Posted on February 13th by Dr Gagan Bhatnagar on the clinoncdoc.
The Government has bulldozed ahead with the imposition of a
junior doctor contract against the advice of every professional medical body in
England. Of the 20 NHS chief executives that supposedly backed his imposition,
14 have stated that they in no way supported this extreme action. It is worth
considering that if the Government can just impose a contract of their own
accord without agreement of the other party, what is to stop them from changing
their mind in the future only to impose another contract?
The crux of the contract debacle is simple, the Government
and NHS Employers are looking to extend services to 7 days on a 5 day (elective
care) budget. Emergency care already runs 7 days a week, 365 days a year. Mr
Hunt is not proposing to increase the pool of doctors to achieve this, so he
will be stretching an already over-stretched workforce more, for the same
pay-packet. The simple solution: If you would like to extend services, fund and
staff them appropriately. Indeed experts suggest an extra 38,000 doctors would be required to safely staff
a 7-day NHS.
This debacle comes on the back of a build up of frustration
within the NHS workforce over a number of years. Increasing demands, real term
pay-cuts for over a decade (ignoring DDRB advice for annual pay rises with
inflation), staffing shortages, no recognition of the need for rest and breaks,
and no support for those in training has left junior doctors (and other
healthcare workers) at breaking point. The workforce now feels under-valued and
demoralised. The dissent that followed asking doctors to do more for less, was
inevitable.
Senior officials within the NHS have acknowledged the
demoralisation of the workforce over a number of years. I place the blame, not
only with the Government, but NHS Employers. They are directly responsible for
looking after their work-force, but in the pursuit of appeasing a relentless
Government hell-bent on ‘efficiency savings’ and ‘extension of services’
without extra funding, they have failed their employees. Employers have failed
to listen to junior doctors and have failed to engage them, all the while
increasing their requirement for service provision and depleting their training
time. Doctors are expected to train in the little free time they do have (often
coming in on their days off, just to gain experience), pay exorbitant fees for
mandatory exams, courses, and medical licenses for the benefit of the Trust and
patients.
The same can be said for nurses that are ever being
stretched thinner due to cost-cutting. Recent studies show that mortality was
significantly improved when nurses are responsible for 6 or fewer patients. However, this is rarely the case
in most hospitals. Indeed recently the Government attempted to bury safe-staffing guidelines. The Government and NHS
employers are hardly champions of patient safety.
It is little surprise then. As working conditions and morale
have deteriorated over the last decade, the medical profession has found itself
in a serious recruitment crisis. In recent years, one third of A&E doctors have left. Last year half of Foundation
Doctors did not apply to specialty, a drop of some 25% from a few
years prior. Across the board, fewer doctors are choosing to continue their training in the NHS due to poor working conditions.
Even more worrying is a drop in medical school applications by 13.5% since
2013 which has been linked to the continuous negative publicity. These
numbers are catastrophic.
In a capitalist society where value is measured in coin, pay
is certainly part of the issue. It is worth clarifying that junior doctors have
never asked for a pay-rise. The government justifies huge bonuses for bankers
and chief executives to recruit and retain the best but the same does not apply
for doctors, nurses, or teachers. Fundamentally, this debacle is about feeling
valued and respected and thereby retaining your doctors to provide the best
care possible. The persistent devaluing of bright, highly skilled and motivated
staff over a number of years has lead to this crisis which will ultimately be
to the detriment of patients.
Unfortunately the actions and words of the Health Secretary
have not helped morale which has received severe backlash on social media. Mr
Hunt has called doctors militant and lacking in vocation (#MilitantMedic,
#LackingInVocation). He has suggested junior doctors don’t work weekends
(#ImInWorkJeremy). He has claimed our motivations are monetary (#DangerMoney).
He is closely linked with the smear campaign by Murdoch media (#MoetMedics). He
has continuously lied and misrepresented scientific data, and when answers are
demanded of him, he shirks his duties by failing to attend urgent questions in
parliament (#TheJeremyHunt, #TheHuntHunt).
Mr Hunt has failed to meet face to face with a junior doctor
in over a year, and has been caught on camera actively running away from a
junior doctor on Sky TV. Furthermore, he has cancelled meetings with the public
for fear of confronting a doctor. If his actions were right, he should have no
difficulty justifying them to doctors face to face. This is not a Secretary of
State that instils confidence or boosts morale. As the single biggest
contributor to loss of morale in recent history, there was a distinct irony
when Mr Hunt requested an inquiry into why doctors’ morale is so low.
Morale may seem an abstract concept to measure, but it is
clear that it has never been lower in the NHS. As it continues to plummet in
the face of contract imposition, doctors may vote with their feet, leaving the
NHS in further turmoil. Improving the morale of staff should be the single most
important item on the itinerary for NHS Employers, and they should begin by
stopping the meaningless lip-service and demanding the Government retract this
imposition and find a way to demonstrate how they truly value their doctors.
Dr. Gagan Bhatnagar MBBS BSc (Hons) MRCP
Clinical Oncology Registrar in Oxfor
Whatthebleep