PMQs review: Cameron plays dirty on the NHS

Miliband accuses the PM of a "disgraceful slur" after he says the Mid-Staffs report was a "reminder of Labour's record on the NHS".

Since the publication of the Francis Report into the scandal at Mid Staffordshire NHS Trust, David Cameron, against the advice of some Tories, has chosen not to politicise the issue. But at today's PMQs, the first for five weeks, he dramatically changed tack. After Ed Miliband challenged him over the sharp rise in A&E waiting times, Cameron declared:

If anyone wants a reminder of Labour's record on the NHS, they only have to look at the report on Stafford hospital. 

His remarks were greeted with loud boos and cries of "shame" from Labour MPs but Tory backbenchers were visibly energised by the intervention (one that bears all the hallmarks of Lynton Crosby). A stunned Miliband replied by accusing Cameron of "a disgraceful slur on the transformation of NHS".  

What happened at Stafford was terrible, and both of us talked about that on the day, but what a disgraceful slur on the transformation of the NHS that took place after 1997 and on the doctors and nurses that made it happen.

But in a sign that the Tories intend to make a sustained effort to pin the scandal on Labour, Cameron ended his exchanges with Miliband by declaring that under a Labour government "all the problems that we have at the Stafford hospital will be repeated again." The political war over the NHS just got dirty. 

Cameron had earlier responded to Miliband's claim that he was presiding over an NHS "crisis" by referring back to Labour's decision not to pledge to ring-fence health spending at the 2010 election. "His answer is to cut NHS spending when we are investing in it," he declared. This is a strong line for Cameron; the Tories' chaotic reform of the NHS has made it even more important for him to emphasise that the coalition has protected health.

But unfortunately for the PM, it's no longer true (if it ever was). As I noted yesterday, in his biggest spending commitment since his election, Miliband has pledged that a Labour government would not cut the NHS. Today's exchange was a good example of why. Polls regularly show that health is the most popular area of spending with voters and Miliband has no intention of finding himself on the wrong side of public opinion on this issue. 

Cameron, who has already seen tomorrow's GDP figures (which will reveal whether the UK has suffered its first-ever triple-dip recession), give no hint as to their content or on whether the government would temporarily withdraw from the European Convention on Human Rights in order to enable the deportation of Abu Qatada. But a notable moment came when, in response to a question on benefits, he declared: "I find it extraordinary that heads are shaking opposite. I thought it was the Labour Party, not the welfare party." The line was an echo of what Labour MPs such as Frank Field and Simon Danczuk have said recently and will unsettle those in the party who believe that Labour has allowed itself to be characterised as soft on "benefit cheats". Expect to see it deployed regularly between now and the election. 

David Cameron leaves 10 Downing Street before Prime Minister's Questions. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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The proposed cuts to junior doctors’ pay will make medicine a profession for the privileged

Jeremy Hunt is an intelligent man with a first-class education. This makes his ill-fated proposed contract appear even more callous rather than ill-judged.

The emblem of the British Medical Association (BMA), the trade union for doctors in the UK, symbolises Asclepius, who was believed to be the founder of western medicine. Asclepius was killed by Zeus with a thunderbolt for resurrecting the dead. In the same way, the proposed government-led contracts to be imposed on doctors from August 2016 may well be the thunderbolt that kills British medical recruitment for a generation and that kills any chance of resurrecting an over-burdened National Health Service.

The BMA voted to ballot their junior doctor members for industrial action for the first time in 40 years against these contracts. What this government has achieved is no small feat. They have managed, in the last few weeks, to instil within a normally passive profession a kindled spirit of self-awareness and political mobilisation.

Jeremy Hunt is an intelligent man with a first-class education. This makes his ill-fated proposed contract appear even more callous rather than ill-judged. Attacking the medical profession has come to define his tenure as health secretary, including the misinformed reprisals on hospital consultants which were met not only with ridicule but initiated a breakdown in respect between government and the medical profession that may take years to reconcile. The government did not learn from this mistake and resighted their guns on the medical profession’s junior members.

“Junior doctor” can be a misleading term, as we are a spectrum of qualified doctors training to become hospital consultants or General Practioners. To become a consultant cardiac surgeon or consultant gastroenterologist does not happen overnight after graduating from medical school: such postgraduate training can take anywhere between 10 to 15 years. This spectrum of highly skilled professionals, therefore, forms the backbone of the medical service within the hospital and is at the forefront of delivering patient care from admission to discharge.

Central to the opposition to the current proposed contract outlined in the Review Body on Doctors' and Dentists' Remuneration is the removal of safeguards to prevent trusts physically overworking and financially exploiting these junior doctors. We believe that this is detrimental not only to our human rights in a civilised society but also detrimental to the care we provide to our patients in the short term and long-term.

David Cameron recently stated that “I think the right thing to do is to be paid the rate for the job”. This is an astute observation. While contract proponents are adamant that the new contract is “pay neutral”, it is anything but as they have tactfully redefined “sociable hours” as between 7am and 10pm Mondays to Saturdays resulting in hardest working speciality doctors seeing their already falling inflation-adjusted pay slashed by up to further 30 per cent while facing potentially unprotected longer working hours.

We acknowledge that we did not enter medicine for the pay perks. If we wanted to do that, we would have become bankers or MPs. Medicine is a vocation and we are prepared to sacrifice many aspects of our lives to provide the duty of care to our patients that they deserve. The joy we experience from saving a person’s life or improving the quality of their life and the sadness, frustration, and anger we feel when a patient dies is what drives us on, more than any pay cheque could.

However, overworked and unprotected doctors are, in the short-term, unsafe to patients. This is why the presidents of eleven of the Royal Colleges responsible for medical training and safeguarding standards of practice in patient care have publically stated their opposition to the contracts. It is, therefore, a mystery as to who exactly from the senior medical profession was directly involved the formation of the current proposals, raising serious questions with regard to its legitimacy. More damaging for the government’s defence are the latest revelations by a former Tory minister and doctor involved in the first negotiations between the BMA and government, Dan Poulter, implying that the original proposals with regard to safeguarding against unsafe hours were rejected by Mr Hunt.  

The long-term effects of the contract are equally disheartening. Already, hundreds of doctors have applied to the General Medical Council to work abroad where the market price for a highly trained medical profession is still dictated by reason. With medical school debts as great as £70,000, this new contract makes it difficult for intelligent youngsters from low-income backgrounds to pay back such debts on the modest starting salary (£11-12 per hour) and proposed cuts. Is medicine therefore reserved only for students from privileged backgrounds rather than the brightest? Furthermore, the contracts discourage women from taking time out to start a family. Female doctors form the majority of undergraduate medical students – we should be encouraging talented women to achieve their full potential to improve healthcare, not making them choose unfairly between work and family at such an early and critical stage of their career.

Postgraduate recruitment will therefore become an embarrassing problem, with many trusts already spending millions on hiring locum doctors. Most hospitals are not ready for Hunt’s radical reforms as the infrastructure to supply seven-day working weeks is simply not available. With a long-term recruitment problem, this would also be a toxic asset for potential private investors, should the health secretary venture down that path.

Jeremy Hunt has an opportunity to re-enter negotiations with the BMA to achieve a common goal of improving the efficiency and recruitment to the health service while protecting patient care. Although the decision for industrial action should never be taken lightly, as future leaders of clinical care in the UK, we will do everything in our power to defend against such thunderbolt attacks, by men playing god, the integrity and dignity of our profession and on the quality of care it delivers to our patients.