Jeremy Hunt has announced with a not insignificant amount of aggression, that he intends to force through seven day working for NHS hospital consultants, regardless of whether a contract can be agreed at the negotiating table with the British Medical Association (BMA). There is inevitably a lot of anger about this, but I was met with the usual derisory comments when I tweeted my thoughts. That some careers in medicine are now a lifestyle choice. That it's good for patients. That thousands of patients die at weekends and its the doctors' fault.
Anyone in their right mind knows by now that the Department of Health and Jeremy Hunt are lying through their teeth about the NHS. Those extra doctors in the Conservative manifesto? No, they're not coming. He admitted this and the fact that there was "flexibility" in the figures because it turns out it's hard to recruit GPs at the moment. (Gasps from the entire medical profession - who knew??!) Instead you're getting the new role of Physician Assistants straight from the American model of healthcare which is universally accepted as being top notch for everyone in the population there... They will train for only two years, and are intended to replace doctors in taking histories from patients and examining them. They can't prescribe yet, but plans are underway to allow them to. Clearly we have been overdoing it as a nation with a reputation for the best medical schools in the world, with our wasteful five years at University, two years junior doctor training, and five-10 years minimum to specialise as a GP or hospital doctor. I wish I'd known this before I had to take out those tuition fee loans.
Now he wants to unilaterally impose contract change as the monopoly employer of hospital consultants, to force seven-day-a-week routine working. That annual review for the cancer you had four years ago, can now be done on Saturday at 4pm. You can bring your elderly relative through the reduced public transport system to have their pre-op assessment on a Sunday at 6pm. You can enjoy your colonoscopy at 9am on a Bank Holiday. This is not URGENT care, it is routine care. Do not fall into Mr Hunt's trap of thinking there are no consultants in hospitals from 5pm on a Friday, till 9am on a Monday morning. He wants you to think that. It is a lie. I have a few problems with his latest ridiculous idea.
1) Like the rest of the NHS, there is a massive shortage of consultants. Key specialities like A&E and psychiatry cannot recruit, much like general practice. Enforced changes to the consultant training is happening, as the government try to rush through new doctors, with all grades of hospital doctor expressing huge concerns that this will lead to consultants qualifying without having the chance to spend enough time training as they want to. If you push routine cover onto a depleted workforce, you either cause dangerous working conditions in the form of excessively long hours (hands up who wants the over-tired 68-year-old consultant operating on them at the end of an 80 hour week?), or you sacrifice mid-week care and create the same situation on another two days a week.
2) Consultants are amazing. They work incredibly hard and I have massive respect for them. But filling the hospital with these highly trained, skilled professionals on a Saturday and Sunday will be useless, because they do not work alone. Mr Hunt needs to unilaterally alter the contracts of all junior doctors, all nurses, nurse practitioners, phlebotomists, theatre staff, receptionists, secretaries, administrators, managers, catering staff, and I am sure many others. He also needs to employ all of social services to work a full seven days as they too currently have a duty team on call at evenings, nights and weekends. There's a lot of these groups that have unions. I wonder if he's considered that. Until he looks beyond the simplistic idea of more consultants = more patients seen, imposing his seven day contract is absurd. And guess what? This will cost money. That thing the NHS doesn't have and the government aren't prepared to invest.
3) The government is about to change the law on strike action. This isn't a coincidence. In future, more than 40% of union members will have to take part in a vote to strike, with over 50% voting in favour of the action for it to pass. Considering the current government was elected to rule the country on 36.9% of the national vote, and they have found the money to just give themselves a 10% pay rise, it's a bitter pill to swallow. They have ignored the recommendations of the independent pay bodies for NHS staff, but have acceded to those for Westminster. NHS staff have always been held to ransom as any talk of strike action leads to rapid allegations of patient harm. To be crystal clear, no one wants patients to come to any harm. We are all patients too, with loved ones treated by the NHS. But that is why we are trying to kick up a fuss. Ultimately this plan of Mr Hunt's, implemented as he proposes, will harm patients. There will be no continuity in secondary care, and it is almost lost entirely in primary care now. Running stretched medical teams on a full shift-based rota means a literal handover of patients, with key decisions made by different staff several times a day. These are the sickest most complex patients. They need the care of a firm of their own doctors.
A truly seven day NHS is something we should aspire towards. I don't disagree with that. But as with everything else, it is the timescale and funding which is wholly unrealistic and will inevitably lead to harm to patients. Can he not remember the waiting time breaches of last winter? Is he ignoring the GP practices closing across the country? This is not doctors wanting a lifestyle choice. Our first role is to act in our patients best interests, as an advocate for them. Why does Mr Hunt refuse to listen to the profession, both at national and grass roots level? Why is he hell bent on chasing headlines and not on improving care and patient safety? He bangs on about not repeating events at Mid-Staffs, but patient care IS being compromised and will only be more so, if common sense continues to be so hugely ignored in the decision making process. The NHS can be better, if he takes a second to stop this headlong rush towards disaster.
I want us to strike. There, I've said it. I want all hospital and primary care staff to stand together. I want us to co-ordinate the most disruptive programme of NHS civil disobedience we can. There is a pile of paperwork and box ticking we can stop doing for a day, a week. There is mountains of red tape we can refuse to engage with. We can stop any co-operation with management, leaving boards unable to ratify decisions. We can refuse to comply with CQC inspections. We can refuse to sign death certificates or discharge letters. None of this will harm patients, but behind the scenes it will be chaos. I can guarantee patients will still receive full medical care. But they might find their paperwork is a few days later than normal. And that - with any luck - Mr Hunt has suddenly had a rethink.
I hope the BMA view this as a gauntlet thrown down. Let's see what they are made of, because I think the profession is ready for a fight. This new look NHS? It's not where I want my children or my parents to be treated, which is a damning indictment. Ask your doctor if they feel the same.