The sight of 20,000 medics protesting on Saturday 17 October filled me with cheer. The immediate issue is the threatened imposition in August 2016 of a new contract for junior doctors. This redefines evenings and Saturdays as part of the normal working week, with only basic pay. Safeguards that prevent hospitals overworking junior doctors will also be removed.
Over the past months, the Health Secretary, Jeremy Hunt, has employed various tactics to justify these changes. He tried to confuse the public by suggesting that most doctors do not work on Saturdays and Sundays. This provoked waves of #ImInWorkJeremy selfies across social media from every grade of medic from consultants down, all hard at it during their weekends on duty.
And then there was the suggestion that our hospitals are dangerously undermanned. Hunt seized on controversial research which seemed to imply that 11,000 people die annually merely as a result of being admitted at a weekend. Even a cursory reading of the paper, published in the British Medical Journal, shows up Hunt’s claim as the fallacy that it is. The apparent excess mortality is a complex issue, not least because patients admitted “out of hours” are predominantly those with serious illness.
The study explicitly warns that to assume these deaths are preventable – precisely what Hunt was asserting – would be “rash and misleading”.
It is a matter of shame that none of the paper’s authors (who include the medical director of NHS England, Bruce Keogh) has publicly criticised the minister’s misuse of their data. It has been left to doctors to challenge his behaviour, thousands co-signing a complaint to the parliamentary commissioner for standards. Anecdotal reports suggest that some patients who are gravely unwell have since been too fearful to seek help at the weekend because of the misinformation – an outcome that has been named “the Hunt effect”.
The NHS already delivers excellent urgent care around the clock, so what is the row actually about? The key is the phrase “seven-day service”. The NHS provides routine appointments on five days of the week (six in general practice). The rest of the time it deals with emergency cases. Demand for health care is rising. If you could get the NHS to provide routine care into the evenings and on Saturdays and Sundays, you would increase capacity significantly. Doctors’ leaders have consistently signalled that if this is what the government wants they will talk about how to provide it, but have warned that doing so safely would carry significant implications in terms of both recruitment and meeting the costs of the expansion.
But what if it could be provided within the current budget and staff complement? This is Hunt’s objective in reclassifying emergency duty periods. He is starting with junior doctors; new contracts for consultants, nurses, radiographers, laboratory staff and therapists will follow. A new GP contract to incorporate seven-day routine services has been signalled for April 2017. There will be no new resourcing. The aim is to squeeze up to 40 per cent more capacity out of what there is.
This will erode work-life balance, compromise existing weekday services, further stress overworked staff and allow a return to unsafe rotas. (Hunt states that no junior doctor will work more than 72 hours in a week; I did that in the bad old days, and it was not compatible with patient safety or personal health.) Such demoralising conditions will deepen the manpower crisis blighting specialties such as psychiatry, A&E and general practice, as well as nursing and the allied professions. The sustainability of the NHS is at stake.
Aneurin Bevan, the architect of the NHS, said that it “would last as long as there are folk left with the faith to fight for it”. Twenty thousand marchers – nearly half the juniors in the country, to say nothing of those who would have attended were they not working – suggests that there are plenty of us still committed to Bevan’s vision. Jeremy Hunt, beware.
Content from our partners
Related
This article appears in the 28 Oct 2015 issue of the New Statesman, Israel: the Third Intifada?