Aneurin Bevan health board: Trainee doctors 'scared to come to work'

Some trainee doctors and consultants at one Welsh health board are "scared to come to work", a report has found.

A report by the Royal College of Physicians (RCP) described "frightening experiences" staff faced at Aneurin Bevan University Health Board.

Chronic understaffing and excessive workloads at the Grange hospital in Cwmbran were causing "very serious patient safety concerns", it added.

The Health Board said it had taken the findings of the report very seriously.

The report, obtained by BBC Wales, said that some trainee doctors and consultants were worried about working in case they lost their licence to practise.

It also said the problems had caused some consultants to feel demoralised and on the brink of leaving.

Dr Olwen Williams, Wales' vice president of the Royal College of Physicians, said: "This was a difficult visit, with some powerful testimony.

"The new clinical model sees both the workforce and patients moving between multiple sites. Where three hospitals once struggled with recruitment, now there are four sites with rota gaps."

Critical care and specialist services at the Royal Gwent and Nevill Hall hospitals, in Newport and Abergavenny respectively, were centralised at the £358m Grange University Hospital last year.

However, the report noted a gap in general medicine at the hospital, meaning older patients and those with more complex general medical needs - which do not fall under specialist care - can sometimes fall between the gaps.

The report said the issues were not limited to care at the Grange, as the other hospitals within the health board area - the Royal Gwent, Nevill Hall and Ysbyty Ystrad Fawr in Caerphilly - have minor injury units but no emergency department, leaving them with limited diagnostics and technology.

One trainee told the authors of the report: "On one overnight shift, I treated a four-year-old with seizures. The ambulance took six hours.

"Colleagues treated an 18-month-old with burns. Lots of kids come in with respiratory distress. Paediatric cases are not uncommon.

"We've treated stabbing victims. Colleagues delivered a baby earlier in the minor injuries unit. These things shouldn't happen at all."

Another trainee said: "There's so much patient movement with [this] model. I recently sent someone from Nevill Hall to the Grange to get a scan, then to the [Royal] Gwent to get a follow-up procedure, then back to Nevill Hall.

"That's three bed moves, three ambulance crews and three medical people dealing with the same patient. It's extremely inefficient."

Another said: "We've got patients who have been moved eight times between different hospitals and wards. These are 90-year-old patients with dementia."

And another added: "I worry about the safety of the patients coming into this hospital."

The report said "almost all trainees" the authors had spoken to told them they would not want to return to work at the health board.

A number of staff said they had made repeated attempts to raise the concerns with management before the Grange was opened.

"Around 60 doctors wrote a letter to the chief executive, but they just weren't listening," said a consultant physician.

"There was this almighty push to open the Grange come hell or high water. It was complete madness."

In June, more than 30 consultants and about 50 trainees and physician associates joined a virtual visit by RCP members.

Consultants have also requested private meetings with the RCP to discuss their concerns - it is claimed some fear speaking up, have been accused of whistleblowing or are on the verge of leaving the health board.

However, the RCP said it has also been told some things have begun to improve since their visit, with one trainee describing the meeting as a turning point.

Andrew Goddard, RCP president, said: "During our virtual visit some trainees told us that they were scared to come to work, in case they lose their GMC [General Medical Council] number.

"In my eight years at the Royal College of Physicians I've visited hundreds of different hospitals - and I had never heard that before."

The report referred to "high anxiety about unsafe working and the potential for patient harm".

One trainee told the report's authors: "We were projected to cover 190 beds, but we were covering 300 and 400 medical beds. Those numbers still haven't come down."

Another said: "I think a lot of people are afraid of losing their GMC number, because at some point, something bad is going to happen. It won't have anything to do with your abilities as a doctor, it's just your bad luck if you're on that shift."

As a university hospital, trainees are expected to attend outpatient clinics, but as those are based at other hospitals, the understaffing issue at the Grange means many say they cannot attend.

Dr James Calvert, medical director for Aneurin Bevan University Health Board, said it is important to remember the report was made during the pandemic, "which has significantly disrupted the delivery of our health services".

He said the health board was working to ensure the right staff are available to deal with "really difficult situations" so those who are training do not have to cope with the "significant emotional" toll of them.

Dr Calvert said staff shortages were being addressed, adding interviews for 21 junior doctor positions would start this week.

"We are listening to our staff to ensure the best service to patients, whilst also maintaining the wellbeing of our clinical teams," he added.