Mr Cameron’s post-Budget, pre-strike world

Here we go again. A week overwhelmed by fallout from the disability benefits debacle, ended with a barely-registered pipsqueak of news: that the BMA voted last Friday to escalate its industrial action.

No more 48 hour strikes for junior doctors. Next time will be a step change, a cranking up of the pressure. Whatever form this escalation takes, the prospect for patients is bleak. The government, hell-bent on imposition, flat refuses to lose face by climbing down. Meanwhile, the BMA is ramping up retaliation on every front: judicial, industrial and public relations. To borrow the marshal language of which Mr Hunt is so fond: two tribes, back at war, with patients still stuck squarely in the middle.

The longer this dispute endures, the more people are asking: ‘what on earth are they still fighting so bitterly about?’ Confusingly, the answers provided by both government and BMA have patient safety at their core, yet are framed within two radically different narratives.

The government insists this is a pay dispute in which the key sticking point is overtime on Saturdays. For them, the broader narrative – the entire raison d’etre of contract reform, no less – is honouring an election manifesto pledge to deliver a ‘truly seven day NHS’, thus protecting patient safety at weekends.

The BMA’s narrative is in flux currently. Until last month, its messaging was hampered by its acceptance of the government’s precondition that delivery of new seven day services must occur within the confines of a ‘cost-neutral envelope’. The new junior contract, in short, could cost no more than the old one, despite delivering new weekend services. That, with hindsight, was a tactical blunder. It meant inadvertently colluding with the government spin that you can somehow provide seven days for the price of five. It also gave the government free reign to frame this dispute as hinging on minutiae: overtime, Saturdays, quibbles.

As of last month, however, the BMA junior doctors’ committee voted to reject the principle that a new seven day NHS can be delivered ‘cost-neutrally’. Its narrative now hinges on the fact that a ‘truly seven day NHS’ is not possible without truly seven day staffing. New doctors are needed to provide new weekend services, not merely the same ones stretched more thinly.

Forget pay, forget Saturdays. What really puts the fear of God into grassroots juniors like me is the sheer, ignorant audacity of a government insisting we can deliver new, all-singing, all-dancing seven day services with a mere re-jigging of our shift patterns. That smacks of utter obliviousness of what life is actually like on the NHS frontline right now. We have nothing, just nothing more to give. Hospital overstretch is already dire, a real and current danger to our patients. Short-staffing blights every doctors’ rota. And unlike aviation where, if an airline pilot loses their co-pilot, the plane will immediately be grounded, in medicine the junior doctor is invariably forced to shoulder their missing colleague’s workload – on top of their own. Crippling for doctors, potentially lethal for patients.

We oppose this contract, in short, because we cannot endure being stretched more thinly still, and we will not permit our patients to be endangered by that over-stretch. Even the Department of Health’s own data demonstrate that at least 4000 more doctors are required to deliver safely a seven day NHS.

So where do we go from here? Would putting temporary brakes on imposition really be so hard for the Prime Minister? Having been accused this week of picking the pockets of the disabled while lining the purses of those rich enough to benefit from cuts in capital gains tax and higher rate interest tax, Mr Cameron’s assertion that “we are all in this together” is looking increasingly shaky. First the tax credits climbdown, now disability benefits. Driving bullishly on with imposing a seven day soundbite backed up with neither evidence nor funding may yet prove to be his third misjudgment of the mood of the nation.

It seems pretty simple to me. Either Mr Cameron is serious about delivering a seven day NHS, or he’s not. Either he demonstrates precisely how he will fund and staff his ‘pledge’, or he needs to back off doctors until he’s done so. Just as doctors practice evidence-based medicine, so too do governments owe electorates evidence-based politics. When we have hard, public data on the costs and staffing requirements of seven day services, then – and only then – can we negotiate a new contract fit for purpose. The onus is entirely on you, Mr Cameron.

4 thoughts

  1. If the co-pilot isn’t there, 470 people may die.
    If the registrar isn’t there, its just 1 (at a time).
    Until you reach mid-Staffs proportions.


    1. Yes. As can be seen from the final report produced on mid-staffs (available at the monitoring and regulatory functions within NHS England, Healthwatch, Monitor as well as the County and Local Council health scrutiny committees all need to be scrutinised and if required overhauled – Monitor in particular has far too narrow a remit, covering financial aspects at the almost complete exclusion of any focus on patient safety. Staffing on wards, particularly nurses, needs to be improved. Note that this means real nurses on real wards – not unfilled vacancies. Same for doctors. One of the problems with mid-staffs was also the habit of local care homes to send terminally ill patients to the hospital. No reporting measure for ‘Dead in transit’ was available so they were attributed to have all died in the hospital. No point collecting statistics unless there are complete and correct.
      Please note that it is my understanding that the reports into mid-staffs rightly castigated the trust and other bodies for their lack of focus on patient care and the consequent poor care given. However, it also states that there was only one unavoidable death of a patient at mid-staffs. The UK tabloids reported that there had been ‘ up to 1000 unnecessary deaths’ at mid-staffs – true since 1 lies in the set of 0 to 1000 but a little misleading. There were no vases on the wards for patients to drink out of, as flowers were not permitted on the wards. The vases were locked in a storeroom inaccessible to the patients, so no patients drank out of them as they were simply not available and were never even filled with water. So beware the stories you choose to trust.
      The key here is staffing. Mid-staffs had many dementia patients on the wards at that time and too few nurses to look after them.
      So yes, mid-staffs will be repeated in terms of patient care unless hospital managers refuse to go against the recommendations contained in the excellent report cited above. More doctors and nurses need to be trained and employed now to achieve these recommendations in the NHS. I would be far happier with money being spent to ensure a safer 5 day a week NHS (excluding those functions such as A&E and care of the critically ill and aged which operate 24/7 today) than a knee-jerk move to a 7 day NHS.


  2. I’d like to know why a person (Jeremy Hunt) who in 2009 wrote a book about dismantling the NHS is then put in charge of ….the NHS!! I truly believe that this government won’t be happy until the NHS is no more. I received an email saying that the government aren’t imposing the new contract on junior doctors. It will be phased in for new doctors and when doctors move on to another stage in their training. This is still wrong and our doctors deserve better.


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