My reasons for striking.

I’m an oncologist and I love my job. I like to think that, for the most part, I’m good at my job. I never thought I would strike and it’s been a tough decision to do so. But I believe I have no choice.

I’m striking because I know first-hand that the NHS is failing our patients with cancer. I’m striking because I know first-hand that the NHS is failing its workforce.

I’m striking because each week in our multidisciplinary team meetings we are referred patients with advanced cancer that could and should have been diagnosed months before.

I’m striking because in 2022, in 97% of cancer centres, patients’ treatment was delayed because of staff shortages; in 50% of centres delays were happening most months or every month1. This is not acceptable. People whose treatment for cancer is delayed by even one month have 6 to 13% higher risk of dying and this risk keeps rising the longer their treatment does not begin2.

I’m striking because the current wait for an ‘urgent’ CT in my hospital is >50 days. The UK now has a 29% shortfall of clinical radiologists1. This means our scans are sent elsewhere, often abroad, for reporting with delayed, overpriced and often inadequate reports. Across the UK, health systems spent £223 million on managing excess reporting demand in 20221; this amount of money would have funded 2309 full-time consultants.

I’m striking because this means that every week, I must apologise to patients because the scan they’ve had to monitor their cancer two, sometimes even three months ago is still not reported.

I’m striking because this means that if I think someone’s cancer is progressing, it’s likely to be several weeks before I can tell them this.

I’m striking because this means each week before clinic, I must ask our over-worked radiologist colleagues to ask if they can magic time from nowhere to report the scans for the patients on clinic this week.

I’m striking because this means that we do miss cancers progressing; we do wrongly continue treatments that aren’t working; we do put ourselves and our patients at risk by trying to interpret scans ourselves. And I’m striking because each week that a scan is not reported is a week that a patient must spend anxiously wondering whether their life will be changed by the report.

I’m striking because so many of our workforce are burnt-out. The pressures of working in an overstretched service, balancing impossible demands, apologising for a failing system and knowing that, despite our best efforts, we’re not delivering our patients the service they deserve is soul destroying. Few of us have the headspace, time or willpower to even think about service improvements. In 2022, because of current working conditions, more than 75% of clinical oncologists and radiologists who left the NHS were under 601. They can do this because they didn’t start their career with huge debts and because, as junior doctors and early consultants they were paid well. They wouldn’t do this if they were working in an environment where they could still love their job.

I’m striking because, while new drugs get approved, the capacity to deliver and monitor them is not funded. We don’t have spare chairs in chemo clinics. We don’t have spare rooms in outpatients. We don’t have spare pharmacists to dispense the drugs. We don’t have spare oncologists to prescribe the drugs. We don’t have the imaging capacity to monitor the drugs.

I’m striking because in 2021 the NHS in England paid £3billion to hire staff from agencies to cover gaps on the ward3. I’m striking because I could earn twice as much as a locum as I do in a permanent post. I’m striking because right now for many in the NHS, when the benefits of substantive posts are so low, money is a motivating factor. If the NHS paid and nurtured their staff better, much less NHS funding would go towards paying recruitment agencies billions of pounds.

I’m striking because I used to love teaching medical students yet, right now, when they turn up in clinic my heart sinks because I wonder how I’m meant to give them the time they need and deserve when we’re already running behind. I’m striking because these medical students will qualify with an average of £50-90k debt yet will start on a salary less than that available to people working in some supermarkets and cafes. I’m striking because these medical students know that they will be working nights and weekends, will be moved around the country at short notice, will rarely feel part of a team and yet despite this, unless they have rich parents, will not have financial security for years.

I’m striking because I work in a system where it’s not normal to take time to eat lunch. I’m striking because I work in a system where there’s no time to process the emotions of breaking bad news. I’m striking because I’m working in a system where we’re expected to be robots and so often, we take the brunt of patients’ entirely justified anger at the failing system.

The NHS is made up of outstanding, caring people in a broken system. When Steve Barclay tells us its ‘time to put patient’s first’ it shows he has absolutely no idea that this is what health care professionals do every day. We fight for our patients in an impossible situation, and we take the pressures of doing this home with us.

I’m striking because I have a voice and I need to use it. Rishi Sunak, who was a student at Oxford at the same time as me, thinks he doesn’t need to listen, but I hope others will.

Previous musings from 2021:

1 RCR 2022 workforce census report.

2 BMJ 2020;371:m4087


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