Jeremy Hunt seems to be positioning himself as the strongman of the NHS. With escalating rhetoric and the use of threats he wishes to portray himself as a ferocious patient advocate standing up against a callous and uncaring medical profession. But, unless I'm much mistaken, much of what he is demanding already exists.
This latest dispute about consultants working at weekends baffles me. I have never worked in a hospital where a surgical consultant didn't review all surgical patients at the weekend and where a medical consultant didn't do a twice daily ward round on a Saturday and a Sunday to review new patients. If waiting lists are beginning to lengthen then hospitals will also often carry out routine operations at the weekend to shorten them. I have also never worked in an area of the country where there wasn't access to GPs 24 hours a day and 7 days a week, his other major target. Is he not pushing violently at an open door?
If this is all just political posturing then he can declare victory tomorrow. He can claim tomorrow that consultants are now working at the weekend and GPs are working overnight and he would be right.
The evidence for the need for these changes is actually extremely weak. He often quotes the figure that a patient is 16% more likely to die if admitted at a weekend than on a weekday. This is a little disingenuous. For the statistically minded 16% is the relative risk which is a ratio comparing the risk of dying on a weekday and a weekend. Perhaps a more useful and more accurate statistic would be the absolute risk which is the raw numerical difference between the chance of dying at the weekend and the chance of dying in the week. This figure is 0.3%.
Whilst it is clear that there is a small difference in the risk there is no good evidence explaining why this difference exists and certainly no good evidence that increasing consultant staffing levels will change it. The increased risk may be due to lack of social support in the community at the weekend, difficulties with accessing palliative care or reduced staffing levels in nursing or residential homes. That's all conjecture, but so is Mr Hunt's argument.
I don't think anyone could criticise the aim of having a health service that functions perfectly every day of the week and the Health Secretary is right to have this as a goal. The problem, as ever, is one of resources. Without a major uplift in staffing and funding there is simply no way services can be improved at the weekend without jeopardising services during the week. There is currently no prospect of this major uplift in funding and, if there were, would it make economic sense? The Office of Health Economics thinks not and argues, in a coldly economical way, that the material benefit to our society of paying for these changes does not justify the expenditure.
Jeremy Hunt's high handed and arrogant manner has alienated him from the medical community on numerous occasions. He presents himself as a wolf, ruthlessly seeking to achieve his aims. But much of what he wants already exists and that which doesn't he can't currently achieve. Perhaps mentally he is more sheep like.