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.

Sunday, 8 November 2015

Dear Mail Group.......

Dear Mail Group

I am writing for several reasons, all under the same general umbrella of admiration for your mighty journalistic tradition which invariably serves the public interest above all else.  It is most excellent that you are now taking such an interest in the junior doctor contract story, particularly the way in which you are now focusing on the characters involved, it is most educational and intellectually invigorating.    Obviously the fact that doctors are in uproar about the lack of robust safeguards to protect their patients from doctors working dangerous excessive hours is not really important.  Also the fact that antisocial hours are going to be less rewarded during a global recruitment and retention crisis is also immaterial, the inevitable workforce crisis that will result will not matter.  It is far more noteworthy to Mail readers that some junior doctors are also young photographic entrepreneurs and have healthy interests outside of medicine, does this make them capable of membership of David Cameron’s ‘party of the workers’?  Or is membership of this neat little club contingent on only particular types of work such as running a hedge fund or banking?

The fact that we already have excellent 7 day services in many areas with the current doctor contracts is also irrelevant, we should simply trust Jeremy Hunt when he says contract reform is necessary for improving the quality of care, he is a man with an impeccable record, a man without conflicts of interest, a virtuous beacon of noble text messaging just at the right Murdoch moment.  This honourable Health Secretary would never attend non minuted meetings during taxpayer funded working time with newspaper editors such as Geordie Grieg of the Mail on Sunday in June 2014 and  then refuse to release any details of what was discussed, would he?  That pesky Freedom of Information does need scrapping while we’re on that topic, allowing the public to understand the real motives lurking behind the big decisions would not really help propagate the benevolent interests of the Daily Mail owners would it?   Meanwhile it is quite right that the Mail ignores the ‘Hunt effect’ which demonstrates that the Health Secretary’s scaremongering may be costing patients their lives; it is also quite irrelevant that Hunt has been instrumental in burying the most important lesson from the Midstaffs disaster, that being the vital  safe staffing work by NICE.

 Anyway I digress, I am just so grateful to you for your powerful investigative journalism, it really is a battle against all the odds, David against Goliath: months of painstaking fieldwork lurking on ‘secret’ forums populated by thousands of people which effectively makes them open, covertly watching and waiting, and then striking out, in brazen tones, and motivated above all else by what you think is right, right for you, for your Editor, for your owner, and right for the short term needs of your newspaper.  While we’re on that topic, it’s worth remembering the benevolent history of the Mail itself, Lord Rothmere was a friend to so many, not matter their race, religion or creed, Hitler and Mussolini were certainly not left out of his fold, what a terrible shame that the rest of the British press did not give fascism the support it so deserved.  It is also notable that the working class ownership of the Mail continues with the controlling shareholder of the Mail Group the 4th Viscount Rothmere is worth around a billion pounds and is a keen supporter of David Cameron.  It is also notable that the noble Viscount, when not fighting for the poor, has non-domicile tax status and pays very little tax on his income, investments or wealth. 

Back to the topic in hand, the Mail really is spot on with its excellently researched article so appropriately entitled “Junior medics’ attempt to plunge the NHS into crisis”.  It really is about time that these lazy workshy junior doctors took their fair share of the blame for the crisis that the NHS finds itself in today.  If only these arrogant spoilt medics, who dare own homes and spend weekends doing things other than working, had implemented the Conservative party’s magnificent Health and Social Care Act better, then we would be not be in the mess we’re in today.  Surely funding shouldn’t matter and the real terms reduction in funding that frontline services have experienced should really be no excuse, these lazy wasters should be working for free and donating their personal possessions to the cause to make up for the government’s rank incompetence.  By fighting against Jeremy Hunt’s magnificently progressive new contract, which promises to make everything better because he says it will, they are the ones to blame for any resulting crisis.  They should just accept this great new deal, after all who needs safeguards from dangerous excessive hours, who needs to retain and recruit staff when there are numerous huge gaping chasms in rotas already, who needs to value staff and reward them fairly for working more antisocial hours? 

The fact that the workable details of the contract have yet to be revealed despite Hunt threatening to impose it in well under a year is a trivial minor snag, these whingeing junior medics should get on with it, sell their kidneys and just damn well do what is in the greater good of the Conservative party.  7 day working according to Hunt will be magnificent, staff recruitment in Australasia is going well, social care is in crisis, spreading everything thinner over 7 days will have obvious gains, the inevitable staffing crisis will be used as a convenient excuse to centralise emergency services, shut lots of smaller hospitals that only the public want, and then it will be child’s play to sell off a lot of profitable elective services to the private sector vultures who are already lurking in the shadows.  This is democracy; this is progress, for the small minority of super wealthy people like our esteemed Viscount it is.

Finally one last thank you, I am so very grateful for your finely engineered prose who so succinctly details the real problems with the junior doctor contract situation.  If only the country was governed by the Daily Mail, what a place it would be, we could get rid of these workshy lazy maggot-like junior medics, we could dump them on Australasia as the convicts of old, and if we are to believe the honourable Mr Hunt, they could simply be replaced with various health ‘Apps’, after all technology is the way forward, long live the Viscount and the party of the 'workers'!

With love

A junior doctor

Saturday, 7 November 2015

Letter for Jeremy Hunt via HEE

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,


Ben Dean

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,


Ben Dean