The Health Secretary’s pitch is that the same number of doctors with a lower limit on maximum hours provide the same level of care across more days. Something has to give.
Junior doctors are upset with Her Majesty’s Government because it hasn’t been honest about its motivations surrounding this dispute. There are a number of minor omissions from the Government’s case for a seven-day NHS, such as the fact that patients are more likely to die on a Friday than, as the Government claims, a Saturday or Sunday. Seven-day services will cost anadditional £1 billion pounds a year. Trials have shown that the theory of patients wanting weekend access to a GP and the reality don’t match. Increased recruitment of doctors and nurses requires expansion of university places which will take years to have full effect. Hospitals like Salford Royal Hospital, which Jeremy Hunt lauds as a model of seven-day care, provide it within the current contract model. So why can’t other hospitals just copy what Salford are doing and save doctors and the general public all this hassle?
The answer is simple – cost-saving. Salaries are a significant part of the NHS budget and a tempting place for George Osborne to look to pinch some pennies. Aware of the economic pressures when negotiations started, the British Medical Association agreed to a cost-neutral salary budget. This fact is remarkable from a trade union and often ignored – doctors agreed not to ask for a pay raise. Whilst the imposed contract is cost neutral now, the change to the rates of Saturday pay means that in the long-term it will eventually become cost-saving for the Treasury. It is revealing what Jeremy Hunt says in the House of Commons. Here he has to be choosy with his words for fear of being reprimanded for misleading Parliament. He previously refused to deny that he rejected a cost-neutral offer from the BMA. One can only speculate as to why.
The irony of the imposed contract is that it adversely affects medical specialties that have significant shortages already. This problem was acknowledged in the report that was the basis for the imposed contract. Emergency medicine (A&E) has one of the highest attrition rates, of junior doctors, of any specialty – 50 per cent leave before completion. Training posts in Paediatrics lie empty, with an increasing number of doctors breaking the limits for safe working hours. Psychiatry is so short of junior doctors that it is on a Government list of shortage occupations. No wonder three-quarters of the recent rise in NHS locum costs was simply due to an increased need of manpower.
Now, of course pay is a consideration in this dispute for doctors. Shifting pools of money around in a zero-sum game inevitably means there are junior doctors that will lose out. A rise in basic pay means a loss in pay elsewhere. It is why the Government has promised pay protection for doctors until 2019, delaying this financial hit. Nonetheless, this dispute is also about safety. The fact that doctors have bills to pay does not make pay and safety mutually exclusive issues.
For most, safety is the most perilous issue. The quandary doctors have is a paradox. A key piece of evidence that influences this belief is also the weakest – anecdote. Many doctors are leaving the NHS. I know plenty of doctors who have left the NHS for the private sector and the Antipodes. Even Sarah Wollaston’s daughter and her mates have left. I can tell you that the vast majority doctors I speak to have similar stories. That said, I can completely understand why some would suggest that doctors are merely scaremongering when they divulge such stories.
Nonetheless, the question here is “what if”? What if these 54,000 junior doctors are right? What if imposition does lead to doctors abandoning certain specialties or leaving the NHS? You really wouldn’t need many doing so to create a serious problem. That is the gamble that George Osborne and Jeremy Hunt are willing to take. Is this bet appropriate when the number of junior doctors continuing training shortly after finishing medical school is down to 52 per cent in 2015 from 71.3 per cent in 2011? Is it appropriate when General Practice had an unprecedented third round of recruitment last year as they could not fill training placements? Is it appropriate when hospitals have already been forced to reduce the number of doctors covering wards at night due to staffing shortages?
Regardless, of the above I feel Mr Hunt should keep his job. First, sacking him only serves to create a sacrificial lamb. It doesn’t change the puppeteers in Number 10 and 11 Downing Street. Secondly I think it would be a travesty if someone else was left to solve Mr Hunt’s mess. It is simply common courtesy to clean up after oneself, and certainly uncouth for Mr Hunt to become Foreign Secretary or move on to the Lords and be deprived of the opportunity to do the honourable thing.
The reason I am personally convinced that there will be a mess for someone to clean up is Mr Hunt’s sales pitch on the qualities of the contract he has put forward. “The same number of doctors with a lower limit on maximum hours, providing the same level of care, across more days”. If something about the mathematics of that osition doesn’t sit right with you, could I ask you to do one thing? Please take the time to speak to a junior doctor. Whether it is a family member, a neighbour, or even going to your local hospital during a strike. You will be gratefully received and just five minutes of your time is enough. Simply ask why doctors are willing to strike over this dispute and if there are empty spaces in the work schedules at their hospital. What you choose to believe after this discussion is up to you.
Jason Sarfo-Annin is a junior doctor currently on sabbatical at the Harvard School of Public Health. He tweets at @Dr_JSA