I’m not a doctor, but I’m pissed off. We all should be. The most caring and intelligent people in our country are being slandered by the government, and the beating heart of the NHS – an institution so sacred to this country that Danny Boyle gave it a starring role in the Olympic opening ceremony – is under strain. It’s beating in the way it might in someone who is lying in intensive care after being beaten listless by thugs on a Saturday night, when, even on a Saturday night (or a Sunday!), there would be an overworked junior doctor – most likely a team of them – giving every shred they had to keep it alive. (Because, Jeremy, we already have a seven day service.) We need to do for the NHS what ANY junior doctor would do for us: we need to fight to keep it damn alive.
To the NHS, Jeremy Hunt’s imposed contract is cholesterol, and he’s serving it up as something healthy; “Eat the CARROT cake, go on, EVERY DAY, carrots carrots CARROTS!”, when it’s actually about to kill us.
The junior doctor story has been long, littered with contract complications and clouded by the government’s spin, and simply the fact that so much is wrong with the new contract in the first place.
There are 53,000 junior doctors in the UK, and the name is misleading. It covers any medic who is somewhere between graduating from medical school and qualifying as either a consultant or a GP. That’s why you’re seeing junior doctors out protesting who are in their 40s – it can take up to 15 years to get that far. Though to be fair, they could be 25 and just REALLY tired.
Contract discussions began in October 2013, and were stalled in October 2014 when the government failed to agree safeguarding measures for doctors’ welfare and patient safety. They only restarted at the end of last year, but no agreement was made, so in February 2016, Jeremy Hunt announced the contract would be imposed anyway. He’s not willing to negotiate so junior doctors, as part of the BMA (British Medical Association) – the trade union and professional body for doctors in the UK – are staging two full walk-out strikes on Tuesday 26 and Wednesday 27 April. During the strikes, there will be an emergency-only service staffed by consultants.
It’s been around a year now since David Cameron won the general election with the manifesto promise, “We want England to be the first nation in the world to provide a truly 7 day NHS”. Interestingly, the manifesto also says: “We will now go further, with hospitals properly staffed, so that the quality of care is the same every day of the week.” Properly staffed, huh? Well, someone please call Dave, because Jeremy is about to contradict one manifesto pledge with the imposition of another.
The contract issues broken down:
1. It is not about pay. Despite what the government would have us believe.
It is primarily about patient safety. As anyone who has ever had their stomach pumped on a Friday night, or gone into labour on a Saturday, or had a cucumber removed from their rectum on a Sunday afternoon WELL knows, we already have a seven day emergency service in the NHS. The government wants to increase this by providing a seven day non-essential (‘elective’) service.
But they aren’t increasing the number of doctors.
What they are doing, is changing the contract so that they can spread staffing even thinner during the week, to provide this seven day service. So, who is going to replace the doctor who isn’t working in emergency care on Tuesday, because she has to work in non-emergency care on Saturday? No-one. They’re not employing any extra doctors. And there are already rota gaps. We need emergency care during the week and at weekends. Doctors cannot provide increased non-emergency care, with the same number of doctors. Emergency care will suffer.
Ashling Lillis, a junior doctor working as an acute medicine registrar: “Every doctor wants to provide a safe seven day service. But they can’t just stretch the existing service.”
AND, they’re cutting places on medicine courses. A student who is about to start medical school in September told me: “Graduate places at my medical school were halved meaning I had to compete with 2,600 people for 60 places to get through, yet the NHS is crying out for more doctors.”
Doctors Constantinos Kanaris and Hoong-Wei Gan, speaking outside the Department of Health, said: “We’re both paediatricians, the number of gaps already in our rota is worrying.”
They also cited the current recruitment crisis in the NHS, which means that tens of thousands of nursing and doctor posts are empty.
The government could either abandon plans for a non-essential seven day NHS, or alternatively, they could actually pay for one.
The crux of it is so simple it’s laughable. Like when you realise that the jumper you’re trying on doesn’t fit because it’s age 12 and not size 12. There’s just not enough fabric. Jeremy Hunt is not adding doctors to the rota. He wants the same total number of doctors, to be s-t-r-e-t-c-h-e-d.
To justify the necessity of this seven day non-essential service, the government has been batting around a flawed report suggesting that more people die at weekends. However, it’s widely agreed that the report displays bad science, and it actually showed that people admitted over the weekend had an increased risk of death within 30 days. So that’s way more complex. Maybe it’s to do with a number of other things, like if you’ve waited all week because you didn’t want to take time off work, you’re a lot worse by the time you crawl through A&E. Or a number of other factors that the government has chosen to ignore because they knew the conclusion they wanted from this article. Trust the doctors on the science, not the politicians.
(And actually, don’t even trust the politicians with the politics, because there’s currently a legal battle going on, led by five junior doctors as part of Justice for Health , who are taking Jeremy Hunt to the high court regarding whether he even has a legal right to impose this contract. Last time Jeremy was taken to the high court, he lost, and Lewisham hospital services weren’t closed down . It bodes quite well that he literally has no idea what he’s doing.)
So in summary, the government wants to cut doctors’ pay at weekends to make them cheaper to roster per hour, so the trust can squeeze more hours out of them. Which conveniently leads to the next point…
2. The government is removing safeguards on the maximum number of hours worked.
Here’s how I imagine it went:
Someone from the DoH with a brain: But that won’t work, we can’t just force junior doctors to work more hours. There are safeguards, the trust will be fined.
Jeremy Hunt: Oh, bugger. Remove the safeguards!
In the current contract, if doctors are working ridiculous overtime, the BMA gets involved, and the trust gets in trouble and has to pay a legal fine. This is the only current safeguard against doctors working crazy and unsafe hours. The new contract removes this legal fine, so there is no legal backbone to overworking. Yes, Jeremy Hunt has reduced the total weekly maximum hours from 90 to 72 (carrots carrots CARROTS) but the new person to be monitoring it – the ‘Guardian’ – is working for the same trust that does the rostering. So it doesn’t matter what the contract ‘says’ – there is no legal process to enforce it.
And also, wow. Can we just stop for a moment to realise how ridiculous either option is? 72 hours?! Please could you pause briefly to total the number of hours that you work a week, and then how many you work when you’re extra busy or stressed, and how many hours it takes to make you fed up to be spending so much time at work. That’s the equivalent, for me, of being in the office 9am-9pm Monday – Saturday, with no break for lunch. Add my commute to that and I’d get home around 11pm. By 8pm Saturday night, I don’t think you’d want to ask me any questions. And if I was presented with a drunk man with a head injury yelling abuse, or some kid who’d willingly shoved a peanut in their ear, I don’t think I’d be as polite as I’m sure a junior doctor would.
Stretching doctors and removing safeguards threaten the quality of patient care, and threaten patient safety.
3. The contract disadvantages women, and anyone working reduced hours.
In order to provide this full seven day NHS, junior doctors are being obliged to work more weekends in order to qualify for out-of-hours pay, whilst reducing the pay they receive for this work.
Here are the thoughts of someone due to start medical school in September: “I would love to specialise in emergency care, but do I want to do it to the detriment of my health and personal life when I won’t even be fairly paid for it?” The new contract is turning people away from acute specialties which are already under-resourced.
In the new contract, Saturdays are a normal working day. Junior doctors won’t qualify for the out-of-hours premium unless they work two or more Saturdays in four. Less than full-time doctors will never reach that threshold, so will lose out disproportionately.
It would destroy medical families, because there is a hugely increased chance that a couple would both be rostered onto the same Saturday. What are they supposed to do with their kids? The government made the helpful suggestion that they find “informal childcare arrangements”. Core week day working hours have also been extended, to include 7pm to 10pm. (Sorry, what?)
Childcare costs and family time are being compromised, and the contract fails to incentivise out-of-hours work, so these shifts will become increasingly unsafe.
And there’s another thing. Previously, junior doctors had received small incremental pay increases linked to the time served in post. This is being scrapped in favour of paying junior doctors for responsibilities held, which doesn’t sound bad until you consider that it affects people taking time out to carry out academic research, women on maternity leave, or those taking time out for reasons of ill health. In terms of pay, they will fall increasingly behind.
The new contract even acknowledges the disproportionate negative effect it will have on women, stating:
“Any adverse effect on women is a proportionate means of achieving a legitimate end.”
Translation: “Never mind.”
Here, again, is one manifesto point crushing another. Here’s the Conservative manifesto *again*:
“We want to see full, genuine gender equality…we will require companies with more than 250 employees to publish the difference between the average pay of their male and female employees.”
Are you going to ask the NHS to publish these figures too, Dave? Somebody PLEASE get him on the phone. (Seriously, where is David Cameron?)
The government is rushing to impose a contract that is both unfair and unsafe – for junior doctors and patients. The result will be tired, overworked, demoralised doctors, who are physically unable to sustain a high quality of patient care.
So Jeremy, what’s the rush?
The BMA explicitly and directly told the government that they would cancel the strikes if the imposition was lifted , with the hope of resuming negotiations.
Dr Hoong-Wei Gan, a paediatrician from Great Ormond Street campaigning outside the Department of Health, wants to ask Hunt, “Why are you pushing through with this imposition? There is no rush. There already is a contract that allows people to work seven days.”
David Henckert, a junior doctor working in general practice in south London, makes the reasonable point: “It needs a considered approach. I don’t understand what is the huge urgency in bringing about these changes in August. It needs a lot more research, it needs really dedicated people to sit down with all the data and think about what we do.”
Personally, I think the reason for the Conservatives’ tearing rush is classic provocative politics. The same tactics terrorists use. Jeremy Hunt acts brashly and unreasonably by unnecessarily imposing a contract on junior doctors that seeks to destroy the NHS. Doctors have to do something to prevent the NHS falling into ruin, but they are running out of time and Jeremy won’t talk. They use the only option they have left: a strike. Jeremy has got exactly what he wants: a PR story in the pipeline to turn public support away from junior doctors. He just needs to find one person who dies in a hospital on Tuesday or Wednesday and BOOM: PR score. People die in hospitals every day. *Obviously.* Here’s junior doctor Ashling Lillis, on one of her shifts:
“Last night I went to my night shift as the medical registrar on call. In the early hours I spent 20 minutes explaining to a family that their dad and husband was not going to survive his pneumonia and held their hand while they cried. Then half an hour later in the bed opposite we resuscitated a man who still had a chance of surviving the very same illness.”
I’ve never watched anyone die and I can’t imagine having to get used to it.
Anyway, someone dies on strike day, Jeremy unleashes the PR machine, and the front page of the Daily Mail reads: “A person dies in a HOSPITAL as junior doctors strike”, and some people actually start to think Hunt is right. Over my dead body, Jeremy. Though I realise that this is a serious threat to make to you, someone who is flagrantly disregarding patient safety and is content to let people die in order to drag the NHS to its knees for your party’s aims of privatisation.
The real reason behind the government’s meddling: break the NHS and usher in privatised healthcare.
The NHS is not broken, though this is the idea the Tories are trying to perpetuate, cleverly talking about “fixing it” to presuppose this very idea. Thankfully, the junior doctors have more faith; here’s Laura McRae, a junior doctor working as an anaesthetic registrar, speaking outside the Department of Health: “I love my job and I love the NHS. I still believe we provide a good service. I believe in the NHS.”
The World Health Organization recently studied the quality of healthcare provided per GDP in the developing world . The UK came out top.
The NHS is not at breaking point, but the government is desperately trying to lead it there, to systematically destroy the NHS and force privatisation on us as the only viable option. The worse the NHS gets, the easier this will be. Imposing this contract, which will overwork junior doctors and compromise patient safety, is one of these tactics.
Let’s look at the facts:
- Virgin Care currently runs over 230 NHS and social care services. In January 2016, Virgin Care won a £126 million contract to take over services across two hospitals in Kent.
- In 2015, the government signed the largest privatisation deal in the history of the NHS, worth £780 million.
- In 2005, Jeremy Hunt co-authored Direct Democracy, a book which advocates the dismantling of the NHS.
There are other factors that suggest the doctors’ outrage is not about money, but about protecting the sanctity of the NHS:
1. Many of the healthcare staff protesting aren’t junior doctors. They’re nurses and consultants. This doesn’t affect their contracts.
Joan Pons Laplana, a “proud nurse” and passionate NHS campaigner (with 17,000 Twitter followers, @thebestjoan) says: “It’s time to join the junior doctors and have a united front and fight for the NHS. If we don’t fight for the NHS, we will lose it, and then everybody will suffer.”
2. In some cases, junior doctors are receiving a pay RISE, or are unaffected, yet they are still protesting, together. They’re spending their limited free time out in the cold at picket lines and throwing their heart and souls into this fight. Doesn’t that suggest something is wrong? When was the last time you turned down a pay rise on moral grounds?
3. Here are the respected medical bodies against the new contract, who you would expect the government to sit up and listen to (they’re not):
- The Welsh and Scottish governments (I lied, these are not medical organisations). The Scottish Health Secretary, Shona Robison, said: “We take a very different approach to our relations with NHS staff and are determined to continue our longstanding positive relationship.”
- The Academy of Royal Medical Colleges. On 20th April, they released a statement backed by all presidents of all the Medical Royal Colleges and Faculties across the UK, stating: “The BMA has offered to call off the all-out strike planned for April 26-27 if the Government will lift imposition of a new junior doctor contract and return to the negotiating table. We urge the Government to accept this offer.”
- World Health Organization: The director of the Health Workforce, Jim Campbell, tweeted that the “Regressive policies contradict the new UN Commission”. The WHO is quite a large organisation.
Interestingly, the Department of Health hasn’t even got its own staff on board. On Thursday, I went and met some of the medical staff protesting outside the DoH.
Regarding the empty chair that’s waiting for ‘Hunt’, they said:
“Someone from the Department of Health came out and told us we’d spelt his name wrong!” Full support from the team there, Jez.
So, in summary, is this new contract honestly good for patients or the NHS?
So, in order to save the NHS, the doctors are doing what they do best: working as a team, and fighting to save a life.
There have been marches, rallies, and on the eve of the strike action, a candlelit vigil was held outside the Department of Health. Junior doctors and their colleagues have been staging a permanent, peaceful protest outside the DoH, chatting to anyone who has questions (me) and visually displaying that they want to talk. They are camped right outside the front door, so not quite being able to work out how Jeremy was avoiding them, I asked if he was in there.
I received a two word reply: “Back door.”
And the doctors here aren’t just from London. I spoke to Jamie Willson, a junior doctor from Bristol, who said, “I’m happy to come up in my spare time. I’m fantastically a-political, but feel I’ve got no option.”
In addition to the demonstrations all over the country, there are even choirs. The National Health Singers ‘aim to raise awareness of the current threats to the NHS, whilst at the same time boosting morale, increasing positivity and ultimately protecting our National Health Service!’ I defy you to watch their single, ‘Yours’, without a lump rising to your throat. Turns out doctors are passionate people. Well, no shit Sherlock.
It’s been a feat for social media, with many junior doctors conveying their passion and fight with staggering eloquence and creativity. It’s also a feat of organisation, which was another question I posed: “How are you organising all of this?”
There are various online forums but they also told me that “in each of the local areas around hospitals, there’s a WhatsApp group.” A WhatsApp group. Jeremy Hunt has the whole of the government’s political spin team in his arsenal, and junior doctors are winning using WhatsApp.
I asked if they’d received any outward opposition to their stance. They said no, and that everyone had been really positive. While I was stood there in the rain, a middle-aged woman came over and was frantically rifling through the sodden papers on the table: “What can I sign?”
During the last strike, many junior doctors spent their day giving CPR training to local residents.
The full walk-out
During Tuesday 26 and Wednesday 27 April, junior doctors will stage a full walk-out, for the first time in the history of the NHS.
Consultants, who are more highly qualified than junior doctors, will be covering their colleagues’ posts. Here is Dr Philip Lee, a senior consultant doctor specialising in acute medicine and elderly care, in his Facebook post that has been shared over 120,000 times:
“Let me now say categorically, you and your friends and loved ones will continue to get world class emergency care those days.
“You see as doctors, we have all sworn an oath to do no harm. Our junior colleagues will not have taken this action lightly, and they do so with a heavy heart but knowing that as consultants, and my staff grade and associate specialist colleagues, we’re 100% behind them. Our support lets them protest the changes to our NHS that is not safe for patient care.
“On the 26th and 27th of April, if you’re ill, please see your GP, or come to hospital. We will be there for you, just like every day.”
During the strike days, there will be ’emergency only’ care – the same as weekends, bank holidays, and oh – the day of the Royal Wedding.
The BMA has repeatedly approached Jeremy Hunt to re-open negotiations. But he has refused, and after spending days researching this article and sifting through all the information, I can’t see what else the junior doctors can do. Yes, it is two whole days. But the stakes are insanely high: it’s the whole frigging future of the NHS. I trust the doctors to be able to calculate a risk. They do it every day under immense pressure.
Let’s think about why doctors want to become doctors
“Doctors want nothing more than better outcomes and better care for our patients, that’s why we do what we do,” said junior doctor David Henckert, sat outside the DoH in the pissing rain. It’s not rocket science, is it?
One thing that’s struck me, that has really made me notice about every health worker I’ve spoken to, is their genuineness. The people at heart of the NHS aren’t bankers or politicians, they’re not driven by profit or agenda. They are people who chose a career where they could just get on with helping people, where they wouldn’t have to sell, market, or persuade. Many of them aren’t particularly political and they desperately don’t want to strike. But they’re genuinely scared about the meddling that’s being done by someone who has no idea how a hospital works, and who I daresay has never even experienced the kind of passion and team camaraderie that these people do on a daily basis in our hospitals.
Dr Henckert continued: “The team spirit and talented and committed people you work with in the NHS are beyond compare.”
Perhaps Jeremy Hunt is jealous. (Dave…? Mr Cameron? Where ARE you, Dave…?)
Our doctors put up with a lot. It’s not all cute kids with broken legs. Here’s a junior doctor who worked as a rehabilitation assistant before medical school, talking about that job: “I was mainly dealing with the elderly post-op or post-stroke. It often involved patients having accidents mid-session and me trying to limit the diarrhoea trail we were leaving behind during our walking practice.”
That’s just to get an interview for medical school.
And here’s junior doctor Ashling Lillis, a member of the National Health Singers, talking about a typical Monday night:
“I walked into a hospital where we had a four hour wait to see an A&E doctor, critically unwell patients were waiting 10 hours for an intensive care bed, confused brain injured patients were transferred across hospital sites in the middle of the night due to bed pressures and I only had half of the staff I needed to run my service due to rota gaps. These gaps exist because junior doctors would rather leave the country than train to be a GP in the UK.
“For 13 hours I looked after patients with sepsis, high blood pressure, confusion and cancer. The team I worked with were fantastic. The ED consultant found me painkillers for my headache and the nursing staff got me some tea and biscuits when I looked tired and hungry. We laughed at the drunk man shouting in the waiting room because it’s the only way to deal with that level of nonsense.”
What do the junior doctors want?
They want to protect the NHS. They want to protect patient safety. They do not want to be treated unfairly.
They do not want to strike.
Junior doctor David Henckert: “We want to avert the strike. The BMA’s door is open but we’re coming up against a brick wall.”
The BMA have repeatedly told Jeremy Hunt that if he stops the imposition, the strike will be called off. Jeremy Hunt has the power to avoid this strike.
What does Jeremy Hunt want?
Personally, I think he wants someone to die that he can attribute to the strike action, in order to reduce public support of junior doctors and barge on with the privatisation agenda. And that’s presumably what back-seat Dave wants, too.
What are the immediate consequences of imposing this contract?
Many doctors will leave the NHS, to find better conditions abroad or in a different profession. They already are: on the day Jeremy Hunt announced that he would be imposing the new contract, 300 doctors – up from an average of 17 – applied for permits to leave the NHS and work abroad.
Medical students who have already begun their training may quit to get out while they can. Fewer people will choose medicine as a career.
There will be increased rota gaps, and increasingly overworked, tired and exhausted doctors. The consequences for patient safety are obvious.
But the government doesn’t seem too concerned about that, otherwise they wouldn’t be rushing through this dangerous contract.
The government is putting the NHS on the road towards a slow and painful death; with ‘Do Not Resuscitate’ plastered over internal memos.
One of many passionate junior doctors I’ve met: “The whole of the NHS is held up by the goodwill of the staff. No one walks out of that door if there is a patient in need. We all work longer hours than scheduled – like many people do in many professions.”
Imagine when you have a stressful day at work. Someone hasn’t turned up or there just aren’t enough hours in the day and you’re staring at your computer screen, exhausted, heart palpitating, unsure which email to deal with first and they’re still coming. Imagine those emails were people’s lives. Imagine being exhausted whilst resuscitating a patient during a 13 hour night shift.
Who do you think you ought to trust, a doctor or a politician*? Trust your instincts.
As Stephen Fabes, a junior doctor writing in the Guardian puts it: ‘Not only do we have a better understanding than the government does of threats to patient safety, but we hold it in higher regard. It’s drummed into us from the first day of medical school: “First, do no harm.” ‘
What can YOU do to help support junior doctors and the NHS?
- Share this article to death.
- Use this dead-easy link to send a message to your local MP, asking them to write to Jeremy Hunt requesting that he stops the imposition of the junior doctor contract and comes back to the negotiating table.
- Continue outwardly supporting junior doctors – online or on picket lines – in whatever way you can.
*For the record, I’m not a doctor or a politician. I’m just a writer with a conscience.
#juniorcontract #juniordoctors #JuniorDoctorsStrike #TimeToTalkJeremy #notsafenotfair #saveournhs #mindtherotagap #consultantcover #JustHealth #hunteffect #NHSYours #WearYourNHS
Thank you to the friends and amazing junior doctors and health professionals I met along the way for their help with this article, and for patiently answering all of my questions: @AshlingLillis, @thebestjoan, @drkanaris, @hwganendodoc, @jamiesbwillson, @DaveHenckert, @cyclingthe6 and Laura McRae.