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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In defence of orientalism, the case against Twenty20, and why Ken should watch Son of Saul

My week, from Age Concern to anti-semitism.

Returning late from a party I never much wanted to go to, I leap up and down in the middle of the Harrow Road in the hope of flagging down a taxi, but the drivers don’t notice me. Either they’re haring down the fast lane or they’re too preoccupied cursing Uber to one another on their mobile phones. My father drove a black cab, so I have a deep loyalty to them. But there’s nothing like being left stranded in NW10 in the dead of night to make one reconsider one’s options. I just wish Uber wasn’t called Uber.

Just not cricket

Tired and irritable, I spend the next day watching sport on television – snooker, darts, cricket, anything I can find. But I won’t be following the Indian Premier League’s Twenty20 cricket again. It’s greedy, cynical, over-sponsored and naff. Whenever somebody hits a boundary, cheerleaders in cast-off gym kit previously worn by fourth-form Roedean girls wave tinsel mops.

Matches go to the final over where they’re decided in a thrashathon of sixes hit by mercenaries wielding bats as wide as shovels. Why, in that case, don’t both teams just play a final over each and dispense with the previous 19? I can’t wait for the elegant ennui of a five-day Test match.

Stop! Culture police!

I go to the Delacroix exhibition at the National Gallery to shake off the sensation of all-consuming kitsch. Immediately I realise I have always confused Delacroix with someone else but I can’t decide who. Maybe Jacques-Louis David. The show convincingly argues that Delacroix influenced every artist who came after him except Jeff Koons, who in that case must have been influenced by David. It’s turbulent, moody work, some of the best of it, again to my surprise, being religious painting with the religion taken out. Christ’s followers lamenting his death don’t appear to be expecting miracles. This is a man they loved, cruelly executed. The colours are the colours of insupportable grief.

I love the show but wish the curators hadn’t felt they must apologise for Delacroix finding the North Africans he painted “exotic”. Cultural studies jargon screams from the wall. You can hear the lecturer inveighing against the “appropriating colonial gaze” – John Berger and Edward Said taking all the fun out of marvelling at what’s foreign and desirable. I find myself wondering where they’d stand on the Roedean cheer-leaders of Mumbai.

Taking leave of the senses

My wife drags me to a play at Age Concern’s headquarters in Bloomsbury. When I see where she’s taking me I wonder if she plans to leave me there. The play is called Don’t Leave Me Now and is written by Brian Daniels. It is, to keep it simple, about the effects of dementia on the families and lovers of sufferers. I am not, in all honesty, expecting a good time. It is a reading only, the actors sitting in a long line like a board of examiners, and the audience hunched forward in the attitude of the professionally caring.  My wife is a therapist so this is her world.

Here, unlike in my study, an educated empathy prevails and no one is furious. I fear that art is going to get lost in good intention. But the play turns out to be subtly powerful, sympathetic and sharp, sad and funny; and hearing it read engages me as seeing it performed might not have done. Spared the spectacle of actors throwing their bodies around and singing about their dreams against a backdrop painted by a lesser, Les Mis version of Delacroix, you can concentrate on the words. And where dementia is the villain, words are priceless.

Mixing with the proles

In Bloomsbury again the next day for a bank holiday design and craft fair at Mary Ward House. I have a soft spot for craft fairs, having helped run a craft shop once, and I feel a kinship with the designers sitting bored behind their stalls, answering inane questions about kilns and receiving empty compliments. But it’s the venue that steals the show, a lovely Arts and Crafts house, founded in the 1890s by the novelist Mary Ward with the intention of enabling the wealthy and educated to live among the poor and introduce them to the consolations of beauty and knowledge. We’d call that patronising. We’re wrong. It’s a high ideal, to ease the burden of poverty and ignorance and, in Ward’s words, save us from “the darker, coarser temptations of our human road”.

An Oscar-winning argument for Zionism

Speaking of which, I am unable to empty my mind of Ken Livingstone and his apologists as I sit in the cinema and watch the just-released Academy Award-winning Son of Saul, a devastating film about one prisoner’s attempt to hold on to a vestige of humanity in a Nazi death camp. If you think you know of hell from Dante or Michelangelo, think again. The inferno bodied forth in Son of Saul is no theological apportioning of justice or deserts. It is the evisceration of meaning, the negation of every grand illusion about itself mankind has ever harboured. There has been a fashion, lately, to invoke Gaza as proof that the Holocaust is a lesson that Jews failed to learn – as though one cruelty drives out another, as though suffering is forfeit, and as though we, the observers, must choose between horrors.

I defy even Livingstone to watch this film, in which the Jews, once gassed, become “pieces” – Stücke – and not grasp the overwhelming case for a Jewish place of refuge. Zionism pre-dated the camps, and its fulfilment, if we can call it that, came too late for those millions reduced to the grey powder mountains the Sonderkommandos were tasked with sweeping away. It diminishes one’s sympathy for the Palestinian cause not a jot to recognise the arguments, in a world of dehumanising hate, for Zionism. Indeed, not to recognise those arguments is to embrace the moral insentience whose murderous consequence Son of Saul confronts with numbed horror. 

This article first appeared in the 06 April 2016 issue of the New Statesman, The longest hatred