Dear Health Education England
I am writing in response to the message sent by Jeremy Hunt, the Secretary of State for Health, which was sent out to all junior doctors by you on the 4/11/2015. It is most excellent that there is now a direct channel of communication between junior doctors and Mr Hunt. As you now appear to be acting as his intermediary, I would be very grateful if this could be forwarded straight back to Mr Hunt,
Dear Mr Hunt
It is most kind of you to have spent the time to write a letter to junior doctors and send it to us via Health Education England (HEE). I know you are a very busy man and that it must be hard to find time to keep up to date on what junior doctors do and our contract situation, especially given you have so many non minuted meetings during taxpayer funded time with editors from newspapers such as the Sun, Mail, Times and Telegraph. I also know you are very busy keeping up to date with the latest research from NHS England. It was also much appreciated that your message reached us via the media well before the email from HEE, I presume this was just to make sure the message got through, it was so very thoughtful indeed. Anyway onto a few simple points I would like to make regarding the junior contract situation, I presume they were all innocent errors, after all you do have so much on your plate.
Firstly on safety, I would love to know a little bit more about the details of how junior doctors will be protected from excessive dangerous hours by CQC inspections. The removal of the current system of hours monitoring which is a robust independently overseen process with real teeth and its replacement with a system which appears utterly toothless appears nothing other than dangerous. The assumption that the CQC will manage to enforce safe hours with a 40% cut in funding, without the necessary expertise and without proper independence from government, appears nothing other than cloud cuckoo delusion which will catalyse the acceptance of dangerous working practices.
Secondly on the ‘pay rise’, the way in which this has been released and propagated in the media is nothing other than a disingenuous insult. It is worth remarking that junior doctors are not paid for overtime, our routine rota’ed hours are covered by basic pay and banding supplements. Certainly this is an unusual system but it works pretty well, but it does mean that effectively our basic pay for routine hours worked consists of both our basic pay and our banding payments combined. In reality our pay is at best being frozen, and in three years’ time when the sticky plaster pay protection ends, many of us will experience significant pay cuts. Therefore please stop misleading the public by pretending that a rise in ‘basic pay’ represents a pay rise, it clearly does not.
Thirdly on your 7 day reforms, it should be noted that many services are already high quality and 7 day, and this has been achieved effectively using current contracts for both junior doctors and consultants. The way in which you pretend contract reform is necessary for improving the quality of patient care is both deceptive and dishonest. Given the recruitment and retention crises we are experienced in many areas of medicine today, forcing more antisocial hours of no extra reward is likely to worsen this already brittle situation, thus posing a serious threat to patient safety. This ignorant ‘Gatling gun’ approach to service reform is unsupported by a credible evidence base and likely to be highly counter-productive, both in terms of financial sustainability and in terms of patient safety.
Fourthly on the argument that transparency can drive better systems for patients, one you have used rather selectively in various speeches in recent months. I am a strong proponent for openness and transparency; however one has to be consistent in applying this logic. You have frequently exploited the Midstaffs scandal for your own political gain, but sadly the most important lesson from this mess looks like being ignored. The NICE safe staffing work has been buried under your watch as a result of political expediency; this is a travesty for those who have suffered poor care in the NHS. This is not the only example of your cherry picking when it comes to transparency, your refusal to release details of what you discuss with editors from newspapers such as the Sun, Mail, Times and Telegraph is another classic one.
I would so much appreciate if you had time to respond to the specific of these concerns raised, whether you choose to answer these via HEE, the media or directly to myself, I would appreciate some honest answers whatever the mode of delivery. Certainly given how frequently you meet with the media behind closed doors, it may be easiest to get your response out as a Sun or Times editorial, I’m sure I would be able to notice it was you responding, even if you were not named directly. I do realise you are a very busy man, I know you have a copy of Trisha Greenhalgh’s excellent book on evidence based medicine to read, as well as a letter from the BMJ editor Fiona Godlee to respond to, you also have meetings with the Colleges to attend to, as well as liaising with NHS England about their research agenda. Thanks so much for your time, I do hope you don’t have to resort to hiding behind vegetation this time around,