Dr Dan Poulter and the 100-hour weeks

Could the new health minister please clear up his statement about his hours as a junior doctor?

With all the excitement over Jeremy Hunt's acceptance of the Poisoned Health Chalice, and the related stories about his pro-homeopathy and anti-abortion stances, you may have missed the news that former junior doctor Dan Poulter MP was appointed as Parliamentary Under-Secretary of State for Health.

Over the last couple of months I've been trying to get Dr Poulter, or "Dr Dan" as he prefers to be called, to clarify some statements he's made about the long hours he used to work as a junior doctor.

On Newsnight on Tuesday 19/06/2012 he said he "often used to do 100-hour weeks" (It's no longer on iPlayer but you can see the video here.

And he made a similar claim in a speech in the House Of Commons on 26/4/2012. I quote from Hansard:

"My hon. Friend said that we do not want to go back to the bad old days of 100-hour weeks. I worked those 100-hour weeks, and I am sure that the other medical doctors who are in Westminster Hall today did so, too. It was certainly not ideal to work 100-hour weeks; it was not good for patient care."

Now these comments have raised a few eyebrows in medical circles. Non-medics reading may wonder why; after all, everyone knows junior doctors work very long hours, right?

Well, kinda. As recently as the 1990s it was not uncommon for juniors to work very long continuous periods on call, and many older doctors can remember working a "one in two" rota (a regular working week, but staying up all night every second night, and working every second weekend continuously from Friday morning til Monday night - averaging 120 hour per week).

As Dr Dan says, "it was certainly not ideal", and that's why the BMA negotiated the New Deal for junior doctors, which was introduced around the time I qualified in 2000, and limited on call workers to 72 hours per week. Some hospitals didn't implement the terms of the New Deal until 2004, but were penalised by having to pay their doctors up to twice basic salary (that's how I managed to pay off my student loans). Hours were then limited further in 2004 with the introduction of the European Working Time Directive (EWTD) which specifies that no doctor should work more than 58 hours per week on average, and all workers were entitled to a period of 11 hours continuous rest a day. Many doctors are unhappy with the EWTD, as a lot of hospitals get around it with rotas containing weeks of up to 7 13-hour night shifts (91 hours per week for that week, but balanced out by random days off elsewhere). Having myself worked both the old "on-call" and new "shift" system, I can say that there are pros and cons to both, but the big pro is that new doctors no longer have to stay up all weekend without sleep.

Why am I telling you all this?

Well, Dr Dan only started work as a junior doctor in August 2006.

If Dr Dan was "often" doing 100-hour weeks in 2006-7, he (and, we must assume, his co-workers) would have been working in contravention of European employment law, and his hospital trust would be liable for fines of several thousand pounds for each breach.

This is where the raised medical eyebrows come in. The EWTD was enforced much more rigourously than the previous New Deal, because of the non-negotiable swingeing penalties threatened from Europe. As a result, I don't know of any 2006 graduate who's worked a 100-hour week, let alone on a regular basis. I'm not sure if it's even mathematically possible to squeeze 100 hours into the strict terms of the EWTD. The most I'm aware of is the 91-hour example above, but that would be an infrequent happening on a rota, maybe every 10-12 weeks; certainly nothing that could be described as "often". It's also worth noting that Dr Dan was elected as a councillor in Redhill on May 3rd 2007, and according to his website was Deputy Leader of Reigate and Banstead Council from 2008 until his election as an MP in 2010. When you factor in his hobbies, and the many good works he's undertaken in his spare time, I'm just struggling to see how the poor chap managed to fit it all in.

But, taking Dr Dan at his word, I felt it was important to find out where he was working, to avoid other junior doctors being exploited in the future. So, I emailed Dr Dan to see if he could shed some light on the matter. Unsurprisingly, I recieved a standardised reply: "Please note that there is a strict Parliamentary rule that MPs can only help their own constituents".

I'm not a constituent, but the Suffolk-based legal blogger @PME200 is. I understand he also contacted Dr Dan recently over his concerns that a local NHS trust may have been exploiting a junior doctor and breaching the law. It appears that Dr Dan point blank refused to confirm which trust employed him during the alleged 100-hour weeks. He effectively told his constiuent to mind his own business.

Why is Dr Dan so coy with the details of his 100-hour weeks? We can only assume that Dr Dan (unlike any junior doctor I've ever met or heard of) was genuinely "often" doing 100-hour weeks in 2006-10, but is so protective of his erstwhile employers he cannot bear the thought of revealing that they were serially breaking European Law.

Of course, there is an alternative explanation. It is possible that Dr Dan (like every other junior doctor I've ever met or heard of) actually WASN'T "often" doing 100-hour-weeks in 2006-10, but has chosen to pretend that he was, perhaps to try and carry some of that junior doctor kudos into his new role in one of the nation's least favourite professions.

If this was the case (and of course I'm not for one second suggesting that it is, merely enjoying a thought experiment while we await confirmation from Dr Dan of the names of the law-breaking hospital trusts concerned), would it really matter? After all, we accept that our politicians will somteimes give a different version of events to suit their own agenda.

Here's why I think it would matter:

1. Dr Dan isn't just an MP, he's a registered medical doctor like me, and society holds its doctors to a higher standard of probity than it holds its politicans. Specifically, the General Medical Council states in Good Medical Practice that:

"64. You must always be honest about your experience, qualifications and position, particularly when applying for posts."

If, (and again, I'm not saying this is the case, merely that it is one possible explanation of the facts we have while we await clarification from Dr Dan), if Dr Dan could be shown to have persistently and deliberately misrepresented his clinical experience in order to improve his standing as an MP, this would transcend politics and hurtle toward the realms of professional misconduct.

2. There's a thing called misleading Parliament. I'm not too familiar with this (hence the Wikipedia link), but apparently if you're making a speech in the House Of Commons, it's frowned upon if you start making shit up.

3. Whatever his many failings as Secretary of State for Health, Andrew Lansley was an absolute master when it came to completely alienating the medical profession. At the last election most doctors I know voted for one of the two coalition parties. With the twin pitchforks of NHS privatisation and pension cuts, Lansley has completely destroyed that support. One can imagine that Dr Dan was elevated to his ministerial position with at least a partial hope that having a doctor in government might go some way to winning back medical hearts and minds. Now, a doctor who could do such a thing would have to show themselves to be of impeccable character. They certainly wouldn't gain any friends if they appeared to be claiming experience they didn't have, or posturing to try and appear older and more battle-hardened than their CV could account for. If a shadow were to fall over Dr Dan's credibility and probity as both an MP and a doctor, it is hard to see how his addition to the government would be beneficial.

Why am I blogging about this now? My exchange of emails with Dr Dan was a couple of months ago, and while he remained a back bencher it seemed somewhat churlish to push the issue. Though I strongly oppose his government's privatisation agenda, I have no beef with him personally, and in fact admire his stance on expenses and his statements in favour of plain packaging for tobacco.

But now that he is a Health Minister, I'd like to know that he can be trusted.

Dr Dan can clear up the situation now by answering three simple questions:

  1. Which Trust did you work for, for which consultant, and at which grade, duing the period when you "often used to do 100-hour weeks"?
     
  2. Can you provide a copy of the rota so we can ensure future generations of doctors aren't exploited in this way?
     
  3. What sanctions if any were taken against the employing Trusts for these breaches of employment law, and if none were taken, what steps will you take as Health Minister to amend this?
     

I hope Dr Dan comes up with the answers soon. I'd also be keen to hear from any medics who think they did work a 100-hour week rota as a junior doctor in 2006, particularly those who worked with Dr Dan himself! If Dr Dan doesn't respond, I suppose it might be possible for a journalist to apply under the Freedom Of Information act. Let's hope it doesn't come to that.

This post first appeared on Pete Deveson's blog here. You can follow him on Twitter as @PeteDeveson

Update, 21/09/2012: You can read Dr Dan Poulter's response, and Pete Deveson's commentary on it, here.  

Dan Poulter appearing on BBC News.
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Jeremy Corbyn speech on terrorism and foreign policy: full text

The Labour leader laid out his vision for British foreign policy. 

Our whole nation has been united in shock and grief this week as a night out at a concert ended in horrific terror and the brutal slaughter of innocent people enjoying themselves. When I stood on Albert Square at the vigil in Manchester, there was a mood of unwavering defiance. The very act of thousands of people coming together sent a powerful message of solidarity and love. It was a profound human impulse to stand together, caring and strong. It was inspiring.

In the past few days, we have all perhaps thought a bit more about our country, our communities and our people. The people we have lost to atrocious violence or who have suffered grievous injury, so many of them heart-breakingly young .

 The people who we ask to protect us and care for us in the emergency services, who yet again did our country proud: the police; firefighters and paramedics; the nurses and doctors; people who never let us down and deserve all the support we can give them. And the people who did their best to help on that dreadful Monday night – the homeless men who rushed towards the carnage to comfort the dying, the taxi drivers who took the stranded home for free, the local people who offered comfort, and even their homes, to the teenagers who couldn’t find their parents.

They are the people of Manchester. But we know that attacks, such as the one at the Manchester Arena, could have happened anywhere and that the people in any city, town or village in Britain would have responded in the same way.

It is these people who are the strength and the heart of our society. They are the country we love and the country we seek to serve. That is the solidarity that defines our United Kingdom. That is the country I meet on the streets every day; the human warmth, the basic decency and kindness.

It is our compassion that defines the Britain I love. And it is compassion that the bereaved families need most of all at this time. To them I say: the whole country reaches out its arms to you and will be here for you not just this week, but in the weeks and years to come. Terrorists and their atrocious acts of cruelty and depravity will never divide us and will never prevail.

They didn’t in Westminster two months ago. They didn’t when Jo Cox was murdered a year ago. They didn’t in London on 7/7. The awe-inspiring response of the people of Manchester, and their inspirational acts of heroism and kindness, are a living demonstration that they will fail again.

But these vicious and contemptible acts do cause profound pain and suffering, and, among a tiny minority, they are used as an opportunity to try to turn communities against each other.

So let us all be clear, the man who unleashed carnage on Manchester, targeting the young and many young girls in particular, is no more representative of Muslims, than the murderer of Jo Cox spoke for anyone else. Young people and especially young women must and will be free to enjoy themselves in our society.

I have spent my political life working for peace and human rights and to bring an end to conflict and devastating wars. That will almost always mean talking to people you profoundly disagree with. That’s what conflict resolution is all about. But do not doubt my determination to take whatever action is necessary to keep our country safe and to protect our people on our streets, in our towns and cities, at our borders.

There is no question about the seriousness of what we face. Over recent years, the threat of terrorism has continued to grow. You deserve to know what a Labour Government will do to keep you and your family safe. Our approach will involve change at home and change abroad.

At home, we will reverse the cuts to our emergency services and police. Once again in Manchester, they have proved to be the best of us. Austerity has to stop at the A&E ward and at the police station door. We cannot be protected and cared for on the cheap. There will be more police on the streets under a Labour Government. And if the security services need more resources to keep track of those who wish to murder and maim, then they should get them.  

We will also change what we do abroad. Many experts, including professionals in our intelligence and security services have pointed to the connections between wars our government has supported or fought in other countries, such as Libya, and terrorism here at home.

That assessment in no way reduces the guilt of those who attack our children. Those terrorists will forever be reviled and implacably held to account for their actions.

But an informed understanding of the causes of terrorism is an essential part of an effective response that will protect the security of our people, that fights rather than fuels terrorism.

Protecting this country requires us to be both strong against terrorism and strong against the causes of terrorism. The blame is with the terrorists, but if we are to protect our people we must be honest about what threatens our security.

Those causes certainly cannot be reduced to foreign policy decisions alone. Over the past fifteen years or so, a sub-culture of often suicidal violence has developed amongst a tiny minority of, mainly young, men, falsely drawing authority from Islamic beliefs and often nurtured in a prison system in urgent need of resources and reform. And no rationale based on the actions of any government can remotely excuse, or even adequately explain, outrages like this week’s massacre. But we must be brave enough to admit the war on terror is simply not working. We need a smarter way to reduce the threat from countries that nurture terrorists and generate terrorism.

That’s why I set out Labour’s approach to foreign policy earlier this month. It is focused on strengthening our national security in an increasingly dangerous world.

We must support our Armed Services, Foreign Office and International Development professionals, engaging with the world in a way that reduces conflict and builds peace and security.

Seeing the army on our own streets today is a stark reminder that the current approach has failed. So, I would like to take a moment to speak to our soldiers on the streets of Britain. You are doing your duty as you have done so many times before.

I want to assure you that, under my leadership, you will only be deployed abroad when there is a clear need and only when there is a plan and you have the resources to do your job to secure an outcome that delivers lasting peace.

That is my commitment to our armed services. This is my commitment to our country. I want the solidarity, humanity and compassion that we have seen on the streets of Manchester this week to be the values that guide our government. There can be no love of country if there is neglect or disregard for its people. No government can prevent every terrorist attack.  If an individual is determined enough and callous enough, sometimes they will get through.

But the responsibility of government is to minimise that chance, to ensure the police have the resources they need, that our foreign policy reduces rather than increases the threat to this country, and that at home we never surrender the freedoms we have won, and that terrorists are so determined to take away. Too often government has got it wrong on all three counts and insecurity is growing as a result. Whoever you decide should lead the next government must do better.

Today, we must stand united. United in our communities, united in our values and united in our determination to not let triumph those who would seek to divide us. So for the rest of this election campaign, we must be out there demonstrating what they would take away: our freedom; our democracy; our support for one another. Democracy will prevail. We must defend our democratic process, win our arguments by discussion and debate, and stand united against those who would seek to take our rights away, or who would divide us.

 Last week, I said that the Labour Party was about bringing our country together. Today I do not want to make a narrow party political point. Because all of us now need to stand together. Stand together in memory of those who have lost their lives. Stand together in solidarity with the city of Manchester. And – stand together for democracy.

Because when we talk about British values, including tolerance and mutual support, democracy is at the very heart of them. And our General Election campaigns are the centrepieces of our democracy – the moment all our people get to exercise their sovereign authority over their representatives.

Rallies, debates, campaigning in the marketplaces, knocking on doors, listening to people on the streets, at their workplaces and in their homes – all the arts of peaceful persuasion and discussion – are the stuff of our campaigns.

They all remind us that our government is not chosen at an autocrats’ whim or by religious decree and never cowed by a terrorist’s bomb.

Indeed, carrying on as normal is an act of defiance – democratic defiance – of those who do reject our commitment to democratic freedoms.

But we cannot carry on as though nothing happened in Manchester this week.

So, let the quality of our debate, over the next fortnight, be worthy of the country we are proud to defend. Let’s have our arguments without impugning anyone’s patriotism and without diluting the unity with which we stand against terror.

Together, we will be stronger. Together we can build a Britain worthy of those who died and those who have inspired us all in Manchester this week. Thank you.

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