2. Like the frog in heated water, NHS staff have become completely used to working in a highly constrained system. We are all used to seeing five or six patients in bays designed for four. Corridor patients have been reduced but at the expense of worse conditions on the wards.

3. In 2023 the frustration felt by NHS staff erupted into a series of strikes. Thus far, the nurses strike seems to have been settled. There has not been a mandate for further nursing strikes. For doctors though it's a completely different matter...

4. Strikes are already planned for 2024 in Wales and England. The junior doctors rightly argue that £15 per hour is not an acceptable pay rate for the enormously hard and demanding work they put in. The Welsh vote was 98% which speaks for itself.

5. We are dependent on locum posts. Which cost more and are less consistent. Juniors come and go, chasing short term contracts that give them more control in their lives. The stability of our ward team is now so reduced. We don't know who will be on the ward each week.

6. Astonishingly the government will not talk to the BMA unless they call the strikes off first - a more irresponsible approach is difficult to imagine. They seem keen to continue to play games in the press rather than talk about a settlement. Which is what patients need.

7. Important to state that junior doctors are not a bunch of ideologically driven revolutionaries. Striking is not what doctors want to do. Their militancy is driven by a strong sense of injustice. They just want fair pay. This is the same in Tory England and Labour Wales.

8. The second big issue is the ongoing failure of governments to address social care. My point last year still stands - hospital bed states are still hugely compromised by large amounts of patients who need either care packages or placement. They sit and wait. For weeks.

9. This is a massive political failure. This can only be solved by government. No government seems willing to look at social care. But the absence of social care is killing the NHS. It is a key piece of the jigsaw. And yet no politician is talking about it. It beggars belief.

10. It is absolutely clear that the politicians have left the room (and I mean both Westminster and devolved governments). They choose to ignore it. We are in the 'too difficult' box. And an election is coming. So everything will go into purdah soon and nothing will happen.

11. Personally I'm done. I'm worn out with emergency work, which uses up so much time it compromises my ability to deliver a decent speciality outpatient service. So I am leaving the NHS. I have taken a job outside the UK where I will be only be doing my speciality. With regret

12. But it is no fun working in a system that is failing its patients. And having to take responsibility for this failure again and again. I must emphasise that I have no gripe with my previous employers. They are doing their best in a constrained system.

13. I have no doubt that things will improve. But this is going to take from 5-10 years to turn around. And that is me being optimistic. But doctors will find their way through this. They are masses of choices. This article says it all very well.

14. But patients are going to have it tough for a lot longer. My advice: be polite but assertive when dealing with the NHS. Remember the person you are speaking to is not responsible for the service. Consider going private - at least for an opinion, if you can afford it.

15. Remember that NHS workers are just people like you. Working hard and trying to do their best under difficult circumstances. Try not to use the NHS for trivial stuff, but don't hesitate to use it for serious issues. It will always be there for you in an emergency. With time.

16. And think hard before you use your vote at the next election. Examine policy. There is more benefit in getting an income tax reduction if you have to spend on inflation or private healthcare insurance. Wishing you all best. Stay healthy if you can. Look after yourselves.

Mistype above. I meant to write "there is no benefit in getting an income tax reduction...." Evil X strikes again....

@peteneville65 Good luck with your new venture. Hope the family is doing well.

@maytheflute All are well thanks Martin. I'm not going far. Just a short trip over the Irish Sea. Things seem a little more positive there. And the pay is better too.

@peteneville65 @chrischirp @threadreaderapp unroll

@peteneville65 Thank you @peteneville65 . Getting older here is terrifying. Let’s hope for some good change ahead.