“There’s not a lot of sense from government right now.”

Ben White, junior doctor, campaigner of NHS no. 1At Xmas and Justice for Health, quit his training job on national television this morning.

In his response something he said resonated with me- “there is not a lot of sense from government right now.” To my mind this phrase  encapsulated the whole dispute.
Ahead of the first full NHS junior doctor walk-out in history now seems a good time to document the completely insane handling of the process.
The ‘Weekend Effect’

Supposedly this all started with Hunt and colleagues ‘discovering’ that patients admitted at weekends had a slightly higher chance of death than weekdays. This whole concept has taken a rightful battering;

What we know about this now is:

– The study was commissioned by government

– The independence of key authors is questioned

– The study showed no link to junior doctor cover

– Pending studies of the same data may show no ‘weekend effect’ at all

– It’s likely sicker patients are not properly adjusted for

– It’s a phenomenon seen worldwide, which no health system has been able to understand or ‘fix’

– The study concludes its unlikely this ‘effect’ is actually avoidable
So, not a great start. From this starting point, we are told, the government began the drive for a ‘Seven Day NHS’
The Seven Day NHS 

A ‘back of the envelope’ idea from the last conservative manifesto.
– originally led by Sir Bruce Keogh

– The actual plan was originally to improve urgent and emergency care, then create elective work throughout the week

– All heads of the NHS said this would require additional funds, staff and years of planning, outside of additionally needed funds to keep NHS going at current service

– A ten-point survey of ‘Seven Day’ criteria found medical cover at 100%, while most other services were between 50-60%. The cut off for finding a service “7-day NHS” ready was 70%. So nearly there without any massive reorganisation required.

– The 7-day NHS criteria desperately fell down on social care and mental health- both areas savagely cut by this government

– Hospitals touted as already ‘7-day’ like Salford Royal, have neither routine elective weekend work or a new contract. They did however spend additional funds and recruit extra staff.

– After a year of ‘7-day’ NHS policy speeches, NHS strategy head Charlie Massey revealed they didn’t know how much it would cost, how many staff would be needed, or what it was. He was told he was ‘flying blind’ on the issue

– A leaked report from the DoH showed that it would need 4000 extra doctors, funding of£0.9 billion/yr or £3.6 billion by 2020, and likely would not change the ‘weekend effect’.
So, you are a government in power- you misidentify a problem, create a nonsensical plan to try to fix said likely unavoidable problem, don’t fund it, plan for it or cost it, and then try to improve upon the existing 7-day cover for doctors, already at 100%, while ignoring the huge 7-day service gaps in social care and mental health that are a genuine problem.
Make any sense so far? No? It gets worse.
The Junior Doctor Contract

Into this mess was ‘imposed’ this new contract.

What we now know about this:

– it will cut pay for junior doctors coming into the system from August, and all doctors by 2019.

– It removes all previous safeguards on overworking doctors, and removes ‘real-terms’ fines for hospitals who make illegal rotas, replacing the system with part-time guardians schedules to work just 4 hours/week.

– Cass Business school said the proposed rotas under the contract risked jet lag, and may ‘breach employer duty of care’

– Remember no study showed junior doctor cover at any time was lacking already

– The contract discriminates against women and parents, by the governments own admission

– The legal power to impose is being challenged in court

– Negotiations have been ongoing for three years- there is no pressing need for new contracts

– This contract is completely untested and unmodelled- trusts need more doctors to implement it safely as it is

– A ‘junior doctor’ is any qualified doctor up to consultant level, 10-12 years of working. There are ‘junior doctors’ who have been doctors longer than Jeremy Hunt has been an MP.

– The contract began as a cost cutting exercise amongst a group of NHS execs in the south west
This has to have been one of the most damaging instruments of government policy in NHS memory. So if this contract won’t fix the problem that may not be a problem and actually ignores the real issues in the NHS, then one has to ask, why bother? Does it make sense to any of you?

The NHS

The NHS is in real peril. Here is a rundown.

– The government ‘promises’ ten billion pounds over 5 years. This would push NHS funding LOWER in the OECD %GDP tables than it is now- to 6.7% which is lower than nearly all of Europe. France and Germany spend 11.1%, the US nearly 18%.

– Prof Don Berwick, former NHS safety tsar, said ‘I know of no country attempting to fund modern healthcare on 8% GDP, let alone 6.7%.’

– This is because NHS costs rises every year – this is called health inflation.

– If you cut funding, you don’t treat patients promptly and properly, they get sicker, and it costs more

– This creates a vicious cycle- where we are now

– Waiting times in A&E are at an all time high

– Hospital Trusts this year will reach a record £2.8 billion in the red- this is because hospitals refused to cut staff to save money, and overspent the budget from The government to keep patients looked after.

– GPs received 12% funding of NHS budget in 2010- this fell to 8% this year. With the government new plan of £2.4 billion this will still be only 10% by 2020.

– Recruitment and retention for medical and nursing staff is in trouble with rising vacancies

– An A&E in Lancashire closed last week because of a lack of doctors

– Meanwhile private companies are buying up services. 500% increase last year alone.
So is the solution to this mess increasingly aggressive political posturing, imposing a contract that is destroying morale, in a bid to fix a problem that doesn’t exist through a programme that doesn’t have a budget or a plan?! Rearranging the deck chairs on the Titanic isn’t even half of it. This is insane.
So when Ben White says “the government isn’t making a lot of sense” that’s TV politeness for – this government has lost all sense of governing. Whether that’s incompetence or incomprehension of the massive danger the service and the patients are now in, it’s hard to tell.
You might think that the strike tomorrow is extreme, but when faced with such an extreme scenario, what else can we do? A sensible offer of proper research and a trial of the new contract was put on the table yesterday by a cross-party group of MPs. The first sensible thing government has done for the NHS in years.

And of course rejected out of hand by Messrs Hunt and Cameron.
This is madness, not from junior doctors, but from a government set to destroy the NHS.
I think it’s time to send in the people in white coats. We are outside your doors Messrs Hunt and Cameron, a quiet word please?
Juniordoctorblog.com

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6 Comments

  1. Please also emphasise that reduced wage bills and extended elective services are required to make the NHS attractive to the US insurance private healthcare companies waiting in the wings looking for a foothold in the UK then Europe. This is not government not making sense it’s a government with a plan.

  2. The problem I have is both sides are lying – I don’t think junior doctors will truly get public sympathy as long as they’re claiming they’re living in poverty….

    It’s frankly absurd to say Junior Doctors start on £22k a year, when they make another £20k in “top ups” and bonuses……

    I think if you were actually honest and said:

    “we don’t think £40k+ a year, starting salary, is acceptable for junior doctors”

    your campaign would quickly fall apart.

    So to conclude, both sides are as bad as each other. And I’m under no doubts that the current contract dispute, is probably mostly about money. And retaining the lucrative system you have at the moment

    1. Matt, I really don’t think that the public see junior doctors as overpaid. Government-influenced media trying to make look that way, however….

      The system is broken as it stands, but don’t see why any doctor should sign up to an untested new system that promises to take away any social time they once had, and place them at the beck and call of managers struggling with understaffed hospitals.

      DOI: was a junior doctor, and did earn 22K in my first year. No ‘topups or bonuses’. Living up north it was OK at the time. Really don’t understand how anyone would be an NHS doctor down South though, given the cost of living.

  3. Matt, I really don’t think that the public see junior doctors as overpaid. Government-influenced media trying to make look that way, however….

    The system is broken as it stands, but don’t see why any doctor should sign up to an untested new system that promises to take away any social time they once had, and place them at the beck and call of managers struggling with understaffed hospitals.

    DOI: was a junior doctor, and did earn 22K in my first year. No ‘topups or bonuses’. Living up North it was OK at the time. Really don’t understand how anyone would be an NHS doctor down South though, given the cost of living.

  4. Referring back to Dr. Alasdair’s comments – this is not about pay. It is a chosen fight in the government’s plan to destroy our NHS by the end of this parliament. The NHS logo will remain as a fig leaf to be used by every privateer seeking profit from our taxes. United Health etc are just waiting for our system to be sufficiently broken to step in and privatise for profit wherever they can leaving a rump service to pick up their mistakes and cater for long term, unprofitable illnesses. Why we are not all out on the streets in revolt is beyond me. See you on the doctor’s picket lines tomorrow and Wednesday.

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