Junior doctors. We're everywhere these days, bleating and moaning about Jeremy Hunt and unfair this and unsafe that. I've made it my business to bleat and moan recently; but believe me I'd prefer not to have to. So what's riled us up so much? Could it be that the new contract the government is proposing is an absolute joke? You know the sort of joke your uncle would make at a family dinner and someone, who at that exact moment happens to be blowing up a balloon, let's the air squeak out slowly in total disbelief. To us, it's one of those moments.
The Conservatives came up with a clever slogan to put into their election manifesto - 'A truly seven day NHS'. However, it had one major problem: they didn't have any money to fund a 'truly' seven day service, or any more doctors, or indeed any idea what they meant by it. Cue slow balloon squeak and silence.
Undeterred by little things like reality, but Jeremy Hunt needed some advice. Not from the friendly NHS staff. No, no. Much better to pay management consultants and get some non-NHS executive types to draw up a report. The outcome is beyond parody. I happened to find their strategy briefing document stuffed behind the ladies loo in Waterloo station cradled by an empty bottle of Lambrini. Weird. See below:
- Attack your doctors: Already working flat out well beyond their hours, ignore the higher than average suicide rate and highest drop out rates since records began. Imply that their 'lack of vocation' and the 'fact they are not prepared to work seven days' is the blockage (Never mind that they already do). Keep repeating 'we need a seven day NHS' as though it doesn't already exist. Ignore the fact that doctors want to improve care across seven days, and can provide many suggestions for how to do so based on what is actually happening in hospitals at 1am on a Sunday night; they are the problem and they are not really there. Keep repeating this. Repeat the lie so much that real patients decide not to go to hospital on weekends, delaying treatment for serious conditions. Look directly into the camera. Repeat 'we need a seven day NHS' without clarifying what on earth you mean.
- Bend the statistics: Use very limited studies done by your mates to claim 'more patients die at weekends'; even though this is not true, repetition again is key. Ignore the fact that actually fewer patients die at weekends and that the most patients die on Wednesdays. Claim 'variations in any care system can be fixed without actually knowing WHY they occur'. Make up willy nilly plans to tackle these 'variations'. Who needs science? Look directly into the camera. Repeat 'we need a seven day NHS' without clarifying whether you mean emergency or routine work.
- Ignore recruitment crisis: Ignore the exodus of doctors; pretend it doesn't exist and that gaps in rotas created by a lack of staff aren't crippling those who remain. Reduce pay to those who offer to fill those gaps as locums, completely ignoring the basic principles of supply and demand. The fact that only now only 53% of doctors continue to train in the NHS after their first few years can be buried, because we'll make the remaining ones work longer. Ignore that one of the greatest dangers to patient safety is tired doctors and deplete workforces. Claim stretching an overstretched overworked workforce even further is the way to make the NHS safer. Claim this tactic won't cause more of them to leave. Look directly into the camera; repeat 'seven day NHS'.
- Remove safeguards: in particular penalties on NHS Trusts for forcing doctors to work unsafe hours. Ignore that tired doctors make mistakes. In later negotiations, offer as a 'compromise' to appoint a 'guardian', another expensive bureaucrat, not independent but appointed by the employer. Don't introduce a proactive system to design safe rotas; instead let juniors complain to the guardian when they realise their rotas aren't safe (putting more pressure on them, and when it's too late). Be sure to claim that this is a SAFER contract for doctors. Unfortunately, the pilot who transformed healthcare safety standards by ensuring maximum working hour limits in the NHS was on the honours list this year; so we'll need to distract everyone with Cameron's Wellies', to avoid a focus on this irony. Look directly into the camera; repeat 'seven day NHS'.
- Be belligerent: Negotiate for two years; don't budge at all on key points of concern of 50,000 frontline doctors who see the relevant issues daily. When talks fail and the BMA ballot for industrial action, claim they have 'refused to negotiate at all' despite the negotiations being on public record; hide those in an inaccessible section of the Department of Health Website and no one will know. Call them 'militant'; get your mates in the press to start a smear campaign against the vocal ones. Look directly into the camera; repeat seven day NHS.
- Manipulate and mislead with media stunts: Misrepresent study data, get mates to do so too. Scaremonger about patient deaths that don't exist as you describe them or aren't as simple as you make out. Use a recent tragic terror plot to release a sexed up 'hard edged' letter to scare the public. Spin the junior doctors concerns with the contract as 'just about pay'. When your dangerous stunts mean patients come to harm because you scare them into avoiding hospitals at weekends; Don't apologise about the 'Hunt effect', or about breaching patient confidentiality in a tweet. Carry on playing with people's lives. Look directly into the camera; seven day NHS.
- Act like nothing's happening: Push 98% of junior doctor BMA members to vote in favour of industrial action, then claim the BMA doesn't represent them. When 20,000 of them march on the streets of London, say they are confused and misled. Claim they are not putting patients first, then when BMA offers to talk with an independent arbitrator say 'No', then a day before the strike is to go ahead, change your mind and still claim all the cancelled operations and clinics are the BMA's fault, never mind that you could have taken up the offer to talk earlier and prevented it. Look directly into the camera; 7 day NHS.
Junior doctors strike next week; if the government had an iota of common sense on this matter we wouldn't have to.
As the Times Journalist Jenni Russell put so eloquently a few days ago; 'The idea that Jeremy Hunt can conjure up an excellent week-round service by forcing already stretched junior doctors to work longer for less is a delusion... When the present service is practically on its knees, it makes no sense to stretch it further.'
Junior doctors are the backbone of the NHS and we have lost trust in the government - can you see why? Maybe the problem is the advice they've had; maybe they should listen to the advice thousands from NHS staff all of whom are shouting "stop, don't". Maybe they should consider that stretching them even further, when they're already struggling, in order to deliver an ill-conceived election promise is dangerous. Maybe they should listen to the public, only 3% of which replied to their consultation on the NHS as believing a 'seven day NHS' is needed in times of austerity. Maybe they should base changes on actual evidence and stop misrepresenting evidence to the public. Maybe we won't let them play poker with your and our safety, your and our NHS, ultimately your and our lives.