Omnishambles? It’s far worse than that.

It’s been a long week for the NHS in politics. The week opened with the announcement of further doctors strikes, three 48-hour emergency care only periods in two months, plus the launch of a legal enquiry into the imposition of the contract.

Jeremy Hunt’s and David Cameron’s argument  goes like this;
“Studies show we have excess death on the weekend because we do not staff our hospitals properly. We need to create a ‘7-day’ NHS to fix that, and this junior doctor contract is needed to do so. We are putting £10 billion into the NHS to achieve this.’

The government has spun a tight narrative over the last six months- but this week it began to unravel.

Firstly the most quoted ‘study’ it emerged last week was shown to the DoH and Jeremy Hunt before it was verified and published; a serious misdemeanour for both ministers and ethical research. David Cameron missed the point at PMQs, mixing up two studies from different years as ‘estimates’, and continuing to misrepresent both. Interestingly he claimed that the Freemantle study arose ‘based on a question asked by the Health Secretary of Sir Bruce Keogh‘. Did the Prime Minister just intimate the government commissioned its own research?

Staffing hospitals is a major issue it would seem- but not at the weekend, throughout the week. During a DoH public accounts committee meeting it became apparent that due to overzealous ‘efficiency’ targets trusts were told to reduce staffing. When this became unsafe they hired agency staff to fill the rotas leading to the £2.8 billion deficit this year
NHS chief executives are also concerned that trusts prioritise ‘quality’ over ‘costs’. In healthcare I think most people would do the same.

On top of this the BBC reported a 60% rise in vacant posts for doctors and a 50% rise for nurses in two years. With so little staff do the department of health think it safe to stretch the NHS to a ‘7-day’ service?
Well it would seem they haven’t thought about it at all. In the same PAC meeting it emerged the Dept of Health have no formal strategy for ‘7-day’ services; they don’t know how much it costs, they don’t know how contract changes will achieve it and they don’t know the impact it will have. That sounds very dry so let me characterise that.
You go to see your doctor feeling tired. She says “you have cancer and we must start treatment straight away.” You are rightly upset.
“How do you know?” You ask.
“Well there are significant ‘data gaps‘ in the judgement, it’s not just scientific fact you know, and we need ‘certainty‘ going forward so, yeah. But we must start treatment straight away- I don’t know how much it costs, what the treatment is, and it’s probably very damaging. To be honest, I have no idea. I’m ‘flying blind’ on this one, but I’m going to impose this treatment anyway, because I’ll get sacked if I don’t’.

So where did this contract come from, if the DoH hasn’t actually done the work that demonstrates its necessity?
In a great article that looks into its origins Steve Topple reveals a group of hospitals proposed taking advantage of a (disappearing) excess of doctors in training to drive down pay and conditions. The originators of that work now hold high level positions in the NHS administration.

Lastly, the money. The NHS needs £30 billion to maintain current standards by 2020. The government chose to make £20 billion of cuts to services and put in the least funding rise in the history of the NHS- 0.9%/year. This is the £10 billion in every Tory quote- that was only ever going to (try to) keep the lights on. Cameron thinks it will pay for a 7-day NHS, despite no one knowing what that will cost, and Hunt is paying for a ‘paperless’ NHS, 7-day services and who knows what else. The £20 billion in ‘cuts’ is already creating huge deficits in care- the £2.8 billion ‘deficit’ this year in trusts is a direct consequence of this political decision. Despite the governments insistence- the NHS is dangerously underfunded.

In a speech to the King’s Fund, Professor Don Berwick, US healthcare expert and former government patient safety advisor, agreed;  “I know no nation that is seeking to provide healthcare at the level that western democracies can at 8% of GDP, let alone 7 or 6.7. That may be impossible.”

Meanwhile the NHS crumbles- in a stage managed fashion as private companies come to collect. This is #cams7dayscam, and far from being an omnishambles it is a controlled demolition.

We need to make it clear to sitting MPs that this is a disaster that we will hold them personally accountable for, an issue that will make or break their political careers for years to come.

The NHS is nearly done- record waiting times, record deficits, record staffing gaps, record low morale. It needs more money and better leaders. We are desperate to get this message out: if you want the NHS to survive you must fight for it, because David Cameron and this government are going to destroy it if you don’t.

Join us on the picket lines March 9th and 10th.

Juniordoctorblog.com

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Imposition? This was never just about a contract.

Jeremy Hunt has gone nuclear and in a statement on 11th February announced forced contract imposition.

You may have heard the story of this dispute as told by Jeremy Hunt- it goes like this.
‘People have less good care at weekends in hospital, because junior doctors are not available. We should have a seven day NHS. We need more junior doctors on weekends but we can’t pay for this, so we will need to make it cheaper. We have to impose a contract to do this.’

This is mostly rubbish. juniordoctorblog explains the dispute so far.


 

Why aren’t there enough junior doctors at the weekend?
I personally work 1 in 4 weekends and nights already- every single patient admitted, 24/7, is seen immediately by a junior doctor – that might be the senior A&E registrar, or the general surgical or medical registrar. We have a ‘banding’ supplement that acts as a financial penalty to stop trusts rostering unsafe hours – trusts that breach this get fined, and therefore invest properly in hiring sufficient doctors to cover the rota. To suggest we don’t have junior doctors on the weekend is ludicrous.

Could there be more doctors on the weekend? Yes of course- but we don’t have many doctors to begin with; there are 2.8 doctors for every 1000 people in the UK- some of the lowest in Europe. There are also huge gaps where doctors should be already throughout the week- in A&E for example 1/8 training positions are empty, and GP posts are 1/3 unfilled. Applications for many training jobs continue to drop, and doctors increasingly migrate. This contract won’t create any more junior doctors.

So where will ‘more doctors on the weekend’ come from if there won’t actually be any more physical doctors?
Well, you could train more- but applications to medical school are dropping year on year, and this would take 7-10 years. You could hire more from abroad- but there are no plans to do this. The only place remaining is moving doctors from the week- leaving new gaps Monday to Friday, when activity and admissions are busiest. Due to imposition many doctors will also resign– meaning we have less doctors than we physically started with.

This doesn’t seem like a good idea.

Why is care less good at the weekend?
We are not sure it is. There been a few big studies that suggest patients admitted at weekends have a slightly higher risk of dying than those admitted during the week. Why this is nobody has researched. It might be the care in hospitals- but the same studies show patients already in hospital are less likely to die at weekends. It might have nothing to do with hospitals- patients are generally more unwell and more emergencies come in at the weekend- this could reflect less GP cover, less hospice access or longer delays coming in by patients- the truth is no one knows.

Is it worth finding out?
Absolutely- mostly because of the very large cost- both financially and in staff morale- in making huge changes without knowing if this would actually make care better and not worse. But this hasn’t been done. A summary of all the research done so far, if you are interested, is here.

What is a seven day NHS?
That’s a good question- no one really seems to know. David Cameron thinks it’s about having GPs 24/7. Jeremy Hunt says sometimes it’s about fixing the ‘weekend effect’ which is nearly exclusively emergency care, while other times it’s about routine care in hospitals. NHS management says it’s about emergency care and sets out 10 clinical standards – most of which are already nearly met, and none of which include junior doctors. So what exactly this means or why this is relevant to junior doctors- no one seems to know.

How is this going to be paid for?
Short answer- it isn’t. Long answer- the government announced an ‘extra’ £10 billion for the NHS in the autumn statement- and apparently this will pay for the 7-day NHS – although how it will pay for a service that no one knows exactly what it is I’m not sure. However- NHS trusts are running out of money trying to fund the services they already have- £2 billion in debt this year already. The NHS asked for £10 billion, which includes the £3 billion already announced, by 2020 just to keep the lights on- not to fund extended services. So – it isn’t being paid for.

Why can’t the government pay for more doctors at the weekend?
Well- we don’t spend a lot of money on healthcare. Currently 8.5% GDP– the lowest in the G7 amongst the lowest in Europe. By 2020 we will be paying 6.7% – amongst the lowest in the industrial world- nearly half what Germany spend, a third of what the U.S. Spends. There is therefore money available for the NHS but it is not being spent, and less and less is spent in relative terms every year. The government often say that a ‘seven-day’ NHS was a manifesto commitment, which is why it is so strange not to fund it properly. It’s not that they can’t pay for it, but they don’t want to.

Why did the government impose the contract?
They claim it was to end ‘uncertainty’ for August 2016- but there really is no reason the contract must be implemented by then. Talks have been going on for three years- contracts are reissued every August. It’s entirely political- to look ‘muscular’, to keep ‘political capital’. Nearly no one supports imposition other than NHS bureaucrats- the Royal Colleges, NHS Trust Executives and the entire medical workforce are all opposed.

So to summarise the government want to take away financial safeguards and cut pay at weekends to fix a problem we are not sure is either fixable or genuinely a problem but we do know will cost a lot of money that isn’t being invested and won’t actually be fixed because we still don’t have any more doctors- probably much less now.

Which doesn’t make sense.

So why do it?
Well the contract actually has many other advantages to the government – it increases pension contributions, and reduces the doctor wage bill to hospitals. It also means lucrative routine work can be done cheaply on the weekends, and for generations to come doctors will cost less. This is the real reason the government want this contract to happen- it will make the system much more attractive to private companies.

What’s going to happen now?
After the junior doctors the same terms will go to the consultants, the GPs, the nurses and the other health professionals.

And then?
In all seriousness- the end of the NHS. A beleaguered system which has been underfunded for years, with huge gaps in many areas, is now being squeezed one too many times.
The junior doctors have been trying to tell you that the NHS is in desperate trouble – not just from this contract alone, but as the start of a succession of workforce changes.
Private companies have taken 500% more contracts in the past year, the head of the NHS is a former U.S. Healthcare company executive, the last health secretary now works for a private health company having changed the law to make it far easier for private companies to get NHS contracts, and the current health secretary wrote a book idealising the privatisation of the NHS. 

With this latest development NHS morale will be even lower, and private companies will welcome the chance to ‘improve’ pay and conditions for staff.

What can I do about it?
If you want a free at the point of service public health system, where your taxes fund an efficient and equitable health service that you never have to worry won’t be there for you or your family, then you need to read this and understand. If we do nothing, by 2020 there will be no NHS.

Write to your MP- and tell them this is the single issue you will be voting on. Don’t accept anything less than the truth- you know now what is at stake.

Educate yourself more; read more about the health service, the contracts, the challenges it faces.

Sign this petition. Join up to local save your hospital groups and support their events.

Come to the junior doctor protests- I would love to talk to you.

Keep writing, come to protests, add your voice to every gathering, every social media group, every local council meeting.

Get on a box and shout as loud as you can. This is what democracy should be. Let’s hope it’s not too late.

I am ashamed to say Nye Bevan encountered incredible resistance from doctors at the beginning of the NHS. But that’s not the generation of doctors we have today- we all grew up with the NHS, most of us were born in it, and we all want to defend it as long and as fiercely as we can.

We can’t do it without your help.

Juniordoctorblog.com

Exhausted? Of course I am.

imageJeremy Hunt’s strategy now is to exhaust the junior doctors.” Guardian 1/2/16

I am, like many of my colleagues, indeed, exhausted.

I’m exhausted of going to work to find huge gaps in the rota where doctors used to be, where nurses used to be, where physiotherapists and OTs used to be. I’m tired of never seeing a contract, never being able to plan to see my family. I’m exhausted by the deaf ears of faceless administrators.

I’m tired of endless top-down reorganisation, target-chasing and publicity managing. I miss looking after patients. I miss training to be a better doctor.

I’m exhausted by the media. I was on BBC radio during the last strike, and a rather hostile presenter asked me “Why are you on strike? Why aren’t your doing your job”. I gave a PC, measured answered. But what I wanted to say was this ; “I’m striking today to protect the long-term health of patients. That’s my job. But what about you and your fellow ‘journalists’? Are you doing ‘your job’? When a Secretary of State and Prime Minister can say anything and it is reported verbatim; unscrutinised,unchallenged and uninvestigated? When they can lie about stroke care, perinatal care, weekend hospital care, consultant cover, NHS funding, NHS safety and privatisation and not a single journalist will take the time to report the utter lack of credibility on any health issue in any way? I’m doing my job to the best of my ability- are you doing yours?”

Sigh.

I’m exhausted by the politics and the endless endless lies and spin. I’m tired of having to counter the same propaganda ad nauseum. A ‘seven-day NHS’ sounds great- but what is it? Is it urgent emergency care? We already have that. Is it routine care? We don’t need and can’t afford that- not when the NHS has never been poorer. Can we make it better? Of course- but we need investment, policy based on evidence not sentiments. Should I go to hospital at the weekend? Emphatically, categorically and unreservedly YES.

I’m sick of noxious columnists pumping out toxic nonsense; d’Ancona, Baxter, Lawson, Vine…the cogs of the Tory spin machine are many, and they are all dirty.

Most of all I’m exhausted by fighting for an NHS on the brink of destruction- and the public remains wholly unmoved. When you go to the doctor and she tells you something is seriously wrong- how do you respond? Do you then go to the Daily Mail to fact check it? Do you ask for a balanced opinion from a government think tank, deeply invested in privitization? I’ll declare my vested interest right here; I’m a junior doctor and I think the NHS is the best healthcare system for my patients- in equity, in outcomes, in value for money. Now the junior doctors are striking, the GPs are resigning, the consultants are halfway between both. The student nurses are striking, the staff nurses are planning, and pharmacies are closing. Meanwhile NHS services are already being sold- to Virgin, Circle, TDL. Domestic and domiciliary have been private for years already. PFI hospitals are £80 billion in debt for £10 billion of services – does that sound efficient to you?

The end of the NHS is here- not in five or ten years, but here, now, collapsing from August. Do you really believe this government is ‘the party of the NHS?’

Did you vote for this? Did you look at the Tory manifesto and read the pledge ‘Seven Day NHS’ and think- “That’s got my vote, now bulldoze the thing and where’s that private health insurance brochure?”

We haven’t explained ourselves properly and for that I wholeheartedly apologise. The junior contract is simply a means to make lucrative weekend work cheaper, and reduce the pay bill and pension bill on hospitals for private takeover. There really is no other reason to do what the government are doing. They don’t care about the safety of patients- they’ve cut hospital budgets in relative terms the deepest in NHS history, we have less doctors and spend less % GDP on healthcare than most of Europe, and they tried to suppress reports on safe staffing levels for nurses. They don’t even care about ‘balancing the books’- the NHS will be £2 billion in debt this year. The national debt in 2007 was £500 billion, now it’s £1.6 trillion. In 2007, the deficit was £41 billion – now it’s £90 billion. I hear your cries of ‘the financial crash’. Exactly- and here is the cost- years of private debt generated by illegal banking practices absorbed into the public purse. Banking and corporate tax evasion remain unchecked. The NHS and every other public service for sale. It’s a crime too huge to see.

I’m exhausted. Yes. And alone, perhaps, defeated. But I’m not alone. 250,000 doctors in this country, 400,000 nurses, 150,000 allied health professionals. 19 million families. 66 million people.

Dear other normal human beings, join us, and help save our NHS, if we can.

Second Junior Doctor’s Protest, Saturday 6th February, 12.00 Waterloo Place, London

Second Junior Doctor’s Strike, Wednesday 10th February, picket lines at every local hospital.

juniordoctorblog.com