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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Will Euroscepticism prove an unbeatable advantage in the Conservative leadership race?

Conservative members who are eager for Brexit are still searching for a heavyweight champion - and they could yet inherit the earth.

Put your money on Liam Fox? The former Defence Secretary has been given a boost by the news that ConservativeHome’s rolling survey of party members preferences for the next Conservative leader. Jeremy Wilson at BusinessInsider and James Millar at the Sunday Post have both tipped Fox for the top job.

Are they right? The expectation among Conservative MPs is that there will be several candidates from the Tory right: Dominic Raab, Priti Patel and potentially Owen Paterson could all be candidates, while Boris Johnson, in the words of one: “rides both horses – is he the candidate of the left, of the right, or both?”

MPs will whittle down the field of candidates to a top two, who will then be voted on by the membership.  (As Graham Brady, chair of the 1922 Committee, notes in his interview with my colleague George Eaton, Conservative MPs could choose to offer a wider field if they so desired, but would be unlikely to surrender more power to party activists.)

The extreme likelihood is that that contest will be between two candidates: George Osborne and not-George Osborne.  “We know that the Chancellor has a bye to the final,” one minister observes, “But once you’re in the final – well, then it’s anyone’s game.”

Could “not-George Osborne” be Liam Fox? Well, the difficulty, as one MP observes, is we don’t really know what the Conservative leadership election is about:

“We don’t even know what the questions are to which the candidates will attempt to present themselves as the answer. Usually, that question would be: who can win us the election? But now that Labour have Corbyn, that question is taken care of.”

So what’s the question that MPs will be asking? We simply don’t know – and it may be that they come to a very different conclusion to their members, just as in 2001, when Ken Clarke won among MPs – before being defeated in a landslide by Conservative activists.

Much depends not only on the outcome of the European referendum, but also on its conduct. If the contest is particularly bruising, it may be that MPs are looking for a candidate who will “heal and settle”, in the words of one. That would disadvantage Fox, who will likely be a combative presence in the European referendum, and could benefit Boris Johnson, who, as one MP put it, “rides both horses” and will be less intimately linked with the referendum and its outcome than Osborne.

But equally, it could be that Euroscepticism proves to be a less powerful card than we currently expect. Ignoring the not inconsiderable organisational hurdles that have to be cleared to beat Theresa May, Boris Johnson, and potentially any or all of the “next generation” of Sajid Javid, Nicky Morgan or Stephen Crabb, we simply don’t know what the reaction of Conservative members to the In-Out referendum will be.

Firstly, there’s a non-trivial possibility that Leave could still win, despite its difficulties at centre-forward. The incentive to “reward” an Outer will be smaller. But if Britain votes to Remain – and if that vote is seen by Conservative members as the result of “dirty tricks” by the Conservative leadership – it could be that many members, far from sticking around for another three to four years to vote in the election, simply decide to leave. The last time that Cameron went against the dearest instincts of many of his party grassroots, the result was victory for the Prime Minister – and an activist base that, as the result of defections to Ukip and cancelled membership fees, is more socially liberal and more sympathetic to Cameron than it was before. Don’t forget that, for all the worry about “entryism” in the Labour leadership, it was “exitism” – of Labour members who supported David Miliband and liked the New Labour years  - that shifted that party towards Jeremy Corbyn.

It could be that if – as Brady predicts in this week’s New Statesman – the final two is an Inner and an Outer, the Eurosceptic candidate finds that the members who might have backed them are simply no longer around.

It comes back to the biggest known unknown in the race to succeed Cameron: Conservative members. For the first time in British political history, a Prime Minister will be chosen, not by MPs with an electoral mandate of their own or by voters at a general election but by an entirelyself-selecting group: party members. And we simply don't know enough about what they feel - yet. 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog. He usually writes about politics.