They say a week is a long time in politics. But for over a decade, at least one aspect of our domestic political landscape hasn’t changed a jot. Now, as much as then, the NHS gives every Tory leader a major case of the heebie jeebies. And no wonder. How – when you’re unashamedly anti big state – do you convince the electorate that its beloved national health service is really safe in your hands?
Back in 2006, Gordon Brown resided at Number Ten, David Cameron was his fresh-faced rival, and Jeremy Hunt – well, Jeremy was probably hard at work honing his lambada. Mr Cameron chose to use his 2006 Conservative Party conference speech to hard sell his NHS credentials. At the time the father of a severely disabled son, as the BBC pointed out in their coverage, he stated: “When your family relies on the NHS all of the time – day after day, night after night – you know how precious it is. So, for me, it is not just a question of saying the NHS is safe in my hands – of course it will be. My family is so often in the hands of the NHS, so I want them to be safe there.”1
Of course. Fast forward nine years to the 2015 general election campaign, and it seemed the Tories had come up with something rather brilliant to address their perennial NHS problem. The ‘truly seven-day NHS’. A world first, no less. What a soundbite, what vision. I know I felt the hand of history briefly caress my shoulder. Critics muttered that if the rest of the world doesn’t do something, perhaps this should give pause for thought about making that something the centrepiece of your health manifesto. But for sheer vote-buying brio, it was elegant and irresistible. First: put the fear of God into people by claiming that 11,000 of us will die at weekends because doctors are too lazy to work them. Next: allay the fears you’ve just stoked up so carefully by promising the solution, the seven-day services this country currently lacks. Finally – and surely most audaciously of all – insist that a ‘cost-neutral’ renegotiation of the junior doctor contract will deliver this fabled seven-day bonanza. Because why would the small matter of more staff and more funds be a prerequisite for improving the NHS frontline? Why shouldn’t you be able to get seven for five simply by rejigging junior doctors’ rotas?
Clearly, voters aren’t that stupid. For the last 10 months, the Emperor has worn no clothes, and I can’t be the only person feeling heartily sick of still having to look at Jeremy Hunt in flagrante. We’d all love a seven-day NHS. It’s just that those of us who work on the NHS frontline – who live day in, day out, with the realities of chronic underfunding – know precisely how corrosive and irresponsible it is to try and palm off an unfunded, unstaffed, unmodelled soundbite as an actual, bona fide policy.
Right now, junior doctors are tied up in tortured knots trying to decide whether to vote for or against the new contract tabled last week by the government and the BMA. The anger, mistrust, cynicism and bitterness are overwhelming. Never have I known doctors so distraught, so demoralised by being turned into the Tories’ political cannon fodder.
While individuals rarely end up mattering much in politics, in this case, Jeremy Hunt – a man whose commitment to the NHS is so transparent he has to wear an ‘NHS’ pin on his lapel to convince us he’s genuine – must accept culpability. For ten long months his rhetoric has oscillated between the downright offensive and the frankly ludicrous. Remember ‘danger money’? The absurd idea that all those nights and weekends doctors work on-call were for our optional adrenalin-rush cash, and not the very fabric of our working lives? Jeremy ‘nuclear option’ Hunt – the man who’s called us ‘militants’, ‘radicals’ and ‘politically poisoned’ – has single-handedly alienated an entire generation of doctors. He’s made voting ‘yes’ so exceptionally difficult – a fact I sincerely hope his boss will address in the inevitable post-Brexit vote Cabinet reshuffle.
So which way to vote? The irony of soundbite politics is that nothing of substance needs to change for a government to crow about ‘victory’. This government’s commitment to safe weekends has only ever been linguistic – and words, as we know, are infinitely malleable. The new contract patently won’t make weekends any safer. What prevents more doctors from being rostered at weekends isn’t contractual limitations – it’s that there simply aren’t enough of us, and we’re already spread too thinly. Nor will it be cost neutral. Only a Secretary of State with negligible understanding of how doctors’ rotas work could ever really believe that.
What we do have in this contract are potentially ground-breaking mechanisms protecting doctors from excessive hours and patients from excessively fatigued doctors. The hours doctors actually worked would be individually logged and quantified, and hospitals would be required to publish quarterly data on every one of the gaps in their doctor rotas.
We all know the NHS’s biggest problem, and no amount of spin can disguise it. There simply aren’t enough doctors and nurses. Hunt’s already had one go at burying data on NHS safe staffing levels. I think he’ll be discovering 54,000 reasons why he won’t get away with that a second time. Doctor rota gaps potentially kill patients. And if doctors vote ‘yes’, Mr Hunt and Mr Cameron, you can rest assured that our new contract will be holding you both to account. Relentlessly.