It's been more than a year since the government floated its plan for a 'truly seven-day NHS' in England. The policy was not only a key selling point in the Conservative Party manifesto, celebrated at every opportunity by health secretary Jeremy Hunt, but also the reason given for why a new junior doctor contract was needed, despite the fact junior doctors already work weekends.
A year on, the health secretary has still failed to answer basic questions, posed by the BMA, about how his ambition will work in practice. How will such a service be funded, or staffed? How will weekday services be protected in an already-stretched NHS? And it's not just medics that want answers. A BMA opinion poll found in June that two-thirds of the public think Mr Hunt has fallen short in explaining the policy.
This week it emerged that there really is no plan, as secret leak documents have shown that senior civil servants trying to deliver the pledge have uncovered 13 major "risks" to it, and no solutions.
The BMA has always said that patients should receive the same high standard of care seven days a week, but we have also repeatedly raised concerns over the past year about the lack of detail and absence of any plan on how the government intends to deliver this.
To see now, in black and white, that the government has not only ignored these concerns - and those of other leading healthcare organisations - but has also disregarded its own risk assessment's warnings about the lack of staffing and funding needed to deliver further seven-day services, is both alarming and incredibly disappointing.
David Cameron promised a 'truly seven-day NHS' before and after the general election, even going as far as to use the word 'plan' 18 times in one speech. The fact that there is no plan, that the government is yet to set the objectives or assess the impact of expanding seven-day services, only goes to show that this was nothing more than a headline-grabbing soundbite set to win votes rather than improve care for patients. The fact that, a year later there remains no plan shows that this was a conscious omission rather than an incompetent mistake.
This isn't the first time that government has misled the public about seven-day services. The government has previously admitted that the rejected junior doctors' contract must enable employers to roster doctors more affordably - or for less money - across seven days. However the government's own figures show that this will require 4,000 more doctors, 3,000 more nurses and almost £1bn extra
funding each year. Where will these doctors and nurses come from? How will this be funded?
The government has also misled the public about medical staffing. Two studies in the lancet debunked the minister's claims that "the weekend effect", where he claimed more people die in hospitals at the weekend, is linked to medical staffing levels. They were the latest to join a long line of health professionals and leading experts who challenged the government on its misleading use of figures. The reality is that it is a far more complicated picture than the one the government has tried to portray. Doctors are not standing in the way of improvements to patient care - we simply want it to be evidence based and fully thought through.
And it's our patients who will bear the brunt of the government's deceit. They are already. Patient care is being compromised by staff shortages. The number of people waiting over 18 weeks for elective surgery is up by almost 80 per cent. Major hospitals in England are failing to see almost one in seven accident and emergency patients within four hours. The average waiting time for a GP appointment will soon hit two weeks, and 201 surgeries closed altogether last year.
Emergency medicine, paediatrics and general practice are being compromised by staff shortages and hundreds of doctors are emigrating to work abroad. Figures from the Royal College of Paediatrics and Child Health show there is a chronic shortage of junior doctors in child medicine. They say the contract has been highly damaging with junior doctors leaving the NHS in England to work in Wales, Scotland and NI and this shortage of children's doctors is only going to get worse.
Hospital and community rotas are riddled with vacancies. The rejected junior doctors' contract is set to widen these gaps by disincentivising careers in the NHS, in particular for women, carers and those with disabilities , and devaluing doctors time, especially for those who work more evenings and weekends.
Rather than paint doctors and their contracts as the roadblock to reform, ministers must sit down with junior doctors and negotiate a contract that is properly funded, fit for purpose, good for patients and has the confidence of the profession.
The Government simply cannot expect to provide their vision for a truly seven-day NHS without also providing adequate funding for it. If the government wants to make more services available across seven days, then it needs to urgently address how it will staff and fund them.