• New CQC chief inspector asks for professional standards to ensure junior doctors are “protected” from being overloaded with patients
  • Warns staff are leaving the NHS because of its culture and bullying
  • Believes it is the “commitment” of staff that “will get us through this winter”

The Care Quality Commission has asked the medical royal colleges to draw up new “safe workload” standards for junior doctors, amid concerns they are still being given a workload that is unsafe, HSJ can reveal.

The CQC’s new chief inspector of hospitals, Ted Baker, also told HSJ in a wide ranging interview that:

  • Staff were leaving the NHS because of culture problems including bullying
  • The CQC had shifted trust chief executives behaviour from performance management to staff engagement
  • Dedicated staff would get the NHS through winter because NHS services and capacity had not kept pace with demand

Professor Baker said the current pressure on some juniors was “just not good enough”, and that he had asked the colleges to produce standards on an “acceptable safe workload for a junior doctor in different specialities”.

Professor Baker is a paediatrician and was medical director and deputy chief executive of Oxford University Hospitals Trust from 2010 to 2014.

He said: “When I was a junior doctor I remember some particularly horrendous nights on call, weekends on call, where we were understaffed and you were just running round in circles trying to manage the patient load.

“For me now in my career to be seeing that still going on in hospitals 40 years later, it is really just not good enough. We need to make sure that junior doctors are protected from being put in that position.”

Professor Baker said that clear standards were needed so “it is not just down to the CQC inspector to determine how many patients each doctor should be in charge of”.

He said: ”What I have asked the royal colleges, the medical royal colleges, is to actually look at producing standards for what is an acceptable safe workload for a junior doctor in different specialities. The system needs to come up with some standards which we can then make sure are supplied.”

He acknowledged that implementing the new rules “will be a challenge for trusts” but said it was important the CQC “start speaking out” about the issue.

Any increased overall demand for junior doctors would also be hard to meet, amid shortages and rota gaps.

Professor Baker took over the post from Professor Sir Mike Richards at the end of August, having previously been his deputy. He said workforce was one of his top priorities, and was “the biggest problem the NHS faces at the moment”.

This included the pressure on staff and working culture, he said pointing out that nearly a quarter of NHS staff report feeling bullied at work. This was a “reflection of the culture in the NHS”, he said, and added: “We are losing staff because the cultures they work in are too difficult.”

He said the CQC’s work could help shape and improve the culture by looking at leadership and engagement and by encouraging openness and honesty.

He said: “It is very clear hierarchical management in the NHS can have negative effects on staff wellbeing, that is something we need to tackle…

“One of the things that changed, when I was in hospital management, [was] that talk about running a trust effectively was about getting a grip, which focused on the performance management side of management.

“Our inspections following the Francis report has put the focus of management much more onto leadership culture, staff engagement, and onto values – that is fundamentally changed.

“Talking to chief execs now I am impressed by how much their discussion is not about meeting this performance target or that, it is about how do I engage my staff, how do we inspire them, how do we demonstrate the values we should be demonstrating…

“I really encourage chief execs who haven’t got that message yet to read our report on what drives improvement in trusts.”

Professor Baker said the NHS would be relying on the “dedication and commitment” of staff to get through this winter.

“The only reason why the system keeps going is that the staff put in a huge amount of commitment to keep it going,” he said. “It is the dedication and commitment of our frontline staff that makes the system work and that is what will get us through this winter as much as anything.”

He said part of the reason was services had capacity had not kept pace with growing demand, nor services been changed to meet it.

“I was having the same discussions five, six, seven years ago when I was medical director in Oxford, saying ‘the system is just getting progressively worse and something has got to change’ and the answer is here we are and it hasn’t changed.

“There has been some change, but it has not changed nearly enough and the system has just got more and more pressurised.”



Exclusive: CQC plans rules on 'safe workload' for junior doctors