Doctors are, I am persuaded, driven by evidence. Sure we get passionate and fixed ideas from time to time. Some of us give up our cherished way of doing something only reluctantly when something better comes along. But ultimately the evidence wins out. Show us the data, give us the resources to change our practice, and away we go.
The NHS has demonstrated this time and time again. More so than many other areas of public service such as education, social care, and dare I say it government policy itself.
Thus the debacle over 7-day working and junior doctors is mystifying. It should have been so straightforward:
"I want a safe NHS that delivers high quality 7 days a week," Jeremy Hunt should have said.
"Great, so do we," should have said the doctors. "But do remember Jeremy, the NHS is a network involving social services, district nurses, GPs, therapists, and countless others. Making a change just to one part is extremely unlikely to produce a difference if the other steps remain unchanged."
"Good point," Jeremy should have said. "Let's conduct a study to identify those factors key to delivering the same high quality of care on Saturdays and Sundays so we can target resources most effectively."
But sadly we live in the murky world of politics and pride. And the politics and pride of the Government and BMA have driven them to declare an avoidable war. And evidence did not get a look in.
The BMA failed to challenge adequately Hunt's deeply misleading narrative that people were dying at weekends due to lack of junior doctors. The study concerned did not look at cause and effect, and made clear that those people presenting to hospital at weekends were sicker than those arriving on other days. Because of course you don't ruin your Sunday by nipping to A&E with something non-urgent. You wait til Monday. Perhaps most compelling was the fact that if you were already in hospital as an inpatient you were not more likely to die - suggesting there were sufficient people at work to sort you out if you deteriorated.
Hunt will have known this, yet chose to misrepresent the data for the purposes of public relations. The junior doctor contract negotiations started and stalled long before the "weekend deaths" study was published. I imagine Hunt merely saw it as a convenient tool with which to manipulate last year's rebooted negotiations.
The BMA has failed in other ways. Historically it has reacted to change defensively rather than leading it. Their justification for the strikes was painfully self-serving, which was all the more startling given the number of good reasons to challenge the new contract in its early form. They could have argued their case on the importance of attracting the best people to medicine, people who would otherwise choose law or banking. They could have argued it on the importance of paying more to attract doctors to antisocial specialties such as emergency medicine, currently plagued with vacancies. But they instead chose the distinctly shaky ground of patient safety - ground already claimed by Hunt. Whilst it certainly started out unfair, it is extremely difficult to argue that the contract was ever unsafe. Sir David Dalton's sensible compromise makes it very difficult to claim it is so very unfair - and the BMA's failure to accept it risks coming back to haunt them.
So, let me propose my peace deal.
Firstly: 7-day working. Everyone working in the NHS wants it to better and wants to be proud of it. Mr Hunt, you and I do not know exactly why the people presenting to hospital at weekends are sicker. Let's conduct a study and find out why. Is it because they cannot see their GPs? Is it because nursing homes cannot get doctors to see their patients? Or perhaps it is something to do with hospitals. Perhaps its because people spend too long in A&E waiting for beds because there are no social workers to discharge my well patients (I refuse to call them "bed blockers"). The point is we do not know. Study it, show us the evidence, and you will not find a bunch more committed to change than doctors.
Secondly: the contract. Stop pretending it is primarily about 7-day working and patient safety - that would require whole-system change and you are not pretending to do that. Money is short, the way people work needs to develop. Fair enough. Be honest. And recognize that the work is hard, antisocial, and emotionally draining. Reward those in specialties with large components of out of hours work such as A&E and anaesthetics. Stop bullying talk of imposition - you want us as your allies. And the BMA needs to get real. Change has to happen and we cannot have everything we want. But Sir David Dalton surely gave you most of it?
Finally, junior doctors don't be demoralized. This too will pass. Medicine is bigger than politics and health secretaries come and go with the wind. You are in the best profession imaginable. Having been a junior doctor for 14 years, and a consultant for 4 I feel privileged to be doctor. My job is brilliant and I cannot imagine a more impressive bunch of people than those with whom I work, each committed to the well-being of the vulnerable people we serve.
Every day. 7 days a week.