Today Jeremy Hunt announced a return to imposition. He justified this despite an emphatic rejection of the contract by 58% of the referendum voters, to end the ‘impasse’ after three years and failing to agree a contract.
But the one question no one has answered for me is “what is the rush?”
Now the government would argue that they are keen to get on with their ‘seven day NHS plans’, despite the fact that the NHS is about to announce even greater spending cuts, George Osbourne has abandoned his surplus target for 2020, and record number of staff gaps for doctors and nurses are being recorded. Categorically, there is no plan for a seven day NHS, vis a vis there is no seven day NHS. What did we get instead? “Junior doctors are now a third cheaper”. There aren’t any more doctors- in fact many have now fled for Australia and Scotland. So no more doctors on weekends- just a third cheaper.
And whatever happened to the ‘weekend effect’- suddenly missing from what was core Hunt go-to doctrine? Well new evidence has dispelled this effect, making it more an artefact of how dodgy data was collected, and subsequently misrepresented. We’ve covered this before. Put simply- there’s no weekend effect for this contract to address.
And even if there were, junior doctors already work 7 days a week, no study ever linked junior doctor staffing to any ‘effect’ and the one study Jeremy likes to quote actually found 100% medical coverage across every day of the week. So this contract fight arose from a political position that has since crumbled away.
So what’s the rush? What’s the benefit of imposing a contract, which is legally fraught, onto a highly mobile professional body, highly
Motivated already to leave?
Now the government might turn back and say- well it’s been three years, and we still haven’t got anywhere.
Be that as it may- but why can’t it be three more years? If this was genuinely all about making patients safer, which it certainly doesn’t now, then why not take the time to actually achieve that?
Let me tell you about the contract. It is going to cover every NHS England hospital- so every patient in England will be affected.
The central Guardian role for protecting doctors from exhaustion, a key concern about this contract, has been rushed through in weeks- but practically no planning has been done.
Some hospitals have recruited this role for a mere 4 hours per week, looking after 1200 doctors. That’s just 12 seconds a week per trainee. Is that sensible or practical?
There is no plan for how human resource departments will be able to cope with the sudden ten-fold increase in complexity in the pay and rostering schedules, nor any plan for how educational supervisors, busy doctors in their own right, are now expected to take on a huge additional workload, another key part of safety completely mismanaged.
We don’t have an effective means of whistleblowing without getting sacked. Put simply- if I find a horrendous breach of patient safety neglected by my hospital management, and blow the whistle to protect patients, I can be sacked from my training post with impunity. Is that a good thing?
Lastly negotiations were still in progress to address the key discriminatory parts of the contract. As it stands it still will mean the careers of female medics are more difficult Than they are now. We are bleeding staff and resources in the NHS- what is the possible benefit of rushing a contract through that will lead to fewer doctors on shift, not more? Is that good for patients or staff or anyone at all?
You might argue that the BMA agreed this contract, and therefore it’s okay to impose it. Which is a rather paradoxical argument from just a few months ago when we were told the BMA were misleading us, now we should blindly follow?
Certain social media commentators ardently claim we are naive and childish. We are a group of people with an average of two university degrees each, twenty plus years of education, an average age of around 33, and many of us mothers and fathers ourselves.
We understand perfectly.
We understand the rush is a political expediency- politically this needs to be out of the news cycle, politically it needs to be off the front page, politically this needs to be out of the next election cycle. But I’m sorry, we aren’t creatures of politics.
We are doctors responsible for human lives; and we see a contract that will push more of our colleagues away from the bedside, stretch the doctors that remain, and leave no means to correct continued unsafe working. I’m not exaggerating when I say this contract imposition may hasten the end of the NHS, and has the very real potential to kill people. It’s not a decision we take lightly or naively. It’s also not a decision or negotiation to rush.
So Mr Hunt, I ask you again: what is the rush?
Work with us for a year to improve the safety mechanisms we have, to retain less than full time staff, to restore the morale and hope of us all. You keep telling us we are the ‘backbone of the NHS’. You are about to break it.
You don’t need a doctor to tell you that’s a rather fatal idea.