforce for the benefit of all. Those in the middle of their career, generally not keen to travel due to family and financial commitments, need to be supported to stay in an often pressurised working environment. Wellbeing will need to be something more than an afterthought, especially in the next few months of recovery. It will also need to be something that we, the workforce, can tangibly appreciate rather than a theoretical consideration, if it is to achieve even half of what is hoped.    

A full pension pot, of itself does not prevent one working, but it can change the perception of the need to work, which is a very different thing. Feeling valued for one’s expertise, feeling welcomed within the workforce, feeling that’s ones contribution is useful all plays a part and is much more difficult to define. The culture of the employer, the flexibility of the working terms offered and the willingness to offer a bespoke job plan solution are increasingly important and not just for our more experienced colleagues. The challenge to the NHS is to be flexible for all (not a common experience) but that is not all that is needed. As colleagues we must be willing to embrace flexibility for our colleagues (and ourselves). We maybe need to think less why has X 'got away' with being treated differently by implication 'pulling a fast one' and more that X makes a valuable contribution that should be maintained if possible. Perhaps by thinking about what we might want, we might be less hard on ourselves as well as looking at others in a more generous light.  

The current consultant career is long (and getting longer). We need to ensure sustainable working lives that carry the majority along for as long as possible. We also need to actively engage with more junior colleagues to understand what they want from their careers, and reflect that as soon as possible in our workforce planning. Workforce planning is at best a dark art with wide confidence intervals and lack of robustness around the models. At worst it continues to view the future workforce through the prism of past behaviours – a sure fire recipe for disaster in the highly feminised, work-life balance valuing modern graduates of medical school.

Dr Jeanette Dickson
RCR President

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