Another well supported strike by junior doctors on Wednesday 10 February was met by government bluster. The day afterwards, health secretary Jeremy Hunt threatened to impose the new terms. The BMA says this action represents total failure on the part of the government.
The latest industrial action by junior hospital doctors built on action taken the previous month. There were hopes of progress and a possibility of calling off the strike, but it was not to be. Picket lines were well populated and attracted public support.
Even such a disciplined withdrawal of labour is a difficult thing for any doctor to contemplate. They do so in the interest of patients and the wider NHS. In contrast this government has effectively abandoned all access and waiting time targets. Its assertion that excess deaths in hospital at weekends are caused by a lack of medical cover disregards the facts.
The government announced on Thursday 11 February that it would impose a new contract on junior doctors in England. Dr Johann Malawana, BMA junior doctor committee chair said this was a total failure by the government. And by the following day a number of senior NHS executives were distancing themselves from the contract imposition.
The BMA accused the government of walking away instead of working to reach an agreement in the best interests of patients, junior doctors and the NHS as a whole. The BMA believes this is a political fight for the government and if it succeeds in bullying junior doctors it will do the same to other NHS staff.
Dr Malawana said that the government has lost the trust of junior doctors, who see the proposal as fundamentally unfair. He concluded “Our message to the government is clear: junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us.”
‘Junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS.’
The underlying claim that there are excess deaths at weekends is tenuous at best. The evidence Hunt cited in support of his case was selective, weak, and insufficient to support his conclusions, as many clinical epidemiologists and other experts have pointed out. Few of the studies cited as evidence were based on admissions data. And those that were show no causal link between staffing at weekends and patient mortality.
So the impression that 11,000 people died because of a lack of junior doctors at weekends is spurious and misleading. This politicisation of science through selective misquoting of research needs to be exposed, especially when it is used as a pretext to attack the NHS. One excellent junior doctor’s blog does that, systematically demolishing Hunt’s case.
The heart of the issue in hospitals at the weekend is the absence of social care services resulting in beds being blocked by mainly old people with nowhere to go. Manifesto promises before the last election about care of the elderly have turned out to be empty words, to the surprise of few working in health or social care.
The secretary of state claims that the new contract is good for patients. He fails to explain why the devolved administrations in Wales, Scotland and northern Ireland have declined to adopt it on safety grounds. He also fails to explain how care will improve beyond saying 24/7 working must be better.
Implementation of the new contract will be within existing financial and manpower constraints. So if junior doctors are redeployed to work at weekends fewer of them will be available during the normal working week. Regardless of working patterns, what Britain needs is more junior doctors; we already have fewer per head of population than most other OECD countries.
Lack of resources
The NHS has always provided a full 24/7 emergency service with elective (planned) operations, diagnostic procedures and clinics operating Monday to Friday. Providing elective services at weekends would require the deployment of nursing, pharmacy, pathology, radiography and other clinical support services as well as ancillary staff. There are no plans for this, no additional resources and no evidence of public demand.
Junior hospital doctors are among this country’s most qualified and dedicated young people. They are obliged on appointment to sign a waiver allowing deployment outside safe standards laid down in the EU Working Time Directive. Other EU member states in the OECD comply with the directive. Many doctors are already rostered in excess of 70 hours a week. Tired doctors pose an inadvertent risk to patient safety.
Doctors are entitled to be properly remunerated for working unsocial hours; we all are. Increases in basic pay, with weekends, nights and evenings designated as normal time amount to a ploy to extend already overstretched services on the cheap. Most doctors would not lose out overall but only so long as their deployment during periods where they would have been paid overtime is increased.
No trade union could willingly agree to such a contract, but imposition is problematic. Hunt has to negotiate revised terms and conditions for hospital consultants and general practitioners in the coming weeks. It would effectively leave him at war with all Britain’s doctors. This threat to undermine the NHS by blaming doctors for government shortcomings needs to be recognised by the wider public and trade unions.