What if your boss asked you to work fewer hours, for 50 per cent more pay, surrounded by great coffee, great beaches and great weather? A third of UK junior doctors have answered ‘bonza!’ and are already planning their move to Australia. This comes as the NHS struggles along, with shortfalls of 12,000 hospital doctors and 50,000 nurses. NHS medics are, unsurprisingly, not happy: the first day of a 72-hour junior doctor strike has begun in England.
While ‘wellbeing hubs’ open in crumbling NHS hospitals, with yoga balls gathering dust and free biscuits going soft, Australia has some solid, cost-effective measures that truly support staff
Junior doctors voted last month overwhelming in favour of industrial action, with 98 per cent of voters opting to strike. Over the next three days, NHS England has warned patients there will be ‘major disruption’ to services. Meanwhile, dissatisfied doctors are increasingly choosing to work elsewhere and Australia has in recent years seen a huge influx of UK-trained medics.
After twenty years of working for the NHS, and after my wife (a primary school teacher) and I spent time working through the pandemic, we too decided it was time for a change. Leaving colleagues, community, friends, parents and a shared history, we headed 9,000 miles away to the endless shoreline and Black Swan dotted rivers of Perth, Australia.
There are many similarities between the South Wales we left and the Western Australia that welcomed us. We moved from a Westerly region of the UK that relied on mining, with its own culture, way of life and public services somewhat estranged from the wider country. But it was the small, important differences in how healthcare workers are supported here that struck me.
While ‘wellbeing hubs’ open in crumbling NHS hospitals, with yoga balls gathering dust and free biscuits going soft, Australia has some solid, cost-effective measures that truly support staff. Importing these into the NHS could stop staff from making the hard decision to leave and may even entice those who have done so to come back.
These ideas do not stand alone. They would work best in combination with pay restoration for the 26 per cent real terms pay cut in average NHS junior doctor pay since 2009. They will help after punitive, double pension taxation using unjust annual allowance rules are scrapped, where some of my colleagues are having to pay to do their work.
Luckily, the Chancellor Jeremy Hunt is in possession a report written by the former Chair of the Health Select Committee who is none other than, you guessed it, Jeremy Hunt. This report urgently calls to ‘remove any perverse incentives for early retirement’ including this annual allowance rule. I’m sure the report is on the Chancellor’s bedside reading table, but there are a couple of extra measures that would save him, and medics, further misery.
Firstly, the organisation of the National Health Service leaves a lot to be desired. With frequent movement of NHS staff in training, pay errors are unfortunately relatively common and understandably very distressing. Having a shorter pay cycle – one or two weeks, for example – allows these to be quickly captured and corrected. It may also allow easier financial planning for those on low incomes.
Unlike NHS doctor contracts that use complex formulae for out-of-hours anti-social work payments, meaning doctors won’t see their overtime reflected in their take-home pay, Australia directly links shifts worked to payment received. Work a bank holiday or night shift one week, get paid more the next. This encourages flexibility in swaps, fairness for individuals and the feeling of worth when work is directly linked to an outcome.
On the subject of money, tax breaks are another area of contention in the UK. Rather than punitive pension taxation driving NHS staff to retire or reduce work, Australian healthcare staff have tax advantages. You can ‘salary package’ many aspects of life that support public service from rent to food shopping. This helps makes public service competitive against private industry employment.
What else? Doctors undertake a number of exams during their time at medical school, and these don’t stop on graduation. To progress through training programmes and specialties, exams need to be passed. It follows that medics will need to take study leave at various points in their careers. In the UK, this is made all the harder by slow, bureaucratic claims processes that reimburse for time taking off (compulsory in order to progress) in retrospect. On the other hand, Australia pays a study budget in your regular pay. This encourages professional development and staff can afford to pay for courses prospectively.
Finally, a point on annual leave and burnout. Down under, staff are given an extra 13 weeks leave every seven years. Mini-retirements, extended breaks or using small amounts regularly helps reduce burn-out, sickness rates and rewards commitment with more than a fake gold clock. It also helps retention in the sector – something that the NHS is struggling with, as less and less junior doctors at the end of their foundation programmes are staying the NHS or entering specialty training programmes, while four in ten plan to leave the NHS as soon as they can find another job.
The good news is that the haemorrhage of staff can be treated. Few people really want to leave their home, their country and their family. And the pull factor to Britain, with its familiar culture, is strong. Most 'things' here in Australia are better: pay, conditions, coffee, weather. But life is not about 'things'. It is about people and culture and the Welsh word 'Cynefin', the place you feel rooted, most at home, where you belong.
The principles of the NHS are as strong as ever, yet the machinery to deliver on these need to be urgently resuscitated. Otherwise, the health service as we know it risks complete destruction.
We are returning to the UK soon, and back to the NHS; to worse conditions, coffee and weather. It is where we belong, where we call home and where our principles lie. I hope when we step back onto our Cynefin, there will be evidence that measures have been taken to ensure that doctors trained in the UK want to continue working in the NHS.
I hope that there will be no more talk of strikes, that junior doctors, and consultants, will be in a place where they no longer feel that they need to strike – and instead feel valued and supported by the system. It is imperative that the UK retains its doctors. Any health service is, after all, completely and utterly reliant on them.
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