Well, it’s fair to say that Jeremy Hunt’s going to have a fun time at the next doctors’ conference he attends. There’s the #Iminworkjeremy trend on social media of furious doctors pointing out that they already work at weekends, and are not playing golf, as they believe the Health Secretary claimed. There’s the multiple petitions calling on the Health Secretary to resign, be sacked, or be subject to a vote of no confident in Parliament. And there are the furious op-eds from doctors who feel completely undervalued.
Now, doctors do work weekends, and they also work twilight shifts and long weeks of nights, and they also have to certify people as dead in the middle of the night, or get punched by a confused patient at 10 in the morning, run to a cardiac arrest in the car park at the end of a 13 hour shift and prescribe medication to help with the horrible panic suffered by someone who has been told they have just six weeks to live. If nothing else, the hashtag campaign has reminded most people that even their most stressful working days don’t include any of that sort of work.
But it’s worth double-checking what Jeremy Hunt actually said about doctors working at weekends. He gave a long speech to the King’s Fund that included sentences like ‘today I can announce that the operating name for the new jointly-led Monitor and TDA will be NHS Improvement’, so chances are that not everyone has listened to or read it in its entirety. Here, for anyone who has missed it, is what Hunt actually said – and what he didn’t.
First, the Health Secretary said that doctors ‘already work extremely hard’ and that ‘this is not about increasing the total number of hours worked every week by any individual doctor’. He then said ‘every weekend swathes of doctors go in to the hospital to see their patients, driven by professionalism and goodwill, but in many cases with no thanks or recognition’. I cannot find in the speech any suggestion that he thought doctors were slacking off or insisting on attending the golf course rather than the ward. I also cannot find any suggestion that he thinks doctors are lazy. Perhaps he does, but he’s kept it from his speech text at least.
Hunt then said that 6,000 people die because the health service does not operate on a seven-day basis. Some dispute these figures (see below), but this, along with the point that ‘I have yet to meet a consultant who would be happy for their own family to be admitted on a weekend’, forms the basis of Hunt’s argument about the need for reform.
Where Hunt was aggressive – and I suspect this is where doctors took offence – is in saying ‘get real’. But this wasn’t to doctors themselves, but their union, the British Medical Association. He said: ‘I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to ‘get real’.
There are other issues in this row. Junior doctors work long hours, but their seniors still complain that they’re not working sufficient hours before becoming consultants to have seen the range of illnesses, complications and procedures that they should have experienced. This is because of the impact of the European Working Time Directive on the health service, something Henry Marsh laments in his excellent book, Do No Harm. So there is not consensus in the medical world about the hours doctors work, either, though an attitude from older doctors that says their juniors should work ridiculous shifts just because they did, even if it puts patient safety at risk, shouldn’t be encouraged. But the WTD may lead to a shortage of consultants during the week if they are required to work more weekend hours.
A more pertinent objection from the BMA is that it’s not just about doctors but about all disciplines within a hospital. If you are going to treat a patient on a Sunday in the same way as you would on a Tuesday, you need all the diagnostics services to be running. You also need social care to work properly so you can discharge people.
And a bigger objection, which also doesn’t seem to have been raised by the #iminworkjeremy campaigners, is over whether a seven-day NHS is actually worth it. This academic paper argues that the statistics cited by Hunt ‘are insufficient by themselves to justify a policy change towards extending normal hours of operation into the weekend’ and there is ‘as year no clear evidence that 7-day working will, in isolation, reduce the weekend death rate; that lower weekend mortality rates can be achieved without increasing weekday death rates; or that such reorganisation is cost-effective.
Obviously Hunt disagrees with that, and is pushing ahead with the seven-day plan, which was a Tory manifesto commitment. He has said that he will impose the new contract on the BMA if it does not co-operate in negotiations, and that this contract will be for newly qualified hospital consultants, as well as an end to ‘extortionate off-contract payments for those who continue to exercise their weekend opt-out’.
This is the problem for any politician who decides to square up to a trade union, which the BMA, in spite of its rather more august and pin-striped appearance than some of the noisier public sector union, is. Even if the union doesn’t, as Hunt claimed in his speech, represent the views of its members, or even if it is doing its job by insisting on the best conditions it can possibly get for its members while ignoring the arguments in favour of the consumers of a public service, an attack from a minister on that union is still read as an attack on teachers/doctors/tube drivers/motherhood and apple pie purveyors. Few ministers work out how to lock horns with a union without offending the trade or profession that union negotiates on behalf of, even if in their own minds they see an obvious distinction between the two.
So where does that leave the #iminworkjeremy campaign? Well, personally I liked being reminded how many people there are out there who take on a job that is nowhere near as well paid – even at the most senior level – as the sort of job in finance that many doctors, who are super-bright and super-hardworking, could also turn their hand to if they fancied. It’s good to be reminded that there are so many doctors trudging off to work a night in A&E because they love working in A&E, or choosing a discipline that means they spend more time at the weekend with very sick children and their frantic parents than they do with their own family. But the campaign is protesting about something the Health Secretary didn’t say. Perhaps it will turn its hand to protesting the design of the seven-day NHS, or the current working conditions for junior doctors, and based on the success it has enjoyed this weekend, it will be very effective.
P.S. I’m aware that pointing out this kind of stuff about a speech by a Tory health secretary on a Spectator blog means that some people will claim that we-would-say-this-wouldn’t-we, in which case here is the speech so you can judge for yourself. You can even skip the bits about the new jointly led Monitor and TDA if you want.
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