Could better HR save the NHS?

Doctor turned author adam kay tells HR magazine about the unique challenges facing NHS staff and their employers, and offers some solutions

I missed what the argument was about, but a woman storms out of gynae outpatients screaming at the clinic sister, ‘I pay your salary! I pay your salary!’ The sister yells back, ‘Can I have a raise then?’

This is the entry for Tuesday 10 October 2006 in This Is Going To Hurt: Secret Diaries of a Junior Doctor, the first book from obstetrician turned comedian and author Adam Kay.

The book includes tales of 97-hour working weeks… of working so much (unpaid) overtime that the hospital parking meter earns a higher hourly rate; and of being so exhausted that Kay woke up in his car after a Christmas Eve shift only to head straight back onto the ward for the Christmas morning shift.

As funny and heartwarming as Kay’s diarised accounts of work on the wards are, they offer some stark warnings for HR leaders – both inside and outside of the NHS – about the dangers of stretching employees too thin.

HR magazine caught up with Kay at Robertson Cooper’s 2019 Good Day at Work Conversation, ahead of the publication of his aptly-named second book Twas the Nightshift Before Christmas, which gives a peek behind the blue curtain over the festive season.

We quizzed Kay on the unique wellbeing challenges NHS employers and HR must rise to, and asked him what the solution might be…

Work/life balance

In most occupations, employees can draw a line under a particularly hectic working day with the old cliché ‘it’s not life or death’. But not so, of course, in the medical profession. “Because it’s life and death the job comes first, so work/life balance is a laughable concept. Work ends up defining your life,” Kay tells HR magazine.

And as shocking staff being responsible for saving lives and performing complex operations on barely any sleep is, Kay is keen to also emphasise the personal impact that poor work/life balance has on staff.

“It’s not a particularly relaxing job being a doctor, but you go into it knowing that,” he says. “Everyone knows the hours are long, but I wanted to get across the other stuff that people don’t realise – that it’s more than just the hours.

“Of the seven Christmases I was qualified as an obstetrician on a labour ward, I worked six of them. Because babies don’t care if it’s 25 December or 25 March, so there has to still be people there.

“So you miss out on all these things – it’s missing your friend’s 30th birthday or it’s being late for your own because there’s an emergency so you have to stay. That has a big effect on your life.”


Unsurprisingly, this all takes its toll on the wellbeing of the workforce. Then there is the trauma, death and bad news that are all part and parcel of the day job. Kay cautions that mental health issues are a major problem – fuelled further by cultural challenges.

“There’s a stiff upper lip, almost militaristic culture, that ‘you’re a bloody doctor, you can bloody well get on with it’ and that’s what the training says,” he explains. “People aren’t encouraged to open up to their bosses or colleagues or even when they get home, so you’re dealing with all that yourself.

“It’s a roll of the dice what support is there for you in any particular hospital, so it’s not standardised across the board. If they can standardise the typography on the signage so it’s the same across all of the NHS, you’d think they’d be able to standardise resources for the people that need them.”

Kay knows only too well the impact of inadequate support, having left the profession after a particularly traumatic experience on the labour ward, where unexpected complications during labour meant a baby died and a mother ended up in intensive care.

He continued as a doctor for some time “not really dealing with it” and with little more than the rest of that shift off, before walking away from the profession for good.

“There was a sliding doors version of events where I was able to continue in the job and it didn’t have the ending it did. But for that to have happened there would have had to be a markedly different level of support,” he says.

“I’m not the only person who has had a rough day at work and has not had the support needed to keep going.”

Kay says it is “relatively rare to have a big disaster”, however, with “the bad days at work still outweigh[ing] the good.” But “more common than someone needing help because of a single big experience is the death by a thousand cuts,” he warns.

H&W strategies

As the UK’s biggest employer, the NHS should take inspiration from the commitment to employee wellbeing currently seen in the HR community at large, feels Kay.

“This is something the NHS can learn from the wider industry of HR because it would be unthinkable in a ‘normal’ company that someone could have a horrendous experience and it just gets brushed under the carpet,” he says.

“Every NHS organisation should have a specific strategy in place for what happens to a member of staff who has a very bad day.”

Part of this should include equipping hospital consultants with the knowledge and capabilities to better support their teams. As Kay asserts, people often forget that consultants are managers and so should be the first port of call for struggling staff.

“They have a team of people and in the first instance the team should speak to their consultant, which means consultants need training,” he says. “It’s really important that every member of staff wherever they work knows who they can speak to if they’re struggling.”

But it all comes back to systemic issues, Kay feels. There’s “not enough slack” in the system to even go home on time let alone enable someone to take time off to recover from a traumatic experience, he points out.

HR’s role

So good HR is critical to avoiding employee burnout, says Kay. But HR is “absent when it is needed most” in many NHS trusts, he claims.

“I always associated HR with being the enemy because these were the people who said I couldn’t have my annual leave because there were big gaps in the rota that had to be filled – they were very much the bogeyman,” he says.

Kay acknowledges though that pockets of good HR practice do exist, pointing to hospitals where counsellors and psychologists are employed to look after the workforce. But he believes these are “outnumbered” by hospitals where support is non-existent.

And, even where HR is taking steps in the right direction, it is often regarded cynically by staff when the fundamental working conditions are poor.

“If you’re routinely leaving work three hours late and a poster goes up saying there’s free Zumba classes on a Tuesday, then people will react badly,” he says.

“The motivation behind that is undoubtably pure and sweet. But that is ultimately putting a very small sticking plaster over a very big wound.”


So what might the answer be? The “very easy answer”, according to Kay, is more government funding to bolster NHS staffing and resourcing. “There needs to be enough staff so that people aren’t routinely staying hours and hours late,” he explains, pointing to the 100,000-plus NHS job vacancies currently available.

But, in the absence of more money, HR should turn its attention to changing the internal culture in trusts and hospitals up and down the country, he says.

“In medicine there needs to be a shift in the culture. The work that people do is critical, but at the same time you’ve got to remember that it’s human beings doing the job and you can’t possibly be the best version of yourself at work and offer the best care to your patients if you’re not looking after yourself.

"My silly stories in the book are basically a reminder that doctors are humans,” Kay adds.

“The NHS isn’t the buildings, it isn’t the CT scans, it isn’t the bedpans. The NHS is its staff – the human resource is the main resource.”

Twas the Nightshift Before Christmas is published by Picador, RRP £9.99

This piece appears in the December 2019 print issue. Subscribe today to have all our latest articles delivered right to your desk