In the last week, junior doctors around England decided to take strike action again the proposed contract changes which were put forward by the Conservative Government. These contract changes were part of their manifesto pledge to create a 7 day NHS. Following this strike action, which was supported by 98% of junior doctors, Jeremy Hunt took the decision to impose the new contract on them.
The main dispute between junior doctors, who were represented by the British Medical Association (BMA), and Hunt was the Government’s insistence on reclassifying Saturdays as normal working days instead of unsociable hours. Hunt’s reasoning came from studies which found a higher mortality rate in patients who are admitted to hospital on the weekends. Because of this, he wanted to give hospitals the ability to roster up staff on weekends easier by reducing the pay that they were granted for working on Saturdays.
The problem with this from the very start, was that one of the key studies that Hunt referred to never concluded that the reason there was an increased mortality rate on weekend because of a lack of junior doctors. Sir Bruce Keogh, one of the authors of the study, said that it was not possible to “determine the extent to which these deaths may be preventable” and that it would be “rash and misleading” to to assume that they were. In fact Dr Fiona Godlee, the editor of the British Medical Journal which printed the study that Hunt used, blasted Hunt for misrepresenting the information that was shared in the journal. She said:
Despite the authors’ very clear statements to this effect in the paper and elsewhere, you have repeatedly told MPs and the public via media interviews that these deaths are due to poor staffing at weekends, with a particular emphasis on medical staffing. This clearly implies that you believe these excess deaths are avoidable. I ask you to publicly clarify the statements you have made in relation to this article to show that you fully understand the issues involved.
When questioned about his use of this study to back up his proposed contract changes on the Andrew Marr Show, Hunt said that “[Keogh] actually said that it would be rash and misleading to say you could avoid every single one of those deaths.” What Hunt was saying here is that, while getting more junior doctors to work on weekends wouldn’t prevent every death, it would help to reduce them. However, Keogh never said that the weekend mortality rate was related to staffing levels – and in fact, as stated above, he said that it was just not possible to determine to what extent the deaths were avoidable.
To me, it seems obvious that the debate should have ended there. Negotiations should have been called off until Keogh himself clarified whether he saw a link between patient mortality and staffing levels and Hunt should have looked for hard evidence to back up his claims before proceeding.
But, of course, this didn’t happen. Somehow he was able to continue, despite 90% of junior doctors saying they would quit if the new contract was imposed, and 66% of the public backing strike action. Surely, at this point in a democratic country, someone is supposed to put the breaks on. Surely there are systems in place to stop elected officials from pushing through contracts on people who are overwhelmingly against it. Surely these elected officials, who are in office presumably to represent the public at large, listen to the advice of those who are on the ground and appreciate the majority of people are completely opposed to further action. No. Of course not.
Instead, Hunt chose to impose the contract on junior doctors against their will – setting what is quite possibly the worst example possible for managers in the private sector for dealing with a worker dispute. If the Government is going to continue to meddle in the affairs of the public sector – rather than leave it to the managers who are actually involved in the day-to-day running of these public institutions – they could at least lead well. It seems obvious that Hunt’s involvement in this was driven purely by political reasons. The Tories made this manifesto pledge and he was going to make sure that it was implemented – whether it made sound logical sense or not.
Another point to add is that Hunt made it seem like he had no choice but to end the negotiations and impose the contract on junior doctors. Why was there such a rush? If the negotiations needed to continue, they should have. Any Government that cares about its citizens, or any health secretary who respects the work the staff of the NHS do, would sit down with the doctors and work something out. The shadow health secretary, Heidi Alexander, made this point the best when she said:
This whole dispute could have been handled so differently. Everyone, including the BMA, agrees with the need to reform the current contract – but hardly anyone thinks the need to do that is so urgent that it justifies imposition, and all the chaos that will bring.
So, okay, we find ourselves at this point where Hunt has imposed this contract despite public opinion. Sometimes politicians have to get their hands dirty, right? Generally speaking, change is met with resistance and occasionally it just takes someone to push something through to generate a positive outcome. Maybe Hunt has got this right. I mean, he has the backing of twenty different NHS bosses, as he made clear to justify his decision to impose the contracts.
Wrong. Within 24 hours of his statement, fourteen of the NHS bosses who he claimed backed the decision to impose the contracts came out and clearly distanced themselves from his course of action. A full list of the statements made by NHS bosses can be seen here. So now, on top of all the other problems with Hunt’s argument, he doesn’t even have the backing that could justify the decision to impose the contracts against the will of junior doctors.
How is it that we live in a world where this is possible? Where a politician is able to distort information (intentionally or not) and then outright lie to build a case for his ‘nuclear option’? When reading up on Hunt, I started to feel sorry for him. I felt that he was trying his best with the information he had and that maybe he was just misunderstood. I didn’t think that made his behaviour towards the BMA acceptable, but I still felt bad that he was blasted so viciously by the media. After hearing that almost three-quarters of his support have said they never supported imposition, I feel Hunt has been exposed for what he is – at best manipulative and at worst an outright liar.
That is why I would encourage everybody to put their name down on this poll as a vote of no confidence in Hunt. The poll has already reached over 200,000 signatures at the time that I write this, but the more signatures it gets, the more powerful it will be.
Hunt claimed throughout the negotiation process that he wanted a cost-neutral solution to solve the problem with mortality rates on the weekend. While the contract that he is now forcing on junior doctors is cost-neutral for the Government, it bears a huge cost for the doctors working relentlessly in hospitals, the patients who are being treated by already overworked staff, and Britain as a whole, as this move is yet another blow to one of our greatest national institutions – the NHS.