Why Hunt’s contract is still failing them six months on
The last five years have seen the tightest financial settlement in the history of the NHS, the BBC reported last September. It claimed that “on almost every measure, the last few years has seen a decline in performance in the NHS in England.” The publication of this article coincided with the signing of the junior doctors’ contracts. Jeremy Hunt, whose contracts have been put into effect since October of the past year, managed to worsen the working lives of overworked and underappreciated NHS staff to such an extent that one is led to question whether only a government bent on forcing the NHS into financial collapse would force such a contract in the first place. There was no shortage of concern at the time over the potential implications of such an apparently unsustainable system. It’s time to consider whether progress was attained by the ‘landmark’ changes.
Have such fears about the well-being of both doctors and patients alike proven justified? Can we not draw a causal link between growing pressure on doctors and the declining performance of the NHS? The answer is simple: too much suggests that the contracts, deemed ‘unfair,’ have pushed young doctors to the brink. Since the contract’s implementation, reports of “low morale unhappiness, anger and disillusionment were widespread” according to the NHS website. Moreover, there have been repeated complaints of the ever-increasing costs of developing as a professional medic, delayed or total lack of information about rotations and on-call duties, and confusion as to the how to interpret rules regarding flexibility in training.
However, when one considers the aim of the government – to give the British people “a truly 7-day NHS” in which hospitals and GP surgeries would run a full service at all times – it is harder, though not impossible, to condemn Hunt’s actions. The Health Secretary has argued that he wants to improve care on Saturdays and Sundays because research shows patients are more likely to die if they are admitted on a weekend. While this may be true, if doctors are tired and overworked, won’t this pose an even greater risk to patient health? No doubt, the manner in which the issue was approached, and the consequences of such an ambitious plan, were far from satisfactory.
How they would be providing more extensive services at weekends without working for nothing, without working more hours, without depleting weekday resources to boost weekend resources, or employing more workers and paying them fairly for the labour they do – was never really explained in the first place. And now doctors are paying the brunt of such a burden by working overtime. The junior doctors are paying the price for the enactment of Tory government’s misguided promises.
You see, in order to implement these plans for a 7-day NHS, Jeremy Hunt changed the way in which we pay our junior doctors. Last May, he stated the basic pay rise was to be reduced from 13.5% to between 10% and 11%, extra pay for night shifts was to be reduced from 50% to 37%. This is particularly surprising when we consider the starting salary of a junior doctor is just over £22,000 in the first place.
Pushing junior doctors to the max by insisting on unreasonably long, unsociable hours – without real monetary compensation – has provoked a great list of complications. Last July, The Lancet, arguably the most prestigious medical journal in the world, had a front page which read: “only a government that sought to hasten the demise of the NHS would impose a contract on junior doctors at this time, rather than taking stock to re-evaluate the repercussions on a post-Brexit NHS.”
Alarmingly, in the immediate aftermath of the new contracts being proposed, the GMC received a staggering number of requests from junior doctors for certificates to work overseas. A survey of junior doctors’ career intentions found that many changed their career plans during the dispute. A report on the findings concluded that decisions made “in the heat of a turbulent time” could turn out to have “significant consequences,” the BMG reported in February 2017.
And the problems extend beyond that. Pressure on hospitals to save money is already leading to shortfalls on wards. Jenna Murtha, 25 told the Debrief, “We work twelve hour shifts routinely, sometimes thirteen hours. But if you’re doing that more often we are going to end up being more tired as a result and you don’t want a tired doctor going to a crash call.”
If the government’s primary concern was to provide the best patient care and treatment possible, then, as staffing cuts demonstrate, they have failed in this regard too. At the end of the day, it is quite evident that the NHS and the country are dependent on the wellbeing of these doctor-superheroes in order to provide good patient care. As it stands, a well-motivated and happy junior doctor workforce, unsurprisingly, was not effected by Hunt’s contracts. Nobody wants to see doctors walk out of a hospital and go on strike. It’s time for the government to take responsibility for a contract that was always going to be bad for patients, bad for junior doctors and bad for the NHS.
Photograph: NHS Confederation via Flickr.