More than 300 overworked NHS nurses have died by suicide in just seven years- my predictions made in 1999

I was deeply disturbed to read this article (1) and I am somewhat sickened. The NHS is losing nurses left, right and centre (2). When I was a final year medical student I was interviewed by The Big Issue on this after my research year (3).

They picked up on several of my findings.

· One in five medical students polled said they would resist any legislation to reduce the average hours working claiming they need the extra hours to pay off huge debts accumulated during training.

· One in four young doctors exceed the recommended alcohol limits (21 units for men, 14 for women) Several respondents said they had experienced severe shaking and suffered aural and visual hallucinations

· One in 5 smoked cannabis at least once a month, while one in28 admitted being multiple drug users.

· One in ten had felt they wanted to harm themselves at some point.

· More than one in three said that they would be too afraid to ask for help for mental health problems because they feared it may adversely harm their career.

· Several respondents admitted resorting to prostitution to make ends meet.

The biggest finding was that I predicted then that by 2010 a student with no parental funding would leave university around £35000 in debt. This would lead to graduates not buying houses leading to a recession in the housing industry leading to a recession in the rest of the economy.

Let me explain. After my 4th year of medical school I took a year out to do a research year. My supervisor and I surveyed every medical student at the University of Sheffield. We incorporated a questionnaire from the Big Issue in the North.

Now as the Big Issue in the North reported- we faced a wall of resistance

A draft copy of the questionnaire was sent by email to the level one and two

Co-ordinator, Dr. Warren. He was very impressed with the draft copy.

I updated him later and then on 25 November 1998 he emailed me again.

“I am sure it will provide some useful insights into medical student’s approach and background. It does not surprise me that the GMC are also interested. — I imagine lots of places will also be keen to hear about the results!

“There I no problem about distributing the questionnaire in level 1 and 2 classes during DR Sessions.”

In fact, he spoke to the project supervisor and said that he had no problem with it. The room staff were incredibly helpful.

Level three

At first, Dr. Simon Cross a member of staff responsible for teaching the level three students was asked for permission to distribute the questionnaire in the lecture block that he was chairing. He said that there would be no problem.

Unfortunately the questionnaire was not ready at the time. He advised

formally approaching the chair of the next lecture block Dr. Hampton. He also said that if there was a problem then he would help.

A formal written request was sent to Dr. Hampton enclosing a copy of the questionnaire. He wrote back to me on 7 December 1998 in his letter he said: “I have no objection whatsoever to your distribution of the questionnaires. If I can be of any further assistance then please do not hesitate to contact me.” (6)

Level four

The people responsible for level four engaged in the most debate on the

matter.

At this medical school there are four subjects taught in rotation. These

subjects are Obstetrics and Gynaecology, Paediatrics, Psychiatry and Medicine in the Community.

At first a formal request was sent to Mr. Fraser who I thought was thought to be the undergraduate (UG) course tutor for Obstetrics and Gynaecology. There was no response to the first letter. In response to the second letter he said that there was a new course tutor. Miss Daksha Patel.

Three formal requests were made to this woman. An email was also sent to

her. The postmaster confirmed that this message was delivered and read.

There was never any reply of any sort. A member of staff at the faculty office, Mrs Jacquie Harrison contacted Miss Patel as a favour. There was still no response.

When the questionnaire was ready another formal request was made.

Again there was no reply. In fairness that department is very short staffed and so they may not have had time to respond.

Distribution of the questionnaire was due to take part in the November 1998 lecture-block but it was not ready. Mrs Harrison said that she would be happy to print out address labels and forward them on so long as postage was taken care of.

Psychiatry

The department was not contacted due to Steve Peters and his cronies falsifying my exam results.

Dr. Amanda Howe the course tutor for Medicine in the Community was contacted in September 1998. She agreed to distribute the questionnaire to the medical students as long as she saw it first, which was a very reasonable request.

A hard copy was sent. However in December 1998 she sent the project

supervisor a copy of an email that she sent to Dr. Warren. This email expressed concern that the project was going to be sent to the GMC. It

was suspected that they did not want the GMC to find out about certain

things. Here is a copy of that email.

Dear Alaister

Sushant Varma contacted me in September about the questionnaire he is circulating to the students. He said that he would send me a copy when it was ready, he never did. He hasn’t shown anyone the questionnaire but already seems to have the results.

If the GMC are going to see the results shouldn’t someone say something to him?

Also I understand that this is a guy we have had problems with in the past, especially with exams, I don’t know much about him should we check with Faculty/ Carole. What do you think?

By the way Tuesday was great, must do it again sometime.

Love

Amanda

Paediatrics

At first this department seemed very helpful. No problems were anticipated with this department. This department is known for being very supportive towards students, being very well organised and being very approachable. The undergraduate professor is very highly regarded by the students. The department in fact has an undergraduate office in one of its teaching hospitals as some of the peripheral teaching hospitals that this university employs.

There was one professor who agreed to be interviewed and was extremely helpful.

A formal request for interview was sent to the undergraduate professor, Professor Taylor.

Later the lecturer of paediatrics, Dr. Wright, who had been given the letter, sent an email. He said that he was the person who had the most contact with the students. He was very helpful. He agreed to be interviewed and was happy to distribute the questionnaire to the students in the January lecture block so long as he saw it first. Again this was a reasonable request.

He was sent a draft copy. He then sent an email regarding the contents on 8 December 1998. He was given a draft copy that had to be checked before distribution. All the problems would be dealt with first.

He made comments about the length despite the fact those other universities

have sent longer questionnaires to medical students. Market research

questionnaires are sometimes every bit as long. The recent Consumer

Product Survey has 190 questions and so is comparable in length.

He asked if the questionnaire had been pilot tested and he also raised issues

about the suicidal ideation. The same question on suicide came from a questionnaire that was in “The Big Issue” magazine. The Big Issue has a distribution of around 500,000 people per week. (Question 15. Issue 23–29 November 1998.) The printing firm had just made a few typing errors that had been sorted out.

Clearly the questions that had been incorporated from this questionnaire had

been pilot tested on more people than could have been done in this project.

He also said that he had copied his email to a person with specialist knowledge in gender and race issues in medicine. No reply was ever received from this person.

He sent me an email on 11 December 1998 (8) saying that:

“I gather that there has been a considerable amount of discussion within the medical faculty about your questionnaire of which I was not aware. I understand that it was discussed at the Level 4 Curriculum Committee meeting. Professor Taylor spoke to me yesterday and I gather the consensus was that ethical approval ought to be obtained for the research that you are proposing. As a result Professor Taylor has advised that we shouldn’t distribute the questionnaire until this matter has been resolved.”

Neither I nor the project supervisor was invited to attend this meeting to put a case forward. However, there was no formal response from the medical school itself.

A formal request for an ethical opinion was sent to the BMA ethics division by

fax that afternoon. They said that there was no legal requirement to go

through an ethical committee in their reply.

Legal advice was sought from one of the protection organisations and the adviser said the same thing. The legal adviser said that there must be something else in the questionnaire that the medical school didn’t like. When he was sent a copy he replied by phone. He said that he was not in the least bit surprised that the medical school did not like some of the questions being asked.

A formal approach was made to a lecturer in another university who had a specialist interest in ethics about the ethical content of the questionnaire. This person said that there was no problem.

Both he and the defence organisation adviser strongly advised omitting the name of the University from the dissertation. They said that the medical school staffs were obviously worried that the GMC and the general public were going to find out about certain things.

However a formal submission was sent to the medical ethics board. In their

reply the chair, Dr. Jackson said in his letter of 21 December 1998 (9): “The “Red Book “ which governs which NHS Research Projects come before an Ethics Committee clearly states that all research on NHS patients or taking place on NHS premises must be approved by an Ethics Committee. Unfortunately there is no similar document for University projects to direct as to whether you should formally seek approval from the Ethics Committee.”

The Professor Taylor sent me a letter on 22 December 1998. (10) His letter said:

“I have read the questionnaire with interest and look forward to seeing the

results of your study in due course. However, in accord with the Red Book,

It will be necessary for you to submit your project to the South Sheffield Research ethics committee for approval before the questionnaire can be circulated.”

At the bottom of his letter it said “Cc (The project supervisor.)” Paula, my project supervisor confirmed that she never received a copy of this letter.

In December 1998 Mrs Harrison sent an email saying that she could not do so at that time and would get back in touch on this matter. She never did. As well as that a formal submission was made to the Psychology Department.

Ethics Sub Division. This was a psychology project. The person who gave advice on how to pass the ethics division (Gerry Kent) had previously worked in one of the level four subject departments. (Psychiatry)

On 9th February 1999 the Psychology ethics division passed it (11.)

On 24 February 1999 an email was received from the Professor Taylor in which he said: “Thank you for the copy of the above email. I don’t know who Paschal Sheeran (Chair of the Psychology ethics division) is nor why the Department of Psychology Ethics Sub-Committee should be considering your protocol. You must submit your study to the South Sheffield Research Ethics Committee.”

He even copied this email to Paschal Sheeran!!! (12)

This put me in a very difficult position as Dr. Sheeran was one of the course tutors on one of the modules I was doing.

He clearly did not realise that this was a psychology project and not a medical

project. The medical ethics forms were not appropriate for this study.

About a month later several emails were received. The writers of the emails stated that they had filled in the questionnaire but had been asked

by staff not to do so.

When emails were sent to Dr. Wright subsequently, no replies were

ever received. In fact when subsequent letters were received from the

university medical school it was obvious that they had been written or at least

checked by someone who was legally qualified.

As a result of all this the number of responses to the research was not as high as it could have been.

Several journals, especially the British Medical Journal specify that a response rate must be at least 50% for them to consider a paper. Due to the above this was not possible.

I wrote to the Consultant, Dr. Bridson, at one of the local peripheral hospitals to see if he would be willing to let me spend a few weeks on his firm.

In his reply of 29 March 1999 (13) he said: “We would be able to offer you an attachment here in paediatrics if that would help. I do not think one extra pair of hands would be too much trouble.”

However Professor Taylor wrote to me on 30 March 1999 (14) and said the following in reply to my email to him.

“Thank you for your email requesting permission to spend part of your final year optional attachment in paediatrics at Rotherham or Barnsley District General Hospitals. Both Rotherham and Barnsley will be taking Level 4 paediatrics students next year and these students will be expected to be on call through the week and at the weekends wand will carry the student bleep. I do not feel that it will be fair to these students to allow a 5th year student to share in these opportunities.”

What was I going to do to spoil their chances of learning?

Was Professor Taylor a little bit annoyed?

I got loads of positive reviews about my research including the Big Issue coverage (15–18).

However the Student BMJ asked me to write an article on why I thought students should have their papers back once marked. (18.) To make it more controversial they asked Professor Weetman- dean of Sheffield medical school to write an article on why students should not have their papers back once marked. He demanded to see my article before he wrote his. Was he afraid I was going to tell the public about how Steve Peters and co falsified my exam results?

The ultimate wind up was

Dear Sushant

I have recently taken over the care/rejuvenation and updating of the
pastoral tutorial scheme within the school of medicine at Sheffield
University. I found an e-mail from you on file, in which you refer
to a GMC document outlining its criteria for pastoral support to
medical students. I was wondering if you could tell me if this is
available on the web, or give me an address where I could obtain a
copy from.

You seem to be very well informed on this subject, and to have a lot
of ideas on this topic. I would welcome any advice you can give me.
I would also welcome pointers to other documents on the subject, as
there are plans underway to totally revamp the system, and I would
like the overhauled scheme to meet the GMC recommendations, and most
importantly the needs of all our students.

Also, do you have any advice on how to change the apathetic attitudes
of many of the medical students, and also some of the tutors towards
the scheme?

I look forward to hearing from you

So why is medical staff at higher risk of suicide?

Sadly a member of medical staff will know how to do it!

What puts people at risk of suicide?

Think of the following.

· Middle age

· Male

· Lives alone, either recently separated, divorced or relationship breakdown.

· Unemployed.

· Financial pressures

· Certain high risk professions.

Certain psychiatric conditions

· High alcohol intake

· Illegal drug use

· Schizophrenia

· Depression

· Mania

· Bipolar affective disorder

· Certain neuroses e.g. post-traumatic stress disorder.

· Certain personality disorders.

However in medicine it’s worse for several reasons.

The macho image

“I did it so you do it” is the predominant attitude.

Bullying and harassment.

There is a hierarch in medicine. It goes

· Medical student

· Foundation year 1

· Foundation year 2

· Specialty trainee

· Specialist Registrar

· GP trainee

· Consultant

The consultant has incredible power.

During my research I found a plethora of cases of consultants abusing students and juniors. The worst were the 5 cases of consultants raping students. In each case the consultants told the students if they complained they’d ensure they never qualified. One reason I think students should have their papers back once marked.

I was pleased to see the British Army and US Army make a stand against racism and harassment (20) and (21.) However no medical school or hospital will ever do the same. They’d lose half their staff overnight most of them abuse their power!

Lack of pastoral care

The GMC has 7 criteria for proper pastoral care of students. At the time my medical school did not fulfil one of them! Counsellors after 20 hours of counselling have to see a counsellor themselves. Something similar needs to be brought in for NHS staff. (22)

What can we do?

Well organised good quality medicine is value for money medicine. Ideally a patient should be seen as quickly as possible by the junior on call. The patient reviewed at 7pm and constructive teaching given. The junior let off around 8pm with the nigh time staff to take over. I would ensure that hospitals are super well organised.

Another ward round done at 7am which should be quick given the first 10–15 will be no change etc.

I would start getting GPs to stop referring patients to consultants who abused them as juniors or students.

I would also get students to never see a consultant alone and without a recording device.

I would ensure that students in all disciplines get their papers back once marked so consultants don’t have that power over them.

I would also repeal the abolition of grants and introduction of fees. I would ensure fees are paid for by the government and the students given £1500 per month.

This is why I get all my students on multiple sources of income http://www.doyouwanttobeafulltimemother.com

I predicted this in 1999. What will it take for them to take action?

Resources

If you have been affected by the issues in this article please see your doctor as soon as possible.

A Cry for Help Warning signs of suicide you shouldn’t ignore. http://jamesbondhealthandfitness.fitpromag.com/11/1/2017/Article/Health4/?LinkId=16886015

Bibliography

1. More than 300 overworked NHS nurses have died by suicide in just seven years https://www.mirror.co.uk/news/uk-news/more-300-overworked-nhs-nurses-14822382?fbclid=IwAR2jG46sMOJt3kVsFoiFtbG3ZcsCIzSLLSPioNTKd-0oqYbHmV3k692RjZo#ICID=ios_TMNewsApp_AppShare_Click_FBshare

2. NHS ‘haemorrhaging’ nurses as 33,000 leave each year http://www.bbc.co.uk/news/health-42653542

3. What’s Up Doc Big Issue in the North Kate Markey https://www.dropbox.com/s/0c4l7pr8yufdfzg/whats%20up%20doc.pdf?dl=0 July 1999

4. Big issue Questionnaire Question 15. Issue 23–29 November 1998 https://www.dropbox.com/s/kxjzf6c4l64meaq/big%20issue%20questionnaire.pdf?dl=0

5. Email Alaister Warren 25th November 1998 https://www.dropbox.com/s/ap882f45leu893n/warren.pdf?dl=0

6. Letter Dr Hampton 7th December 1998 https://www.dropbox.com/s/r4as8qg9nx8mcsw/hampton.pdf?dl=0

7. Amanda Howe email 7th December 1998 https://www.dropbox.com/s/k8w904cba3nwdq0/amanda%20howe.pdf?dl=0

8. Neil Wright email https://www.dropbox.com/s/3ahcwks4n1utr61/neil%20wright.pdf?dl=0

9. Letter Medical ethics committee 21 December 1998 https://www.dropbox.com/s/c69b2yz7xswxlia/csuh.pdf?dl=0

10. Letter 22 December 1998 Professor Chris Taylor https://www.dropbox.com/s/88uw4wao5vltmpc/cjtaylor1.pdf?dl=0

11. Pascal Sheeran email 9th February 1999 https://www.dropbox.com/s/8g8vq27n68elhs6/pascal%20sheeran.pdf?dl=0

12. Chris Taylor email 24th February 1999. https://www.dropbox.com/s/80a59ti6tai2fec/cjtaylor2.pdf?dl=0

13. Letter Dr Bridson 29th March 1999 https://www.dropbox.com/s/o4xh2lnmshtzqt7/bridson.pdf?dl=0

14. Letter Professor Taylor 30th March 1999 https://www.dropbox.com/s/o4xh2lnmshtzqt7/bridson.pdf?dl=0

15. BMA letter 15th June 1999 https://www.dropbox.com/s/z97p9ar8fslbtvd/bmajune.pdf?dl=0

16. GMC letter 16th June 1999 https://www.dropbox.com/s/xwhu8jupub5pu6f/gmc%20june.pdf?dl=0

17. Medical Council on Alcoholism https://www.dropbox.com/s/2t14hlnmq9p570h/mca%20june.pdf?dl=0

18. Student British Medical Journal https://www.dropbox.com/s/5gun8526lis6h9h/studentbmj.pdf?dl=0

19. Single dad with just £4.61 took own life after waiting weeks for Universal Credit https://www.mirror.co.uk/news/uk-news/single-dad-just-461-took-18457364?utm_source=facebook.com&utm_medium=social&utm_campaign=sharebar&fbclid=IwAR2HVm4haRodyYHeZ_oWjGlr7g7awJsh3-C3Nb2z6asXGeMY1-rQLnpkSsI

20. News | Army Sergeant Major responds to soldier conviction https://www.youtube.com/watch?v=V1e5q7vidgQ

21. Hear Lt. Gen. Jay Silveria’s full speech about racism at the Air Force Academy https://www.youtube.com/watch?v=mU0RfhvYN8s

22. Make the Difference: Preventing Medical Trainee Suicide https://www.youtube.com/watch?v=I9GRxF9qEBA

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