Get real! Doctors will need to turn 7-day anger into action

Last month health secretary Jeremy Hunt told doctors to “get real” over the need for “proper seven-day service” in the NHS.  Whether those two small words were a deliberate attempt to antagonise doctors or whether he underestimated the response, there is no question about the mood of doctors.

As Dr Mark Porter, chairman of the British Medical Association (BMA), said, Hunt was “calling into question the professionalism” of the doctors. Doctors are furious, and understandably. It is the Secretary of State that needs to “get real” as the state of NHS finance means that 9 out of 10 acute hospitals are predicting a deficit this year. 

The influential health policy charity the King’s Fund, which monitors NHS finance, warned on 3 July ahead of chancellor Osborne’s budget that financial problems are now endemic among NHS providers, “with even the most prestigious and well-run hospitals forecasting deficits”.

Crisis

Four factors are working together to create the sharp financial crisis: demand for health care is rising, payments for treatments to hospitals have been cut, spending on agency staff is increasing and hospitals are finding it increasingly hard to find “savings”.  

As a profession doctors have never disputed the need to enhance NHS services at the weekend. The issue is how to fund this and how to do this in a way which enhances the service without provoking a deterioration elsewhere – see “Healthcare professionals face 7-day challenge”, Workers, October 2014.

‘Most hospital consultants already work at weekends.’

Most hospital consultants already work at weekends. A recent BMA survey of nearly 900 consultants shows that 88 per cent are on a “non-resident on-call rota” – which means they are regularly required to attend hospital at evenings or weekends if required, often in emergencies. More than two-thirds of those surveyed had been on call on Saturday or Sunday in the past week, working on average six hours or longer.

In making his case Hunt said that around 6,000 people die every year because of lack of “proper” weekend working.  “It’s all your fault, doctors” was his argument. In fact Sir Bruce Keogh, the medical director of NHS England, told MPs on the Commons Health Select Committee at the end of July that patients admitted at the weekend are already “sicker”. He also warned against describing “statistical excess” deaths as necessarily “avoidable”.  So the day of admission is important but this is not the same as deaths occurring at the weekend because of lack of care.

Bad value

In advising doctors to “get real” Hunt was himself taking a flight of fancy and pretending that what he wanted could be achieved without expenditure. A recent analysis by health researchers at Manchester and York universities of the case for more seven-day services found that providing comprehensive seven-day services would cost between £1 billion and £1.4 billion – and that the health benefits could be achieved at half the cost if the money were spent on other health priorities.

Doctors would like their own plans for dealing with emergency pressures to be listened to. These include:  putting in place  the necessary arrangements to deal with emergencies that occur in the “quiet hours”, such as a proper triage service staffed by clinically qualified professionals (not NHS 111); proper arrangements for  patients  to be discharged to social care; bed-occupancy and utilisation to be at realistic levels (for example, if Britain with 2.8 hospital beds per thousand population had the same ratios as Germany [8.2] or France [6.9])

And doctors also know that there is a government “agenda” for blaming NHS staff for any shortcomings in the NHS and then using this to undermine the service as a whole.

Fighting back

So there is now a fierce war of words between doctors and the government. And there is a war of images, too, with doctors all over the country posting pictures of themselves in the workplace at the weekend.  

The relationship between Hunt and the medical profession has suddenly become as toxic as the relationship between former education secretary Michael Gove and teachers. An online petition for a vote of no confidence in Hunt set up by a Dan Furmedge, a young doctor at the Princess Royal Hospital in Bromley, Kent, reached the requisite figures in a matter of days.  It now stands at over 100,000 signatories.

The government’s response to the petition further enraged doctors by ignoring the part of the petition talking about doctors’ employment conditions and focusing solely on seven-day working. Furmedge has pointed out that the government is deliberately using poorly evidenced, inflated figures to win headlines and generate fear.

Collapse

The part of the petition which was ignored in the government response was in relation to the new consultant and junior doctor contracts. The BMA and the NHS have been in negotiations for nearly two years about the new contract, but talks collapsed back in October 2014.

One of the areas of dispute is around the government’s wish to remove a clause in the previous contract, negotiated in 2003, which allows senior doctors to opt out of doing non-emergency work at the weekends. This non-emergency work is quite separate from the regular emergency work mentioned in the BMA survey above.   

From the doctors’ perspective this opt-out clause allows them to manage their own workload and avoid becoming exhausted, given that they already do regular emergency work at the weekend. The doctors want to control their shift pattern for their own health and patient safety reasons, but this is being misrepresented by the government as a threat to patient safety.  (Of course there is the small matter of there being no funding to do this non-emergency weekend work and no additional nurses or other diagnostic staff to facilitate it, but this is not the doctors’ main argument.)

Even if there were copious funding, doctors want to agree working patterns which are compatible with adequate rest and a family life. So the real battle is now staring doctors in the face. How are they going to respond to the contract negotiations? Will Hunt seek to impose a new contract?  If he does then the current war of words and online images and petitions will need to move to a new stage.