A neurosurgeon alleged during his employment tribunal that a “gang culture” exists within the neurosurgery department of an NHS hospital already beset by claims of a toxic culture and investigations into negligence.
As reported by the BBC, Dr Mansoor Foroughi was dismissed from University Hospitals Sussex in 2022 for misconduct. At a separate employment tribunal, Krish Singh, the former clinical director for general surgery, claimed that rota changes reduced the number of “safe” consultants, putting patients at risk.
Four whistleblowers had also told the BBC of a “Mafia-like” culture, where patients had died unnecessarily and others “maimed”. These new allegations came to light as the BBC and The Times fought a nine-month court battle to have the employment tribunal documents unsealed.
Dr Foroughi alleges that one colleague was signed off to do complex spinal procedures despite lacking training, another performed procedures with a “disproportionate” mortality rate, and yet another took on private work while on call to the NHS – a serious breach of conduct.
University Hospital Sussex encompasses several hospitals, which includes Royal Sussex Country Hospital, which has been the source of many complaints, and a history of poor service delivery, which was put into special measures between 2016 and 2019.
At least 105 cases of alleged medical negligence from failings at the hospital’s neurosurgery and general surgery departments are being investigated by police. According to court documents, there was “serious dysfunctionality in the neurosurgery department” with “stark divisions between colleagues”.
An investigation by the Royal College of Surgeons found that “a culture of fear” existed in the hospital’s surgery department, and that senior staff were “dismissive and disrespectful”. Two staff were allegedly assaulted.
In a statement, the trust said: “The trust will vigorously contest these claims at the Employment Tribunals, which we are keen take place at the earliest opportunity so they can be examined properly and fairly.
“Dismissing anyone, or removing someone from a leadership role, is an absolute last resort and we would always seek to avoid this outcome if possible.
“In both of these cases, due process was followed, and we are confident we did the right things, in the right way, for the benefit of our patients, their care and safety.”
Work stress, high workload, and understaffing are the primary factors driving health professionals out of the NHS, suggest the results of a survey published in the open access journal BMJ Open.
The findings prompt the researchers to suggest that pay increases alone may not be sufficient to fix NHS staff retention. The NHS is short of well over 100 000 staff and fallout from COVID-19 has seen worsening retention.
The researchers investigated the ‘push’ factors behind decisions to leave the NHS, and whether these were ranked differently by profession and NHS setting, a year after exposure to the effects of the pandemic.
In 2021, NHS health professionals completed an online survey to determine the relative importance they gave to 8 factors as the key reasons for leaving NHS employment.
The respondents included 227 doctors; 687 nurses/midwives; 384 healthcare assistants and other nursing support staff; 417 allied health professionals, such as physiotherapists and occupational therapists; and 243 paramedics from acute, mental health, community, and ambulance services.
Using the paired comparison technique, whereby two push factors at a time were presented at a time, respondents were asked: ‘Which of these two factors is the bigger influence on why staff in your profession/job role leave the NHS’?’
Compared to other professions, paramedics gave a much higher relative weighting to work stress, work-life balance, work intensity and pay higher relative weighting.
The factors compared were: staffing levels; working hours; mental health/stress; pay; time pressure; recognition of contribution; workload intensity; and work–life balance.
Compared to other professions, paramedics gave a much higher relative weighting to work stress, work-life balance, work intensity and pay higher relative weighting. Paramedics also ranked work-life balance as a stronger driver to leave the NHS. They ranked this second compared to a fourth or fifth ranking across the other professions.
Pay was considered more important by healthcare assistants and other nursing support staff and paramedics, but was generally ranked fourth or fifth by other professional groups.
This contrasts with “some contemporary media and industrial relations accounts, and some academic research findings,” say the researchers, who nevertheless add: “While other variables appear to exert a stronger push than pay, this is not grounds to diminish it as a potential source of dissatisfaction in absolute terms.”
Overall, health professionals ranked work-related stress, workload intensity, and staffing levels as the primary ‘push factors’ underpinning decisions to leave the NHS. Recognition of effort and working hours were ranked lowest. But there were differences in the order of importance and relative weighting given to the push factors among the different health professions.
Work intensity in acute care hospitals and community services; time pressure in community services; and recognition of effort in mental health services were given higher relative weightings.
“In common with the NHS annual staff survey and all other voluntary participation employee surveys, the potential for self-selection response bias cannot be discounted,” emphasise the researchers.
But they conclude: “Excepting paramedics, rankings of leave variables across the different health professional families exhibit a high degree of alignment, at the ordinal level, and highlight the primacy of psychological stress, staff shortages, and work intensity.”
They add: “While increases in pay are transparently important to NHS staff, findings from this research suggest that enhancements in that domain alone may produce a modest impact on retention.
“An equivalent conclusion might be drawn with respect to the current high-profile emphasis on increased access to flexible working hours as a solution within contemporary NHS staff retention guidance to employers.
“Both have potential to do good, but there are grounds for inferring there is a risk that neither may deliver sufficient good to redress the high and rising exodus in the absence of attention to what present as more fundamental factors driving exit.”
South Africa is not the only country faced with a flight of doctors over working conditions. According to a survey of UK medical students published by BMJ Open, one in three plan to leave the National Health Service (NHS) – either to practise abroad or to stop practising medicine entirely. Of those who plan to go abroad, nearly half plan on never returning.
The responses indicate that pay, work-life balance, and working conditions are the key drivers behind the decisions to leave.
The UK has 3.2 doctors for every 1000 people, ranking 25th among the Organisation for Economic Co-operation and Development (OECD) countries. This figure also represents the lowest number of doctors per head among European countries in the OECD, note the researchers.
In response to the shortage of doctors amid rising healthcare demand, the British government has opened new medical schools and expanded the student capacity of existing ones. But without addressing the issue of retention, increasing the number of medical students is unlikely to provide a sustainable long-term solution, they point out.
In a bid to understand current career intentions after graduation and on completion of the 2-year Foundation Programme, the researchers surveyed 10 486 medical students, around 25.5% of the total, from across 44 UK medical schools between January and March 2023.
The survey included sections on intended career immediately after graduation and after foundation training (if applicable), as well as the factors influencing decision-making.
Respondents’ average age was 22; around two thirds (66.5%) were women. All students were asked their career intentions after graduation with most (8806; 84%) saying they planned to complete both years of the UK’s foundation training after graduating.
But around 1 in 10 (10.5%;1101) intended to complete year 1 of foundation training and then emigrate to practise medicine: completion of the first year of foundation training provides doctors with full registration with the UK’s medical regulator (GMC), which is recognised internationally.
Another over 2% (220) planned to emigrate to practise medicine immediately after graduation while just over 1% (123) intended to take a break or undertake further study.
Just over 1% of respondents (132) planned to complete their first foundation year and then leave the profession, while just under 1% (104) intended to leave medicine permanently immediately after graduation.
Among the 8806 respondents intending to complete both foundation years, nearly half (49%;4294) planned to enter specialty training in the UK immediately afterwards.
Around a fifth (21%;1859) intended to enter a ‘non-training’ clinical job in the UK such as junior clinical fellowship or clinical teaching fellowship, or working as a locum doctor).
A further 23.5% (2071) intended to emigrate to practise medicine abroad, while around 6% (515) planned to take a break or undertake further study. Just 67 planned to leave medicine permanently after completion of year 2 of foundation training.
Around half (49.5%;1681) planned to return to UK medicine after a few years, while nearly 8% (267) intended to return after completion of their medical training abroad. But 42.5% (1444) indicated no intention to return.
Of those favouring emigration immediately after graduation, just under 81% didn’t intend to return to the UK. This fell to 60% (661) among those planning to emigrate after completing year 1 of foundation training and 29% (605) among those planning to emigrate after year 2.
Among the 2543 medical students expressing a preference for destination country, Australia was the most commonly mentioned (42.5%), followed by New Zealand (18%), the USA (10.4%) and Canada (10.3%).
In total, around a third of medical students (32.5%;3392) plan to leave the NHS within 2 years of graduating, either to practise abroad or to pursue other careers.
Remuneration at junior level, work-life balance, lack of autonomy over choice of training location, and the working conditions of doctors in the NHS were cited as the most important factors for those respondents intending to emigrate to continue their medical career.
These reasons were also given by those planning to abandon medicine altogether, with nearly 82% of them also listing burnout as an important or very important reason.
Only just over 17% of all respondents said they were satisfied or very satisfied with the overall prospect of working in the NHS.
Intention doesn’t necessarily translate into action, and minds may change, say the researchers. And while the 25% response rate is relatively large, that still means a substantial proportion of the medical student body weren’t surveyed.
But they highlight: “This study highlights that an alarming proportion of surveyed medical students intend to leave the profession or emigrate to practise medicine,” emphasise the researchers, “representing a potential loss of valuable medical talent.”
They continue: “The findings of this study emphasise the urgency of addressing the factors that are driving the exodus of doctors from the NHS and suggest that increased recruitment of medical students may not provide an adequate solution to staffing challenges.
“The causes of the problem are complex, and finding a solution will require a multifaceted approach. Steps could include improving work-life balance, increasing salaries, addressing the growing competition for specialty training posts and promoting greater flexibility in career pathways.”
They conclude: “Undoubtedly, the continued loss of skilled professionals from the NHS represents a significant concern, so it is critical to consider means of reversing this trend.”
