Health service: `The staff just don't feel appreciated'

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DUNCAN BEW, 25, is a house officer at the Royal London Hospital, Whitechapel, in the East End of London. The hospital opened in 1740 with 15 beds. Now 360,000 patients a year flock through the doors.

George Ward, Dr Bew's patch, specialises in colo-rectal procedures, typically bowel cancer. It is uncomfortably sticky in the summer, and a pungent and distinctive smell hangs all year. Dr Bew is accustomed to the smell. It goes with the job, as do long hours and less than spectacular pay.

The ward of 27 beds, 29 when demand rises, has big windows that open only a couple of inches. There is no air-conditioning. The cleaning staff do not have enough time to clean properly because they have to cover such a large area.

Very little could be described as spotless. Not the paint chipped walls with their ancient Sellotape marks, the scuffed floors or the lightly rusted drip stands.

Dr Bew begins at 7.30am. The typical day includes ward rounds, organising scans and investigations, to be done in other parts of the hospital. His patients sprawl across the 12 beds in the men's room, wearing boxer shorts that expose their surgical scars.

He arranges follow-up appointments and writes letters for referrals, fills in drug charts and connects intravenous drips. He gets patients' consent for operations and pages all the anaesthetists involved to discuss those cases. Not until 9pm does he finish all his note- keeping, breaking off to talk with the visiting relatives of some patients.

Working these sorts of hours, for a basic pay of pounds 16,710, would be enough of an irritation for junior hospital doctors. But they are not the whole picture.

Increasingly, they are concerned that surgical training, traditionally a long apprenticeship in this country, is being cut short. Attempts to reduce the number of hours junior doctors work has meant in a technical specialty such as surgery, valuable hours spent gaining experience in theatre have been lost.

As the public demand for more doctors grows, the competition for jobs has also increased. It is one of the reasons junior doctors have become increasingly dissatisfied with their lot.

Dr Bew's boss, Sina Dorudi, a consultant surgeon aged 40, said: "Young men and women are having to do lots extra to get a surgical training post. Relatively junior people are coming to us to do research to get something extra on their CV." This kind of work will have to be done when Dr Bew gets home at night.

Jon Tilsed, 36, a registrar, said: "The big problem is that the junior staff don't feel appreciated. In the past, they weren't at the whim of anyone with a telephone and their bleep number . They had some social standing in the hospital.

"If they were needed in the middle of the night they wouldn't just be bleeped, they would perhaps be woken by a porter with a cup of tea. You'd made it, you were a doctor."