Saturday, 28 November 2015

Words of a not so junior doctor

Sadly despite our common goal of improving NHS care, talks between our union, the BMA, and government broke down many months ago due for reasons which have yet to become fully clear.  Recently the overtly hostile and aggressive mode of the government’s ongoing threat of unilateral contract imposition upon junior doctors has been particularly morale sapping and depressing to endure.  After all, I am rightly expected to be totally honest with my patients, so how can it be fair or right that the government and Jeremy Hunt treat me and my colleagues with such a total lack of dignity and respect?  The details of the contract are complex but the key flaws within the government’s argument can be summarised fairly succinctly.

Jeremy Hunt and the government claim contract reform is essential to create a ‘truly 7 day NHS’.  There are two critical problems with this as what is meant by a ‘truly 7 day NHS’ has yet to be defined, while many NHS services have already been reformed to become high quality fully 7 day services and this has been done within current contracts and well before Mr Hunt’s reign began.  Notably this has only been managed because ground breaking reforms in areas such as cardiology and trauma were clinically driven and the views of those who would have to deliver these very reforms on the frontline were honestly sought.  Therefore the government’s argument is a weak straw man; existing contracts are perfectly compatible with improving services, while pretending to reinvent the wheel of ‘7 day services’ does not magically create a new wheel.

If Jeremy Hunt and government wanted to incentivise better care at weekends, then surely the new contract to achieve this aim would have to increase the reward for antisocial working?  One would think so, which makes it particularly strange that the new contract imposition rewards antisocial hours less than the current deal.  This is particularly problematic in terms of the recruitment and retention of doctors, which are already in pretty dire straits in several areas including General Practice, A&E, Paediatrics and Psychiatry.  Jeremy Hunt’s ‘11% pay rise’ is a disingenuous sleight of hand, the deckchairs have simply been rearranged, the overall pay package is unchanged, money has simply been moved away from rewarding antisocial hours and into the basic pay pot.  Given that recruitment and retention is particularly dire in many of the specialties with a lot of antisocial hours, this makes the contract particularly regressive and potentially unsafe in terms of creating more dangerous gaps in rotas. 

Jeremy Hunt has claimed that junior doctors will work fewer hours under the new contract but has actually removed the only robust contractual safeguard against excessive hours from the contract, the financial penalties for employers who breached hour limits.  At the same time he has introduced nothing credible with teeth which could possibly ensure that his vision could become a reality.  Many of us already work many extra overtime hours which are currently unpaid by the current system, despite Hunt’s ignorantly offensive claims that doctors lack ‘professionalism and a sense of vocation’, the system is still very reliant on this professional goodwill.  Again Hunt’s claims do not fit with the objective reality of the new contract, there will be no more doctors, and with the removal of our only robust hours safeguard, it is highly likely that junior doctors will be left unprotected from dangerous excessive hours.  This inevitably means that patients will be needlessly put at risk of harm; as there is a plethora of solid evidence showing that tired doctors make considerably more mistakes. 

There are many more significant flaws in Hunt’s contract including the negative effect on both research and gender equality, but the recurring themes remain the same: there is a gaping chasm between the government’s rhetoric and the likely reality of the contract they aggressively threaten to impose.  It is no coincidence that both representatives of the Department of Health and Jeremy Hunt routinely refuse to appear in public or in front of the media to take open questions on this mismanaged dog’s dinner, while junior doctors are more than happy to be questioned live and to speak to members of the public on the street to inform them of the reality of this toxic contract imposition.  If the government had such a great progressive contract on the table, why do they hide from public discussion and why have 98% of highly educated professionals voted in favour of industrial action?  The stressful dilemma facing us now is that none of us want to strike, what we want is a safe contract which is compatible with a sustainable 7 day NHS.  However the government has not given us a good option, we have the option of industrial action or a regressive dangerous contract which will destroy any hope of a safe sustainable 7 day NHS in the longer term.  With heavy hearts we have opted for the least bad option of industrial action, knowing not where it will lead, but at least knowing we are doing the right thing for what we hope will be our many future patients in the NHS.  We want negotiation but we welcome the recent move from Jeremy Hunt to engage in conciliatory talks with the BMA via ACAS, however while the government refuses to withdraw its threat of contract imposition meaningful negotiation cannot happen and a strike remains inevitable.

I am honestly not sure what I am meant to feel anymore, the emotional rollercoaster has still to run its course.  Since I graduated from medical school over ten years ago life has certainly had its up and downs, the biggest ups were getting married and having a wonderful daughter, the downs have included failing several exams along the way and the incessant shifting of the goal posts in medical training.  On the whole medicine has been a wonderful career, being a doctor is a great privilege in ways I had not imagined before embarking upon this journey; simply being in a position to meet and learn from so many fascinating diverse characters is a great privilege.  It says a lot given how rewarding I find the day to day job, that I doubt that I would encourage my daughter into medicine these days.  It is a pretty sad indictment on the mismanagement of this situation by the government and Jeremy Hunt that they are bullying through the creation of an environment in which I would not want to see my own child work, consequently they are sculpting an NHS in which I would not want to be a patient, and that is the most damning indictment of them all.  The continued creation of a high quality 7 day NHS can only be done with collaborative and cooperative working, bullying misguided flawed policy from on high will only create more problems, not solve them.

No comments: