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‘Insecure’ junior medics ‘crying every day’ in ‘chaotic’ department

Published on: 24 Aug 2023

Delays in patient care and a lack of consultant support have left junior medics fearing for their mental health, an NHS England investigation has discovered.

Junior doctors described haematology services delivered from University Hospitals Birmingham’s Heartlands Hospital as “chaotic”.

Their concerns are raised in a report by NHS England Workforce, Training and Education (formerly Health Education England). UHB’s haematology service has been under scrutiny since 2021, when HSJ revealed whistleblower concerns over patient safety, including a series of blood transfusion’ never’ events.

The WTE team visited UHB in April. As a result, the haematology service is now subject to the General Medical Council’s enhanced monitoring regime. This means intensive support is given to trainees and the trust to improve medical training. UHB’s obstetrics and gynaecology department is also under enhanced monitoring.

Another recent investigation into patient safety at UHB recommended a proper assessment of the integration of haematology departments at Heartlands and Queen Elizabeth Hospital following the Heart of England merger in 2018, widely considered a catalyst for problems. Report author Mike Bewick also recommended an external review of the blood transfusion never events and deaths in the department after an internal investigation by a whistleblowing consultant resulted in no action.

Patient care affected

The WTE report warns that consultants working across multiple sites left trainee medics at Heartlands without sufficient support and supervision. Most conversations with consultants were via telephone, leaving juniors feeling “unsupported and insecure”. 

The report stated: “Trainees described the workload … as chaotic and some reported the stress … was affecting their mental health…

“Some reported they do not feel valued, and the panel heard examples of people crying every day. Most described their roles as 100 per cent service provision… [they] reported very limited learning opportunities overall.”

Trainees working at Heartlands also reported that a lack of on-site support was leading to delays in patient care. There were often no consultants available to review blood films in the laboratory when required. A limited number of beds at the trust’s main QEH site was also causing slow transfer of patients from Heartlands, the junior medics added.

The report also flags a lack of access to the emergency haematology medication hydroxycarbamide and a shortage of specialist nursing care at the Heartlands site which, when coupled with slow transfers to QEH, risked no specialist care being available to haematology patients.

None of the trainees the panel met with said they would recommend Heartlands Hospital as a place to train, with most also not recommending the department as a place for patient care. However, their experience was in stark contrast to that of trainees working at the trust’s QEH site, who praised support received from consultants and felt “valued and listened to”.

The WTE team told UHB they must monitor the transfer of patients from Heartlands to QEH, ensure minimum consultant presence at Heartlands at least five, and preferably seven, days per week, and provide “robust assurance” that the environment at Heartlands is suitable for trainee placements.

Professor Colin Melville, GMC director for education and standards, said: “We’ll keep working closely with NHS England Midlands WTE to make sure an improvement plan is implemented, and we will check that progress is being made to ensure a safe, supportive, and sustainable training environment.”

A UHB spokesman added: ”The trust is committed to enhancing the experience of all its doctors by removing unwarranted variation across their teaching and learning opportunities, and raising the quality of their pastoral, welfare and senior support.”