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We need to talk about Jeremy: why doctors are so angry with Jeremy Hunt

Jeremy Hunt is at the centre with another row with the medical profession. What's going on?

The long summer break can’t have come too soon for Jeremy Hunt. In the last 10 days alone, two separate waves of vitriol from the medical profession have come crashing down on him, and as he scarpers off to sun himself he must be wondering what type of mood he’ll be coming back to.

First there was the #Iminworkjeremy campaign, a fierce rebuttal of Hunt’s attack on the BMA over consultants’ supposed unwillingness to work seven days.

This must have seemed like a breeze though, compared with the last week’s bruising.  Cue #weneedtotalkaboutjeremy, an even angrier backlash sparked by the government’s response to a petition which has gathered more than 200,000 signatures (and rising), calling for a debate of no confidence in the Secretary of State. The reply was meant to silence the mob – it’s had the opposite effect, and been branded as “manipulative and misleading” by Dr Hamed Khan who I know speaks for many doctors out there.

The whole saga has yet further uncovered a bitter divide, a growing rift between the Secretary of State for Health and the medical profession.

Yes, the government’s response to the no-confidence petition made the valid point that reports by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHSPRB) both cited consultants’ rights to opt-out of weekend and evening work as something needing to be examined.

But somehow that seems beside the point – the anger it sparked certainly suggests it is. It’s at best tactless, at worst downright insulting to effectively blame consultants – the vast majority of which do work weekends by the way – for 6,000 deaths a year without proper proof.

Especially when you’ve just handed them another four years of pay-freeze; when you’ve already incensed a straitened profession by shrugging off doctors who tell you that they see dangerous levels of understaffing before their eyes; and when you’ve compounded their stresses and strains by cutting social care and public health funding.

And it’s certainly not very dignified when you’ve just gone back on a key manifesto pledge to cap social care costs.

One of the organisers of the campaign, GP Dr Zoe Norris, a founder of General Practitioners pressure group GP Survival, told me that the handling of the seven-day policy was just the final straw.

She said: “This is one in a long litany of reasons we don’t have any confidence in Jeremy Hunt being in charge of the NHS. We were massively disappointed with the government’s response to the survey; it was standard churn, it didn’t say anything about Hunt himself or the no-confidence vote”.

The issue may resurface – Andy Burnham has pledged to press for a debate on the no-confidence vote in the new parliament – but for the time being the profession will have to grin and bear it.

What Hunt seems unwilling to even acknowledge is that the medical profession is unanimously behind the idea of working in a seven-day service – most of them already do – they just want to make sure it’s properly run and resourced.

So to claim that what’s really stifling a proper 24/7 service is the professionals who graft in the hospitals often well beyond their contracted hours, rather than five years of under-funding and disruption, is plain scapegoating.

As Dr Norris tells me: “Seven day working is something we aspire to, but what Hunt’s trying to do is push it through with inadequate staffing and resources as a political priority without demonstrating any commitment to patient care”.

If you’re going to slap down the profession you’re in charge of, expect to be slapped back. And when it’s a profession as dedicated and well-informed as medicine, expect it to be a pretty sturdy slap.

The uproar isn’t coming from a hysterical social media mob - it’s a forensic attack by people who know what they’re talking about, with an abundance of facts, figures, evidence and counter-evidence.

Within the conversation there’s GP Survival’s detailed challenge of the government’s response and Hunt’s claims on the heightened death rates, and a point-by-point account of exactly why many have so little confidence in him.

There is this robust retort by a trainee doctor, a damning open letter to David Cameron from a dejected junior doctor, and an impassioned video blog by a nurse.

An investigation in the BMJ behind the facts Hunt relied on; this no-holds-barred critique of the whole policy by Mark Exworthy at the University of Birmingham; an international comparison which shows the ‘day-of-the-week-effect’ is almost universally recorded.

There is this study by the Manchester Centre for Health Economics which even questions the economic soundness of implementing a seven-day service, going as far as saying that there is “no clear evidence that seven-day services will reduce weekend deaths or can be achieved without increasing weekday deaths”.

Very revealing indeed is GP Survival’s own research into weekend work patterns based on FOI requests to NHS trusts. The findings are still coming in, but of 13 acute trusts to have responded in full so far, only one consultant out of 3,755 is on record as having opted out of non-emergency weekend work - there is no opt-out for emergency work, a fact somewhat overlooked.

Saddest of all, there is tweet after tweet from disheartened junior doctor and medical student, questioning whether they should go any further in these early steps of their careers.

Even by Jeremy Hunt’s standards of flying in the face of doctors’ and nurses’ opinions, this, plus the 200,000 strong petition, is a lot to go against.

On July 16th Dennis Skinner said of Hunt that “doctors and nurses do not trust him – it is time he got out”. He’s not the only one calling time. We shall see whether he manages to keep flying through the summer and into the new Parliament – many, including me, were surprised he was reappointed at the DoH in May.

In the mean time GP Survival is building support, and Dr Norris says the aim now is to take its campaigning message beyond the Twittersphere and straight to patients.

Jeremy Hunt might be willing to make enemies of doctors and nurses, but voters are another thing when you’ve only got a majority of 12 MPs. And with even NHS England now saying that funding is falling short, and more cuts to local authorities on the way, pressure is mounting. 

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.

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Brexit could destroy our NHS – and it would be the government's own fault

Without EU citizens, the health service will be short of 20,000 nurses in a decade.

Aneurin Bevan once said: "Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community."

And so, in 1948, the National Health Service was established. But today, the service itself seems to be on life support and stumbling towards a final and fatal collapse.

It is no secret that for years the NHS has been neglected and underfunded by the government. But Brexit is doing the NHS no favours either.

In addition to the promise of £350m to our NHS every week, Brexit campaigners shamefully portrayed immigrants, in many ways, as as a burden. This is quite simply not the case, as statistics have shown how Britain has benefited quite significantly from mass EU migration. The NHS, again, profited from large swathes of European recruitment.

We are already suffering an overwhelming downturn in staffing applications from EU/EAA countries due to the uncertainty that Brexit is already causing. If the migration of nurses from EEA countries stopped completely, the Department of Health predicts the UK would have a shortage of 20,000 nurses by 2025/26. Some hospitals have significantly larger numbers of EU workers than others, such as Royal Brompton in London, where one in five workers is from the EU/EAA. How will this be accounted for? 

Britain’s solid pharmaceutical industry – which plays an integral part in the NHS and our everyday lives – is also at risk from Brexit.

London is the current home of the highly prized EU regulatory body, the European Medicine Agency, which was won by John Major in 1994 after the ratification of the Maastricht Treaty.

The EMA is tasked with ensuring that all medicines available on the EU market are safe, effective and of high quality. The UK’s relationship with the EMA is unquestionably vital to the functioning of the NHS.

As well as delivering 900 highly skilled jobs of its own, the EMA is associated with 1,299 QPPV’s (qualified person for pharmacovigilance). Various subcontractors, research organisations and drug companies have settled in London to be close to the regulatory process.

The government may not be able to prevent the removal of the EMA, but it is entirely in its power to retain EU medical staff. 

Yet Theresa May has failed to reassure EU citizens, with her offer to them falling short of continuation of rights. Is it any wonder that 47 per cent of highly skilled workers from the EU are considering leaving the UK in the next five years?

During the election, May failed to declare how she plans to increase the number of future homegrown nurses or how she will protect our current brilliant crop of European nurses – amounting to around 30,000 roles.

A compromise in the form of an EFTA arrangement would lessen the damage Brexit is going to cause to every single facet of our NHS. Yet the government's rhetoric going into the election was "no deal is better than a bad deal". 

Whatever is negotiated with the EU over the coming years, the NHS faces an uncertain and perilous future. The government needs to act now, before the larger inevitable disruptions of Brexit kick in, if it is to restore stability and efficiency to the health service.

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