Vital Signs Magazine Issue 5: NHS Workers' Struggles & Migration Policies

www.vitalsignsmag.org VITAL SIGNS P1
CONTENTS
P1: Changes to the visa and
migration regime
P3: No exclusion of the bank
staff from the pay increase
P4: Pay strike: Lessons from
the last round of nurses’
struggles
P5: Over 150 days of strike by
phlebotomists in Gloucester
P6: NBT / UHBW Merger and
struggle in Dorset
P7: Dicey donations for surgical
theatres?
P8: Admin workers,
pharmacists, occupational
therapists - Work and
struggle in the NHS
P14: I lost all my life savings -
Patients pay for treatment
P14: Enough is enough -
Uprisings in Nepal,
Philippines
P15: International working class
action against the war
P16: The pharmacy robot and the
volunteer
AUTUMN / WINTER 2025: ISSUE FIVE of a magazine by
workers from Southmead hospital and the BRI. Together
we can reflect on our experiences, our struggles and our
potential to create solidarity across bands, departments
and professions.
CHANGES TO THE VISA AND MIGRATION REGIME -
What is the logic and how can we defend ourselves?
OVER 100,000 PEOPLE demonstrated in London,
many of them blaming migrants for the shitty
conditions in this country. Investment wanker
Nigel Farage announced that he wants to get rid of
the Indefinite Leave to Remain, which would affect
tens of thousands of workers in the UK. The Labour
government also wants to appear tough on migration.
Starmer talks nonsense about the UK “turning into
an island of strangers” and in 2025 the government
announced various measures:
• Reduction of job categories that get you a visa
• Increase in visa fees
• Settled status only after 10, not 5 years
• More difficulty to bring family over
• More migration raids and deportations than
under the Tory government
At the same time it is clear that the UK needs
migration more than ever! Farm bosses have more
and more trouble finding workers within Europe
and often hire workers from as far away as Nepal or
Indonesia. The health and care sector is still severely
understaffed and many infrastructure projects, such
as high-speed trains, power plants or micro-chip
factories depend on engineering knowledge from
abroad. So what is the logic behind pretending to be
hard on migration?
DIVIDE AND RULE
Like everywhere, the UK economy is tanking, while
the state pledges to spend a few extra billions on
re-armament. The government cannot promise
anyone a golden future, so they promise people that
others will be even worse off. They cut disability
allowances, blame sick people for being unemployed
and launch tirades against migration. Some parts of
the local working class, often in the poorest areas
of the country, pick this up and attack refugees. The
government cries a few crocodile tears about the
violence, but is happy that their discontent about the
crisis and impoverishment targets other poor people,
rather than the rich and the government. The recent
anti-government uprisings in Indonesia, Nepal and
the Philippines scare them.
PUTTING MORE PRESSURE ON THE LOWEST PAID
WORKERS
Like Trump in the USA or the right-wing Meloni
government in Italy, the Labour government has no
interest in ‘stopping migration’, they know that the
local economy depends on it. By tightening the laws
and increasing repression against migrants they want
to keep them in a weak position, ready to accept low
wages and unstable conditions. Once the state is able
to impose such conditions on a separated segment
of the working class, they can expand it to others,

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P2 VITAL SIGNS
for example by curbing unemployment benefits or
increasing the pension age. They have an interest in
us competing in a down-ward spiral. Ultimately an
‘internal enemy’ is not enough and all governments
rely increasingly on creating ‘external enemies’, see
article on war in this issue.
The current crisis shows us the absurdity of this
system. People go hungry or homeless or sick, not
because there aren’t enough resources (knowledge,
labour, technology) to produce what they need, but
because production of such goods doesn’t promise
any profits. The crisis of profits and markets exceeds
the power of any national government. All that is left
for them is to intensify national competition. A lot of
it is at the same time a spectacle to try to convince
their citizens that they are doing anything at all, when
in reality they have little control over the situation.
This sets off a dynamic where states tumble into the
direction of global conflict, which in turn creates
millions of displaced people looking for refuge.
THE IMPACT AT SOUTHMEAD HOSPITAL
AND THE BRI
These current state measures have consequences for
us at NBT and UHBW. For example, a recent vacancy
at Southmead said:
“Please note, this role does not currently meet the
minimum £25,000 salary threshold required for
Skilled Worker visa sponsorship, effective from
9th April 2025. Although higher pay points may be
available depending on relevant NHS experience,
most new appointments commence at the lower
band, which falls below this threshold.”
In areas of the hospitals like pharmacy, where Band
2 and 3 workers don’t meet the criteria for a “skilled
worker” visa, colleagues are being told that the Trust
won’t renew their visa sponsorship. Colleagues
who are doing training courses are being told that if
they don’t find a job that pays the threshold amount
after finishing within two weeks that they will face
deportation. At Elgar at Southmead hospital we met a
HCA colleague who told us that he got his visa just in
time before the new rules became official and that the
non-stop discussion about future rule changes causes
a lot of stress for everyone.
WHAT CAN WE DO?
Here, in the two hospitals in Bristol, we are 18,000
workers from all over the world. The first step is to
understand the conditions we are in. We want to
hear from colleagues who depend on work visas how
they experience their situation. The second step is to
build links of solidarity amongst us and our patients.
One aim of the government is to make us police our
patients, e.g. by asking about their migration status
before treating them. Initiatives like ‘Patients not
Passports’ can be of help.
https://patientsnotpassports.co.uk/
We have to fight back against migration raids against
our colleagues. Co-workers who are scared that the
police will raid their workplace will be more likely to
accept low wages and shit conditions - we have to fight
the regime of fear! Initiatives like ‘Bristol Anti-Raids’
can be of help.
https://www.facebook.com/brisantiraids/
On the London Underground, cleaners are also being
threatened with deportation. In response, colleagues
are staging regular protests. They demand that
the employer do more to prevent workers being
deported. They have managed to drag their union
into supporting them. We could do something similar
here and make it clear that we won’t accept our
colleagues being ripped away from their lives.
Fellow migrant workers in the UK!
Fellow warehouse workers,
doctors, nurses and bricklayers!
Let’s go on strike for a day or two -
that will shut dickheads like Starmer
and Farage up for good!
NO EXCLUSION OF THE BANK STAFF FROM THE PAY
INCREASE - Petition and rally at Southmead hospital
IN JULY 2025, the respective interim Directors of
People at NBT and UHBW announced that unlike
substantive staff, bank staff will not receive a back
payment for the pay increase in August – and that
only in September the Trusts will decide whether
bank rates will be increased at all.
Gloucester and Avon and Wiltshire Trust paid
their bank staff the increase, why can’t NBT and
UHBW?
Bank staff do the same work shoulder to shoulder
with their permanent colleagues, it is unjust and
discriminatory that they are excluded from the
increase. HCA bank staff had already been excluded
from the back payment during the re-banding
process!
The management decision also means that
permanent staff will get a lower rate for their extra
shifts and won’t get the back pay for their bank work
either! The Trusts already abuse the bank system
in order not to pay the higher over-time rate, but
colleagues in other towns have found ways to respond
to that. In late December 2024 more than 1,000
nurses working across Greater Manchester pledged
to boycott the staff bank, after their enhanced rates
of pay were cut. Similar boycotts were organised at
other Trusts in the UK, putting significant pressure on
management.
MASS PETITION
At Southmead hospital, several bank workers and
supporters went in teams through the hospital
and collected signatures for a collective petition. It
seemed that all colleagues who we talked to, whether
permanent or bank, whether doctor or porter, shared
our view that the exclusion is unfair. We collected
over 280 signatures in no time and a group of bank
workers went to NBT headquarters to hand them over
to top management. Early October we also had a small
protest in front of Brunel. The question is how we can
go beyond a petition, which the trust management
can choose to ignore.
The question of Bank work is a difficult one. On
one hand people prefer the flexibility that it can
offer - it can be useful for colleagues with childcare
responsibilities for example. At the same time, it gives
Trust management too much control over our ability
to live and work. They can take it away in a moment
if there is no resistance. Bank work also undermines
our collective strength on wards and in departments.
If people come and go, there is less mutual trust.
How can we plan to stand up for ourselves, if we don’t
know if and when the other person will return? These
are issues that we have to confront collectively, and we
can’t allow management to drive a wedge between us
by not including Bank workers in the pay increase.
If you are a Bank worker and want to get involved,
drop us an email!

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P4 VITAL SIGNS
STRIKING FOR HIGHER PAY - Lessons from the last round of
nurses’ struggles
AT THE TIME of printing this issue of Vital Signs there
has still been no clear signal from the RCN whether
there will be a strike for higher wages in 2025 or not.
We are bored of waiting and want to use the time to
reflect on the most recent pay strike in order to learn
some lessons.
THE HOLDING PATTERN
The pay rounds in the NHS follow a similar pattern, a
pattern that weakens our collective strength to strug-
gle for better pay and conditions:
• Each year in April the government announces a
ridiculously low pay increase, e.g. this year it was
2.8%, while it was clear that inflation would be
higher than that.
• The trade unions grumble a bit, but don’t coordi-
nate any cohesive action together. At our Trusts
in Bristol we have more than half a dozen unions,
but they compete with each other, rather than join
forces.
• The government improves the offer slightly, e.g.
this year it was 3.6%, which is still pretty much a
real wage cut. The trade unions take ages to con-
sult their members. They are largely absent from
the day-to-day situation in the hospitals and only
send out a few emails, reminding people to vote
whether to accept or reject the pay increase.
• By August NHS workers are paid a small chunk in
money as a back dated payment from April, which
is meant to make people think: “Well, now that I
have this bit of money, why should I bother to vote
against it. There is no open process to prepare for
a pay strike, so why should I bother to get en-
gaged?”
• As a result, only some unions manage to mobilise
enough members to vote for taking action. This
means that any potential strike is already in a
weak position.
The only way we can interrupt this pattern is by
creating a common strike platform that reacts to the
government pay offer immediately, not months later.
LESSONS FROM THE LAST ROUND
Now that some unions might call workers out to strike
we should look back at the last round of strikes in
January 2023. This was the first time in three decades
that nurses went on strike in the UK. We took part in
pickets at Southmead hospital and spoke to colleagues
in various NHS Trusts in the UK in order to learn from
their experiences.
• Once it became clear that only members of the
RCN would go on strike at Southmead hospital,
management and union reps of the joint union
committee met initially in talks that treated the
upcoming industrial action as a ‘serious incident’,
similar to grave accidents, and started discussing
possible derogations (minimum staffing levels
during the strike) and exemptions.
• In contrast, there was no collective meeting of all
unions on how to support the RCN strike and no
communication towards the members and work-
ers. The only emails that were sent by Unison and
GMB to their own members made clear that, as
both unions failed to meet the legal threshold,
members could not participate in the RCN strike.
• Trust management sent emails that they respect
the right to strike, but at the same time increased
payments for bank workers between mid-Decem-
ber and mid-January 2023 by 30% for nurses and
15% for the rest, incentivising people to take on
extra shifts. This clearly aimed at weakening the
impact of the strike.
• In the meantime, the government added some
sticks to these carrots. On the 7th of December
2022, they first threatened to legally ban strikes in
the health sector. On the 10th of December 2022
they then spoke publicly about using army per-
sonnel to replace striking workers. This turned
out to be a paper-tiger early on, as the number of
potential soldiers was very low (around 600 army
drivers and 150 logistical staff compared to a total
of 16,000 plus ambulance paramedics who were
balloted to strike) as they often lacked the neces-
sary qualifications and knowledge.
• In England the RCN leadership decided to limit
the first round of strikes to 44 Trusts out of the
102 that met the legal threshold for strike action
(out of 215 eligible in England). This caused
frustration amongst those members that had
voted in favour of industrial action.
• In tandem with this, the top-level of the RCN and
the NHS hierarchy decided the so-called ‘deroga-
tion’, the exemption of certain departments from
the strike and/or the imposition of minimum
staffing levels on certain wards. This was done
without input from members or hospital workers.
• Local RCN reps and committees then decided
about particular minimum staffing levels during
the strike. The way this was negotiated between a
few RCN reps and management left a lot of scope
for confusion and most workers felt pretty
manipulated by or disengaged from the process.
This issue is at the heart of the question of who
is in control of the strike. Workers on each ward
know best what their current patients need in
terms of minimum health and safety and would
be able to coordinate how many workers can
participate in the strike.
• There were many individual texts and emails from
ward managers to people who they suspected
would go on strike – allegedly in order to be able
to ‘plan for the strike days’.
• In some wards, managers ‘allowed’ workers to go
on strike, often for a limited amount of hours. It
seemed the strike was controlled by managers. In
a few cases nurses decided collectively on a ward
level how many and how long to attend the strike
picket - that’s a good start!
• Even if this was not intended by the RCN, the way
that the derogation process was handled, left the
control of the strike largely in the hands of the
trust hierarchy. This can be done differently, as
strikes in Germany have shown. There the striking
colleagues on the picket-line itself kept in touch
with workers on the wards and decided together, if
more people were needed on the wards or not.
• The impact of the strike differed sharply from
ward to ward. At Southmead, some workers
reported that they actually had higher staffing
levels on the strike day than normally, in particular
in the emergency department. On other wards,
colleagues said that matrons and managers had
to do bed care and bring patients to the toilet –
which can clearly be stated as a positive result of
the industrial action in terms of educational value
(“it’s good if they get their hands dirty every now
and then”).
•
•
PROPOSALS
If there is another round of strikes, we need to start
with the following steps to avoid repeating the mis-
takes of the last round:
• Let’s use the picket-lines to discuss strike tactics,
not just to wave flags or blow into whistles.
• Let’s organise common rallies of workers at the
BRI and Southmead.
• Let’s talk with colleagues, first and foremost with
health workers who have not been part of the
strike, such as porters, cleaners or HCAs, how we
can strengthen the strike and make our voices
heard.
• We need open meetings to reflect collectively on
our experiences and circulate reports of struggles
in different areas and efficient tactics.
For a strong and united struggle,
led by those who fight it!
OVER 150 DAYS OF STRIKE -
Phlebotomists in Gloucester
SINCE MARCH 2025, around 40 phlebotomists at
Gloucester hospital have been on strike. They want
to pressure trust management to re-grade them from
Band 2 to Band 3. Currently phlebotomists, who take
blood samples from hospital and GP patients, earn 17p
more than the minimum wage. At the BRI in Bristol,
the trust used to offer vacancies for phlebotomists
on bank – this means that the samples on which most
medical diagnosis is based are gathered by minimum
wage workers on zero-hour contracts.
The issue of re-banding workers is peculiar. There
are national job profiles for phlebotomists, which
local Trusts should use in order to write their job
descriptions and band their workers. In the case of
health care assistants (HCAs) the national job profile
said that anyone who is doing medical tasks (taking
blood pressure, performing blood sugar tests or
taking blood samples) should be paid Band 3.
Most Trusts re-graded their HCAs themselves, in
other Trusts the trade unions used the opportunity
to stage strikes, which in the case of HCAs were often
successful. Unison was able to present these disputes
as victories, although the strikes just enforced what
workers were entitled to anyway. In the long run, the
trade union strategy to justify the fight for higher
wages by referring to skill levels and job categories
will only contribute to the deepening of divisions
within the workforce – and thereby weaken everyone.
We all need higher pay - when we pay our rent,
electricity bill, council tax, supermarket shopping,
no one asks for our skill levels!
It seems that with the phlebotomists in Gloucester the
union miscalculated slightly, which could explain the
fact that the strike is dragging out that long. The work
of phlebotomists is even more reduced to single tasks
than the work of health care assistants. This means
that it is easier for the trust to replace the striking
workers by forcing nurses and health care assistants
to perform more venepunctures for blood samples
than they normally do.
Unfortunately it seems that there aren’t any strong
links between striking phlebotomists and their HCA
and nurses colleagues – not even with those nurses
who are members of the same trade union. For the
strike to hit home, the nurses and HCAs would have to
refuse to do the extra work of taking blood samples.
This lack of practical solidarity between professional
groups is a major problem, which undermines the
strength of the strike. This lack of strength cannot be
compensated for by well-meaning trade union propa-
ganda. What we need is more analysis of the strength
and weaknesses of our struggles.

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P6 VITAL SIGNS
DICEY DONATIONS FOR SURGICAL THEATRES?
Thoughts on our social responsibility as workers
I WORK IN surgical theatres in Bristol. The other day,
a representative of a private company was hanging
out in one of our theatres. That in itself is not unusu-
al, we often have company reps explaining to nurses
and even surgeons how to use their new instruments,
equipment or implants. This representative came
with a cooled box, delivering a particular bone dona-
tion, flown in just-in-time from the USA. His company
is called RTI Surgical and is one of the world’s biggest
tissue and bone donation corporations. I wasn’t aware
of the fact that we receive donations from the ‘pri-
vate sector’, so I spoke to a fellow nurse about it. She
told me that one of the reps had mentioned that they
receive a fair amount of donations from the prison
system. Not wanting to rely on rumours I tried to find
out more.
RTI SURGICAL AND PROBLEMATIC DONATIONS
FROM UKRAINE AND BEYOND
RTI Surgical has many local and international suppli-
ers of tissue and bone donations. The company makes
280 million USD revenue and supplies hospitals in 30
countries. In 2008 it bought the German company
Tutogen Medical, which was involved in various legal
proceedings around unethical donorship in Ukraine.
Families in Kiev complained to police in 2005 that a
morgue supplying Tutogen was taking tissue without
proper consent.
Three years later Ukrainian police investigated anoth-
er Tutogen supplier in central Krivoy Rog. Families
claimed they were tricked, pressured or threatened
into consenting. Police said in some cases signatures
had been forged. Records show the company has of-
fered Ukrainian tissue to hospitals in New York. Only
in 2012 RTI Surgical decided to withdraw from the
market in Ukraine.
In 2012, further issues were raised against one of RTI
Surgical’s former US-based suppliers. Michael Mas-
tromarino, a former dental surgeon from New York
now serving a prison sentence, supplied the company
with tissue from more than 1,000 cadavers. In every
case, the consent documents were forged. In most
cases information about next-of-kin and physicians
were fictitious. In some cases the bodies were infected
with cancer, HIV or Hepatitis.
NOT SQUID GAME, BUT THE US PRISON-COMPLEX
After the colleague told me about the alleged use of
donations from US prisoners I read up on the matter.
In general the situation is not very transparent, e.g.
only 40% of prison systems having accessible policies.
In most US states prisoners cannot donate tissue or
organs while being incarcerated, but some states have
passed new laws that open the prison complex for the
donor market. In 2023, legislators of the Democratic
Party proposed: “The Bone Marrow and Organ
Donation Program shall allow eligible incarcerated
individuals to gain not less than 60 and not more
than 365 day reduction in the length of their com-
mitted sentence in [prison], on the condition that the
incarcerated individual has donated bone marrow
or organ(s).” Also the state of Utah liberalised the use
of prison donations in 2012.
We know that it is fairly easy to end up in a US prison
if you are poor and even easier if you are poor and
black. We know that many multi-national companies
already make profitable use of prison-labour, such as
Boing, Walmart or McDonalds. We know that there
is little freedom of choice once you are in prison and
that prison sentences are often arbitrarily extended.
We, as NHS workers, should know whether our trust
is in any way involved in all of this.
A WALL OF SILENCE
To be clear, I don’t know whether RTI Surgical re-
ceives prison or other unethical donations. As a
theatre worker who has to handle donations, I asked
the manager of our theatres if she knows more about
the connection between our Trust and RTI Surgical.
The manager said that they did not and suggested a
Freedom of Information Request.
I issued the first request to the Trust in July 2025, but
received no response. I issued a second request a
month later, but they only replied that the Trust has
no relations with RTI Surgical. I sent them the exact
date and patient details of the surgery where the RTI
material was used, but received no reply. I wrote to
RTI Surgical directly and asked whether they receive
donations from the prison system, but no reply.
I wrote to the head of nursing of the Trust, no response.
PRESENTATION OF MEDACT
WE ASKED FRIENDS from MedAct to present
themselves. We are planning a longer interview
with them - watch this space!
We are building a community of local health workers
who organise for health justice towards safe and just
futures for all life. We resist the social, political and
economic conditions that drive inequity and injustice.
We work in solidarity with the communities direct-
ly affected, building power from the ground up and
demanding the system change we need. Over the last
four years we have worked across various campaigns
including: Patients not Passports, Homes for Health,
the Barton House Campaign, Reclaim our Buses and
more. For more information about our work or to join,
get in touch…
Insta: @medact_bristol
Email: [email protected]
Website: https://www.medact.org/membership
groups/bristol/
THE NBT AND UHBW MERGER
AND THE STRUGGLE AGAINST
OUTSOURCING IN DORSET
Other results might be negative, for example they
might shrink teams or services or force people to
work across both hospitals. So far the process has not
been very transparent and bits have been confus-
ing, e.g. if you work ‘Cloudstaff’ shifts at UHBW they
appear on NBT payslips and are paid from the NBT
account. Let us know your thoughts and about your
experiences.
Meanwhile, down the road in Dorset, 1,700 cleaners,
porters and other support staff in hospitals are under
threat of being transferred to a NHS-owned subco (a
subsidiary company). This normally comes with job
cuts and deterioration of pay and conditions.
What sense does it make for some of us working in
the same building for the same organisation to have
worse conditions than our colleagues? This leaves
too much space for dive-and-rule tactics - and in most
cases subcos are just another way of tax avoidance!
The fellow workers in Dorset saw the risks of
outsourcing and reacted accordingly: at the end of
September 2025, 94% of Unison members voted for
industrial action against the plan.
This collective show of force moved the government
to pause the outsourcing for the moment. Still, this
struggle is not won yet.
We should support our colleagues in Dorset by all
means necessary, as we might be facing similar
measures in the future!
NBT AND UHBW management want to join parts of the
Trusts. So far it is unclear what the consequences might
be. Some things will make sense, e.g. that you don’t have
to go through all the bureaucratic procedures twice if
you want to work bank shifts at both Trusts.

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P8 VITAL SIGNS
OUR SOCIAL RESPONSIBILITY AS WORKERS
According to the current system we have no say in how
we produce things and what we produce. We are forced
to sell our labour power to pay our bills and the compa-
nies that buy it can do as they please. This puts us in a
difficult spot. Officially powerless, it is still us who make
the whole system work, who produce all those things,
whether harmless or deadly. Recently, more and more
workers have become aware of this paradox.
In France, workers of ST Microelectronics in Greno-
ble went on strike against the use of their micro-chips
in the Israeli war machine. They went on strike to
enforce that they are informed about where and how
the micro-chips they produce are used. In Genoa and
Marseille, dock workers refused to load and unload
ships that carried arms. In the USA, tech workers at
Google and Amazon protested against the use of their
software for military or surveillance purposes.
Currently the UK government wants to outsource
NHS data processing to the US company Palantir,
which also supplies the war machine that commits
genocide in Gaza.
Together, as NHS workers, we can question this! This
is the power we have to influence what is happening.
As you were able to gather from this article, as long
as we are alone it is difficult to find out even basic
information - but if we get together we can take on
responsibility for the world we live in.
ADMIN WORKERS, PHARMACISTS, OCCUPATIONAL
THERAPISTS - The way we work and struggle in the NHS
AS HEALTH WORKERS we do all kinds of jobs and
many of us don’t know what the other one is actually
doing. This is a problem in at least two senses. First-
ly, our struggles for better conditions for ourselves
and our patients often remain divided into profes-
sional groups, Trusts or departments. Secondly, in
the current system industries are structured in the
interest of those in power and according to the rules
of markets and money relations. That turns them
into often fragmented and hierarchical systems
that are not very conducive for a free and effective
cooperation of everyone involved. As health workers,
we therefore have to start understanding how our
industry actually works in order to be able to take
it over and run it in the interest of everyone in the
future. We have to understand various aspects, from
the supply of material, to research and production of
pharmaceuticals or medical machinery, to the wider
management of hospitals and services. We there-
fore spoke to an admin worker, pharmacists and an
occupational therapist about their work.
THE MULTIDIMENSIONAL WORLD OF HOSPITAL
ADMIN STAFF
It’s pretty surprising, but nearly a third of hospital
staff at Southmead or the BRI are categorised as
admin! Do we know what they are doing? How much
of their work is to do with catering for high-up
management or with financial transactions? How
much of their work helps us to care for patients?
I work in a radiology department as an appointment
facilitator. There are two aspects to the job. Firstly,
we arrange radiology appointments with patients.
So radiology appointments include ultrasound, CT
scans, X-rays, MRI scans. We receive referrals either
internally from hospital doctors asking for scans to be
carried out, or we would get requests from GP’s asking
for scans to be arranged for patients. There’s also a
private hospital that sends referrals to us - and all
their referrals are treated as urgent, they get priority.
The referrals will be scored. You have a two week rule,
when the clinician believes that the patient might
have cancer. In this case we have to book that ap-
pointment within seven days. A lot of the time we can
book appointments within seven days. Sometimes we
cannot.
We handle phone calls from patients who want to
book scans. There are various bottlenecks that cause
delays of scans. We had a bottleneck with CT scans.
One of our scanners was out of action for seven
months, we were 25% down on CT scanning.
Management has been very quiet about this, but I
think it could have led to deaths.
We also actively ring patients to arrange appoint-
ments. We don’t just send out appointments without
speaking with the patient.
Sometimes doctors do explain to the patient why
they’ve actually referred them for an appointment,
but sometimes they don’t. This is absolutely bizarre.
Sometimes we do not know if the patient has had
a face to face conversation with the GP. Now, some
of our referrals are quite intimate. It could be like a
trans vaginal scan, for instance, which is an internal
scan. Some women may not want an internal scan, or
they may want the scan done by a female radiologist
or radiographer. So that leaves it up to us to explain
what the procedure is, explain what the doctor maybe
hasn’t said.
It also creates a difficult situation for us when it comes
to cancer scans. Going back to those two week refer-
rals, we can’t say your doctor thinks you have cancer.
We can only say that the doctor wants you to be
checked out as soon as possible. Sometimes, patients
don’t want the scan done or they don’t think it is im-
portant. If the doctor hasn’t told the patient the reason
for the scan, then that leaves us to find ways to bring
across the urgency of the scan, while being restricted
with what we can and can’t say. We are sort of trapped.
Apart from doing the job on the phone there are be-
tween 4 and 5 people working at our reception desks,
booking patients in. That’s a different aspect to the
job. We rotate between phone and desk. We book
patients in, directing them to the clinics. We deal with
patients that have come in late, because if they’re
more than ten minutes late, they may not be seen. So
we then have to speak to the relevant co-workers, like
senior healthcare assistants, who might be able to slot
them in. That requires a lot of improvisation, you have
to know who to talk to. I would go down and speak with
the CT technicians directly:
Can we get this patient booked in?
Then you have to ask a patient medical questions,
depending on what the scan is. Some CT scans have a
contrast dye and iodine dye. If you scan the chest up-
wards, the patients shouldn’t have eaten for two hours
beforehand. If it’s from the abdomen and below, they
shouldn’t have eaten for four hours. We might then
have a conversation with the technician saying: “Well,
they’ve had a couple of biscuits and a cup of tea or
coffee - is that still okay?”. Or when it comes to steroid
injections. For that procedure we would have to talk
the patients through the precautions that they need
to be aware of. So they can’t have the steroid injection
within two weeks of having had any vaccinations, be-
cause the steroid injection will completely invalidate
the vaccination. You can’t have it within one week
from when you took an airplane. You can’t drive home
yourself, after the injection. You can’t be on certain
medication, if they are, we have to talk to the clinician.
We have to keep all that in mind.
We also have to have a spreadsheet with all doctors
and radiologists on it, telling us what kind of proce-
dures each individual clinician can do.
We have to bear that in mind when booking in
patients - not every radiologist will do all scans. Some-
times, when things are overstretched, patients end up
in the wrong clinics.
We also prescribe medication, as Band 3 admin work-
ers! When people have a colorectal they have to go
on a soft food diet 24 hours before the scan and take
a certain medication called gastrografin. We talk the
patient through this and send out the medication by
post - we have to make sure it reaches them in time
before the scan.
Each case has got quite a lot of different factors, it’s
not that straightforward. There are potentials to
automate some of the phone work, but then AI would
perhaps not get the nuances or would be able to im-
provise, e.g. when a patient doesn’t speak English well.
AI is already looking at scans, but that may be more
straight-forward.
The main issue that prevents us from doing our job
is the restricted budget. A restricted budget causes
other problems which prevent us from doing our job
properly, for example a lack of desks, not the right
chairs or monitors. Very basic things. The lack of
money filters through. For example, not all clinicians
can or want to do bone density scans. So often we
don’t have enough staff to do scans, because they also
cut all bank shifts. Clinics reduce their opening times,
which increases the waiting list. If elderly people
don’t get their bone density scan, that might result in
delayed treatment and possible fractures.
When there is a lack of porters, it is us admin staff
who push patients in wheelchairs out to the taxi stand
or guide them there. But then the transport has been
outsourced to a private company paying minimum
wages, and sometimes there are long waiting times.
Then we have to arrange a sandwich or a cup of tea
for the patient. Sometimes patients wait four hours
in a chair, which can cause pressure sores. At the site
where I’m working we have volunteers and they can
help if we’re a bit stuck. This raises a whole other
issue about how the NHS is using unpaid workers to
do the work.
The lack of staff can cause problems when it comes
to coordination between different departments. For
example, elderly patients get discharged, although on
their file it says that they are still supposed to have an
ultrasound scan. Then family members might have
to bring that patient in again, and are upset. A lack
of investment means that our data platforms are not
integrated. The radiology department uses a different
system from other departments, which could mean
that a warning note in the online form, for example
that a patient uses a wheelchair, might not be passed
on electronically to others. Other issues are caused
by outsourcing, for example our MRI scans are done
through a private company within the hospital…