Scarlett McNally: Schoolchildren give me hope for future generations of NHS staff
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r516 (Published 19 March 2025) Cite this as: BMJ 2025;388:r516
- Scarlett McNally, professor
- scarlettmcnally{at}cantab.net
Follow Scarlett on X @scarlettmcnally
I recently had an amazing time when I was invited to speak at a primary school careers day. We played with plastic bones and passed around joint replacements and intramedullary nails. I explained that NHS staffing isn’t exactly what you see on TV: only 12% of NHS workers are doctors and 26% nurses.1 I explained that there are 14 allied health professions2 and that half of our 1.7 million staff have jobs involving computers, maintaining buildings, laundry, patient booking, catering, equipment, and organising other staff and procedures. We worked out that the number of workers needed to keep the NHS running would fill thousands of classrooms.
The children were dressed up for their dream job. Aspiring astronauts, firefighters, and doctors asked insightful questions. After 30 years as a surgeon I found this one of the most powerful reflections I’ve done, seeing my career through their eyes. They asked what my most difficult operations had been. I explained that, before seatbelts and airbags, two cars would crash into each other and we’d have to operate on the occupants of both vehicles, one after another.
Did I ever have to do operations I didn’t like? I replied that surgeons used to have to do whatever operation was needed and to keep operating through the night to make sure that the operating theatre was always in use for any emergency cases. I described how this had changed with new rules in 1998,3 stating that it was better for most patients to wait for a fresh operating team the next day or a little longer for a specialised team. I remember that the new “life or limb threatening only” rule was better for us surgeons too and allowed us to sleep.
I explained to the children that many important people still wrongly think that you have to be a heroic surgeon, a knight in shining armour,4 who can do every operation without needing sleep—and this expectation means that they can discourage doctors who don’t look heroic from becoming surgeons. Surgery now needs teamwork, and we refer really tricky operations to the surgeons who are best at them.
Flexibility
I told them that I love my job. Work, whether paid or voluntary, is a key social determinant of health and gives people a sense of fulfilment and purpose.5 Colleagues can be like a supportive second family. I’m grateful to my former manager who helped me back to work part time while I was undergoing chemotherapy, while others were advising me to take ill health retirement.
I didn’t tell the children that 29% of NHS workers are thinking of leaving.6 The Royal College of Nursing describes nurses quitting as a “perfect storm” that threatens patient care.7 The 74% of NHS workers who are women6 will be disproportionately affected when budgetary changes in April increase the costs of childcare and care of older people, which may make it unaffordable to work.8910
I also didn’t tell them about new government plans to “sweat the assets” with three session day operating.111213 The “assets” are our staff, and we need them energised, including the 7% who report a disability.6 More flexibility in staffing, such as two surgeons sharing a list with early and late sessions, may be helpful. Since 10% of planned operations are cancelled at short notice,14 clarifying workforce roles to ensure good pathways, patient preparation, and team communication15 would be a better way to increase efficiency than reinforcing archaic views about surgeons’ productivity.
The schoolchildren’s enthusiasm gives me hope for the future. I trust them to work hard in teams and to look after the rest of us. We should nurture this future generation of NHS workers. I encourage other NHS staff to connect with their communities—it brings joy.
Footnotes
Competing interests: Scarlett McNally is a consultant orthopaedic surgeon, president of the Medical Women’s Federation, and deputy director of the Centre for Perioperative Care.
Provenance and peer review: Commissioned; not externally peer reviewed.