'If contract for junior doctors is imposed in England, then it will almost certainly be imposed in Northern Ireland'
Dr Michael Moran (36), a leading figure in the campaign on working conditions, tells Lisa Smyth why he has swapped Northern Ireland for London and why the strike by junior doctors could soon land on our doorstep.
Q. What is your current grade and your specialty?
A. To complicate things, I have two job titles, depending on my work context. I am a clinical lecturer at University College London and an ear, nose and throat (ENT) specialty registrar (level ST6) at UCL Hospitals.
This means I have a research contract with the university alongside my work as an ENT surgical registrar. I have just over two years to go until I complete my training and become eligible to become a consultant.
Q. How long has it taken to get to this stage?
A. I qualified in 2004, so it has taken me 12 years to get here, and I still have two more to go as a junior doctor.
ENT is a fascinating and varied specialty, and I work with patients of all ages. ENT surgery is very technologically advanced, and many of our operations involve microscopes, endoscopes, hearing implants and other gadgets.
Lots of our work is non-surgical, and we often perform one-off procedures in the outpatient clinic. The throughput is very fast, so a day at work usually doesn't involve much hanging around.
Q. How do hospitals in NI compare with other countries?
A. The health service here provides great care and is built on the goodwill and friendliness of staff. The most impressive system I have seen was in Australia, where all hospital and primary care IT systems in Western Australia were integrated. There were also innovative approaches to staffing, with extra doctors in the system to always ensure seamless clinical handover and cover for leave.
They have extra doctors, so if they need 40 doctors they would employ 45. It means if you have a heavy week one week, you can get a lighter week the next week, which means a really good work/life balance.
Medical records were neat and organised, and access to diagnostic tests was fantastic. It just works over there. It seems much more well-oiled.
Q. Why should people here pay attention to the junior doctor contract dispute between Jeremy Hunt and doctors in England?
A. The way that the Government has handled the contract negotiation has been terrible, and it is most worrying that the voices of the junior doctors, as well as other health professionals, patients and members of the public, are not being listened to.
England is on the brink of a workforce crisis in the NHS, and many doctors I know are applying for jobs in Scotland, Wales or further afield in countries like Australia.
If the contract is imposed in England, it is almost certain that it is going to be imposed in Northern Ireland. If it is imposed in August 2016, I think we would be looking at it being introduced here in 2017.
Q. Would that result in doctors here taking industrial action?
A. We have a devolved government in Northern Ireland, so I would like to think we could avoid industrial action by both sides talking to each other. The industrial action in England has been a last resort. We need to learn from the mistakes that have been made there.
Q. Do you think it likely that a compromise will be found soon?
A. I don't see an agreement without some kind of stand-off by both sides. The Government is still talking about imposition, so I think there is going to be unrest. I'm not sure we will see the Government negotiate until there is a Cabinet reshuffle.
I have spoken to some of the HR departments in health trusts and they don't really know how the system will work if imposition goes ahead. If they want to run theatre lists on a Saturday, they are going to need all the support staff, such as nurses, porters, domestic staff, in working as well. It's not just about the doctors. That means they are going to have to find more money to pay for that.
Don't forget, if I am in doing a list on a Saturday or Sunday, I am going to have to take a day off in the week, which means services are going to suffer. It's like robbing Peter to pay Paul.
They are talking about trying to run a seven-day week with the same number of staff, which I don't think is possible. They're going to have to come up with more resources or it won't work.
Q. Can you explain why doctors believe the new contract is unsafe?
A. The concerns relate to the removal of requirements for rest breaks, and also the removal of pay penalties applied to health trusts if they roster their doctors for excessively long hours.
These penalties have incentivised trusts to redesign rotas to allow adequate rests during and between shifts, but the new contract has worrying work patterns. These involve a mixture of day and night shifts in the same week, listing a day after a night shift as 'off', when the doctor would have worked eight hours on that day since midnight.
Doctors love their work, and want to be able to take care of patients safely. We're so disappointed that there has not been a stronger defence of our working hour caps because we feel that our job is really important. We wouldn't board a plane with a tired pilot, wouldn't want to drive along the motorway beside a HGV driver who is drowsy, so why should it be acceptable for the same restrictions not to apply to those who make complex medical decisions?
We want to help the public, our patients, but we need the public to help us win this fight. The contract is not safe for patients, and therefore our duty of care dictates that we must not accept it, until we are sure it is safe to do so.
Q. Do you believe it is possible for the health service here to operate full services seven days a week?
A. Everything is possible, but these things cost money and we must consider how public money should be spent. If the Northern Irish health service is to operate full services every day, it will need significant investment, and this money would likely deprive another vital public service, such as education.
We need to acknowledge that if resources are finite, compromises have to be made. Yes, waiting lists for outpatient appointments may be long, but at the same time, if you have a genuine emergency in Northern Ireland, you will be treated immediately.
Q. Would it help doctors here if our health minister gave a commitment to not impose the contract?
A. This point is key. Northern Ireland has a real opportunity to follow Scotland and Wales, as they have both said they will not impose the contract. But more than that, it has a chance to lead the way. If the Department of Health, Social Services and Public Safety rejected the contract and actively sought to define a new one, we could lead the way and provide a solution to the problem in England, which does not look like it will be resolved any time soon.
I'm worried that because the Assembly is influenced by Westminster, it will be difficult for the health minister here to have the courage to do what works best for the people of Northern Ireland.
Northern Ireland has already lost many doctors to other countries. This is not a new pattern, and I worked for a year in Australia myself in 2005. The worrying aspect is the lack of desire to return, and from discussions with those who are away, there is concern around the ambiguity in Northern Ireland about the junior doctor contract.
Q. There is much talk about doctors leaving the UK, with the junior doctor contract and working conditions both cited as contributing factors. How big is the problem?
A. Doctors here who have families and are midway through career pathways are unlikely to move in the event of contract imposition in Northern Ireland, but we should be very concerned about a brain drain of our newly qualified doctors and medical students, who have not yet committed to life in Northern Ireland.
In recent years, the number of applications to specialist training programmes has notably dropped, not just in Northern Ireland, but also across the UK, and this is a worry.
Doctors, especially GPs are retiring at an earlier age also, and therefore we could face a workforce mismatch in the near future, with consultant and GP places unfilled, let alone junior doctor rota gaps.
At an operational level, rota gaps that already exist lead to a very stressed and demoralised workforce, and one that is at risk of burnout.
Work as a doctor finishes when patients are sorted out and the next person comes to take over a shift, not at any given time. What happens when no one comes to take over at night?
To go back to the flight analogy, a commercial airline would not take off with only one pilot and one cabin crew member, and we would support this.
Why then, is this not a non-negotiable standard for healthcare professionals, who look after us, and our loved ones, when ill?
Q. What can be done to address waiting times in hospitals here?
A. A key factor here is that in cutting waiting times, corners are not cut also. This comes down to resources, both in terms of finance and workforce.
I have worked in great NHS units in Northern Ireland that take a very proactive approach to tackling waiting lists by scheduling extra activity at the weekend or in the evenings. The staff who cover these sessions do so voluntarily and for a premium overtime payment or time off in lieu. This model keeps the paper trail that goes with clinical care within the NHS system, and it works well.
It is costly, but then perhaps demonstrating excess costs in contexts like these to budget holders may mean bolstering of core staff, such as the appointment of another consultant, which then supports the system and may help in the longer term to keep waiting lists shorter. There is no easy solution to this one, and certainly none that does not incur significant costs.
Q. What has been the high point in your career?
A. The high points in my career are the days when you feel that you have made a difference, even if small, to someone's day or health experience. The people you meet every day are what make a career in medicine amazing.
Patients, their loved ones, surgical trainers, fellow doctors, nurses, health care assistants, other health professionals, administration staff, ancillary staff - everyone who adds a piece of the puzzle that is health care. The miracles and joys of the career are hidden in the everyday, and not much is achieved apart from as a team.
Q. And what about the low points since you started out?
A. In January last year I had applied for an Irish Fulbright Scholarship and missed out on this great opportunity to work at Harvard at the interview stage.
This came at a really difficult time in my career, and so the impact of this was really significant. Looking at this from a wider perspective, I realised that I was very lucky to have even come close, and that what I did after the failure would be much more important and formative. I am happy providence had other plans for me, and I have so much in my life to be grateful for. And as someone said at the time, Harvard will always be there.
Q. What piece of advice would you give to the next health minister?
A. I suppose it would be to encourage them to make the changes recommended by the independent reviews.
There is always the chance the new minister may not be from the DUP and may be minded to conduct their own reviews.
But it is important to remember there have been so many independent reviews that have said the same thing.
There are difficult decisions to make that may be difficult politically, such as the closure of hospitals, but I think they are necessary. There are hospitals that are difficult to staff and we need to rationalise services.
Ultimately, people have to be realistic if funding isn't going to be massively increased. Decisions need to be made on evidence as opposed to emotion.
Q. Why have you become so involved in the drive against the contract?
A. The campaign against the contract feels like a natural extension of my day-to-day work. It is helping and protecting patients, but just not on a one to one level in hospital.
I am someone who always stands up for what is right, and cannot sit on my hands if something needs to be done.
Whilst I have been inert at other contract changes, such as pension reform, which really only has a financial impact but does not impact on patient care, this one made me sit up and take notice.
Q. If the contract is so bad, why have you moved to England, where you will almost certainly work under the new contract in August?
A. At the end of the day, a job in medicine remains a vocation for me. The position that I have taken in London is a fantastic opportunity that superseded the contract imposition issue.
It should enable me to build on the excellent surgical training that I received in Northern Ireland, and also develop my research career in a world-class university. In any case, I am confident that the junior doctors' contract is a battle that we will win.