I'm not quite clear how we ended up here, but I woke up this morning, read the papers, and realised the whole NHS seems to be broken and at war with the Government. It takes real effort on the part of the Secretary of State for Health, the Prime Minister and his cabinet colleagues to alienate every single arm of the NHS, but - as they say at Eton - by Jove! They've done it!
We GPs have been grumbling for years now - we're a pretty grumbly lot generally. Mr Hunt himself confirmed why this is when he admitted that the underfunding of general practice from the Conservative government has been as "penance" for the 2004 GP contract. Just to be clear - general practice was in crisis then after years of underfunding and a collapsing workforce. The Labour government at the time eventually realised this, corrected the lack of funding and introduced a new performance based pay system. GPs performed, and we got paid. Patients could get an appointment easily, young doctors were clamouring to join this highly competitive speciality. There was no shortage of applicants so wages were kept down as a result and locums weren't needed because there weren't any gaps. Then the penance started. In trying to make a political point and score some cheap right wing headlines, the Government has admitted it has made GPs the sacrificial lamb. This is at the expense of patients who are waiting weeks for appointments. It is also to the extent that the only way GPs feel we can get our voices heard is to explore how we can resign en-masse from our contracts with the NHS. Our own "nuclear" option. What a cock up.
Then we can add Consultants into the mix - they came next. The consultant contract is up for renewal, and suddenly we are being told about all these consultants who can "opt out" of working at the weekends. It was news to the Consultants. It was news to the nurses, and the junior doctors who work alongside them every weekend. It made great headlines, but when the Freedom of Information request information came in, and revealed that less than 1% of Consultants use this opt out - the rest are routinely working weekends - it rather killed Mr Hunt's argument. What it did do was infuriate the Consultants, who were being blamed for 6000 weekend deaths, despite the fact they were in hospitals and at work.(please search #iminworkjeremy if you think that's not true). It also incensed the other staff working at the weekends, who seemed to have been totally brushed aside as being vital for patient care. The message was "it's Consultants we need - you nurses, porters, healthcare assistants, cleaners, you're all pointless. Get the Consultants in and it solves everything." The Consultants were astounded to be accused of lacking "a sense of vocation and professionalism". This was not an example of how to get staff on board with contract changes. It was the exact opposite.
Then it was the junior doctors turn. Their sin was not only the fact they don't work weekends and nights (they do...) but that they were responsible for even more deaths - 11,000 deaths. Those figures do keep adding up don't they? Almost like they are just coming out of thin air...
They were amazed to have these deaths laid at their doors. They were amazed that after several years of negotiations with no mention of a 7 day NHS, suddenly it was thrown in as the main aim for contract reform. No one disagreed the NHS needed more doctors full stop, but achieving this with recruitment at an all time low, and no extra funding seemed impossible. Those doctors who have trained for over a decade and have tried to juggle professional and family life whilst working unpredictable shifts, felt slapped in the face by the Health secretary. He made this about their selfish decisions, rather than about a government who weren't prepared to invest in the service it had promised the public. He misjudged the mood massively when he then turned his ire on the doctors union the BMA, and accused them of misleading junior doctors - which indirectly implies junior doctors (the ones with 3 degrees and often postgraduate doctorates too) of being too stupid to understand their own contracts. The clue was in the 98% and 99% support for the BMA in the ballot for industrial action, but that didn't register with the government. Repeatedly it has antagonised the situation by communicating with the press for easy headlines, not the juniors themselves. Now it appears a deal had been reached between the BMA and NHS employers - but Mr Hunt refused to agree to it for fear of being perceived to have conceded some ground. He has vetoed something which both sides agreed on, and which could have ended this dispute. Now months of industrial action stretches ahead of the NHS, causing disruption to hospitals trusts, to patients, and to junior doctors themselves. But with a Government who won't agree to a deal even when everyone else does, it doesn't seem to matter.
But then, most incredibly of all, they turned on nurses. Public sympathy for GPs and Consultants might not be that high. For junior doctors it's pretty good. But nurses?! The absolute bedrock of the NHS? The Government decided they weren't pulling their weight either. There aren't enough nurses so let's get rid of the bursaries that help them to train. Let's put an income cap on foreign nurses working in the UK propping the system up so they get deported. Let's refuse to publish a report on safe staffing which would protect our nurses and patients. Let's repeatedly say we don't want another Mid-Staffs to happen, but not back that up with action. Let's do this because it will really make young people want to join the NHS and stop staff from leaving. Oh no, hang on...
Across the NHS, morale is low. Paramedics and ambulance technicians are repeatedly told they are too slow to respond. They don't do enough. Physiotherapists are to blame for delayed discharges. Healthcare assistants aren't caring for patients properly. The non-clinical call handlers at NHS 111 are misdiagnosing patients. Patients are avoiding hospitals at the weekend because they don't think there are any doctors there - people are dying purely because of Government spin. When did the NHS become a collection of incompetent, uncaring, neglectful individuals? That's what the Government are telling us. They wonder why staff are so disheartened.
Here's a thought - maybe it hasn't. Maybe the NHS is broken because parts of it are being neglected. Maybe it's broken because the people running it prize headlines above evidence. Maybe it's broken because Secretaries of State are too busy thinking of the next leadership contest instead of running their departments properly.
Mr Cameron and Mr Hunt - maybe it's time you took responsibility for this horrific mess. Turn to the NHS staff. Turn to the patients and relatives. Apologise, say you got it wrong and let's fix the most important thing this country has. You forget when the NHS is broken, it isn't just about headlines and careers, it's about lives. People are dying because of you. Time to stand up and face the music.