Jeremy Hunt

Andrew Lansley has not gone into my good books. He presided over the widely-derided Health and Social Care bill  – the biggest top-down reorganisation of the NHS in its history – in direct contravention of the Consevative Party’s manifesto and in spite of a complete lack of evidence that it would improve anything.Tory ManifestoHmmm. He also received £21,000 pounds from the director of Care UK (a private healthcare company that benefited strongly from Lansley’s reforms), and introduced significantly more private healthcare into a supposedly-not-private National Health Service. Fortunately, Andrew Lansley is now gone. Unfortunately, his replacement, Jeremy Hunt, appears so far to be as bad, if not worse.

Jeremy Hunt was reshuffled into office as the Health Secretary in September 2012, still under a shadow of suspicion over his (mis)handling of a sizable bid for BSkyB from Murdoch’s NewsCorp. Andrew Lansley, having attracted votes of no confidence from both the Royal College of Nursing and the British Medical Association, as well as enough negative publicity to last several lifetimes, was quietly moved to Leader of the House of Commons.

Hunt came under fire almost immediately for his belief that the public should fund homeopathy on the NHS and for having previously co-authored a book suggesting that the entire institution should be dismantled. Why you place a man who has literally written a book on why the NHS shouldn’t exist in charge of said NHS is an interesting question for another time.

Hunt has been involved in a few spats since then – a false claim that foreign nationals using the NHS came at a cost of £200 million (when official statistics place it at £33 million), backing a regression in abortion limits from 24 to 12 weeks, and presiding over the worst winter for the NHS ever (with one hospital even erecting field triage tents in the car park simply to deal with demand). The latter point, I admit, is more an illustration of the result of the Conservatives cutting of healthcare spending over many years rather than Jeremy Hunt’s specific failure, but it is specifically Jeremy Hunt’s responsibility (despite Conservative attempts to remove that clause from the Health and Social Care Bill 2012).

Speaking, however, of specific failures by Jeremy Hunt brings me neatly on to the current furore. Hunt has picked out hospital consultants as lazy, money-grabbing targets within the NHS and has, in combination with a epically-misquoted scientific paper, given a firebrand speech in which he declared that unless the BMA agreed to his demands he will impose a new 7-day contract upon doctors within six weeks. The contract he proposes has many faults, but the one I take most issue with is the change in definition of ‘anti-social hours’.

Currently, ‘normal hours’ are defined as 08:00 to 19:00 Monday to Friday. Working shifts within these times attracts no anti-social hours pay, which seems perfectly reasonable. Hunt wants to redefine ‘normal hours’ as 7am-10pm, Monday to Saturday. I don’t know about you, but ‘and evening with your family/friends’ and ‘an evening when you finish work at 22:00, get back at 22:45, scoff some food and go to bed’ do not seem compaitable in my eyes. Certainly working for no additional pay on Saturdays and calling it ‘normal hours’ seems harsh (and equivalent to a 15% pay cut: a stark contrast to MPs 10% pay rise). Jeremy, not content with that, cutting pay for extra hours worked (stating we should use our ‘professionalism’ to justify working without pay), and demonising consultants, then really stepped over the line. He criticised doctors for not working weekends, for not being vocational enough, and told them to ‘get real’. That was a mistake.

Doctors work weekends, and we do it because it is our vocation. Not because we have no friends or family to see; no weddings to attend, no hobbies to enjoy, but because we care for our patients.

We work lots of weekends – I work three weekends in every 5.  It’s not just junior doctors, either: there are consultants in every hospital, every weekend – lots of them. The #iminworkjeremy hashtag was started on Friday and became a fully-fledged grassroots campaign within hours. Letters from junior doctors – incandescent, furious letters – were shared tens of thousands of times. A petition on change.org (which currently stands at over 75,000 signatures) was rapidly superceded by a parliamentary petition to debate a vode of no confidence in Jeremy Hunt (which has accrued 68,000 signatures in under 24 hours so far). There was criticism of Hunt’s lack of understanding of the difference between emergency and elective care, and what this means for mortality rates. There was criticism of the chronic lack of funding for emergency care – for the supoort staff over the weekend whose absence makes additional weekend consultants redundant. There was no explanation from Hunt about where the funding for all these consultants would come from, and who would cover the weekdays they were taken from. In fact, the only response from Hunt I’ve found so far is a tweet thanking doctors for working the weekend and saying that means they need a new contract. Not. Good. Enough.

With regard to the pay cut, some of the letters rightly pointed out that after 9 years of training and working, a doctor earns as much as a tube driver does on day one. Other comparisons were drawn with pret-a-manger managers and various other non-life-or-death professions whose pay is generally equal or higher than the pay for doctors of various grades. It was pointed out that doctors would be paid more under a private healthcare system – it should speak volumes that doctors know this, but do not support private healthcare. Why? It would be worse for patients, and even after all the media hatred, the political slander, and the fact that (certainly in A&E) we are insulted and sometimes assaulted daily, we do care.

There’s been a smattering of coverage in national news – but only a smattering. Nothing in the Murdoch press on the front pages of their websites, a small article hidden on the BBC website, and a feature on the Guardian from the initiator of the #ImInWorkJeremy campaign. Various small pieces elsewhere. A disappointment.

I hope against hope that even that disappointment will be enough. I realise that this may be unrealistic; I realise the the government is unlikely to listen – there is, after all, an awful lot of precedent for that. I don’t even think that firing Jeremy Hunt will be helpful – what I hope for is that he takes a moment to listen. Takes a moment to learn what would actually be useful in hospitals, from people in hospitals, as opposed to arbitrarily picking things to slander. Most of all, I hope the government realises that the NHS can’t take more cuts, more efficiency savings, more streamlining. It needs more funding. More nurses, more doctors, more porters and radiographers and lab technicians – and certainly it needs those people at the weekends. Ironically, about the only thing that isn’t needed at the weekend is more consultants. Jeremy Hunt needs to understand this. If he loses his job in the process, so be it. If he doesn’t, and if he doesn’t learn from his errors…well, you might get to live the reality of a country where the NHS is consigned as a failure to the history books.

At least, a failure in the books that Jeremy Hunt co-authored, of course.

Hunt

 

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5 responses to “Jeremy Hunt

  1. OK, sorry for this sort of comment on a health-related post again, but…

    You’ve written about this affecting doctors – all doctors. Hunt’s speech referred to ongoing talks with the BMA about changes to consultants’ contracts. According to this Guardian article, at the moment they can decide whether or not to work weekends, and the government would like to change this so they contractually have to work some.

    Whether or not this is fair is one question, and I’m not seeking to suggest an answer on that. But to re-frame it in a broader context to make it sound wider-ranging than it actually is seems a little bit unreasonable, and isn’t exactly a good starting point.

    I would suggest that as this story is being used as part of negotiations with a union, that perhaps the actual intention is somewhat less stringent than it would seem from the speech? Jeremy Hunt being a politician is likely to act politically, since it’s his job and all.

    By the way: “an illustration of the result of the Conservatives cutting of healthcare spending over many years” – adjusting for inflation, the coalition government cut NHS spending from £116.9bn in 2009/10 to £120.0bn in 2013/14. Hmm.

    • Glad you could make it to the healthcare discussion – I was expecting you!

      A few points in reply. First, and foremost, the government is not just trying to change consultant contracts (although that was the focus of Hunt’s speech) – it is also trying to change the contracts for junior doctors. As such, the above is not a re-frame (if anything, it’s understated): it’s a depiction on what is actually going on between doctors and the government at present on a variety of fronts. I’ll acknowledege that I didn’t make that especially clear, but I was angry at the time. And still am.

      Amongst the changes suggested to for the junior doctors contract (some of which are referred to above) are:
      – Increasing the hours of the day defined as ‘normal working hours’ from 8am-7pm Monday-Friday to 7am to 10pm Monday to Saturday (this is where the equivalent 15% pay cut for junior doctors comes in)
      – Refusal by the government to consider payment for extra hours worked at the end of shifts when shifts over-run. Their statement was that the government “expects junior doctors to demonstrate their professionalism” and to work those extra hours without pay. Coincidentally, this also avoids a financial penalty for employers who know their doctors work late, every day, and do not improve staffing.
      – A change in how junior doctors pay is calculated resulting in an immediate 1% pay cut.
      – The BMA attempted to place more provisions for junior doctors’ welfare during the negotiations. The following is a sample of things refused by the government: abolishing fixed annual leave determined by rota co-ordinators, forcing rotas to be available for doctors months in advance (currently it is common to receive the next rotation’s rota the day before you start, meaning you can make no plans for the next 4-6 months), and providing a safe place to sleep for doctors who’s night shifts have overrun and who are too tired to drive home (I reckon roughly half of the registrars I know have had a car accident driving home from night shifts).

      Also, bear in mind that I will be a consultant in a few years. Anything attacking them is attacking me, and every other non-GP trainee from CT1 to ST7 (7 years worth of cohort of hospital doctors). It’s doubly insulting because the way that Hunt has spoken is misleading the public into thinking that consultants are all lazy slime who don’t work any weekends and rake it in. Well, take Karan Kapoor’s (a consultant ENT surgeon) paycheck that he posted on social media to demonstrate his on-call supplement which worked out at a rate of £2.61 per hour (one weekend in 5, being on-call one night per week. Yes, the basic salary is good, but is it good enough for the anti-social hours, the additional hours of work, and the endless flaming by the government? Increasing numbers of consultants think not, and are leaving the country.

      Finally, as I’m beginning to rant again, the issue of Conservative funding of the NHS. In absolute terms, you are correct – they have increased spend per year. However, they have coupled this with an ‘efficiency drive’ which has resulted in significant cuts to front line funding. I’ve posted about this in more detail here.

      I’ll leave you with this open letter to the BMA, which sums up a few additional points more elegantly than I could.

  2. “Doctors already work extremely hard, and their hours should always be within safe limits”
    “Every weekend swathes of doctors go in to the hospital to see their patients, driven by professionalism and goodwill”
    I’ve read the speech. The above quotes characterise the way he spoke about doctors. I don’t see how you get from “work extremely hard” to “lazy slime who don’t work weekends”. It seems that the only people who have actually referred to being lazy are… doctors, protesting that they’re not!

    According to the NHS website, consultants earn at least £75,429pa. Is it fair that – amongst all the things wrong with healthcare in the UK – the thing that seems to have fired everyone up the most is proposed changes to the terms of employment for some of the best-paid people in a hospital? You realise how that looks?

    To be honest, I have a limited amount of sympathy. The NHS is a monopsonist employer, so there’s fewer curbs on these sorts of changes. Whenever anyone suggests changing this, doctors are at the forefront of arguing against it, even though it would inevitably lead to a better health service for patients (and probably better working conditions for doctors!). You want politicians running the health service, you get politicians running the health service. Even if they don’t know what they’re doing.

    • None of what he has said in the speech covers any of his proposed changes to the junior doctor contract detailed in my above comment. All of the changes detailed in my comment justify a response, which looking at them is bound to be negative. I can see your point regarding consultant weekends, and am pleased to note that Hunt has no intention of bringing consultants who’ve not worked a weekend on-call for over a decade in to do so (which would be positively dangerous). However, the negativity in the media following Hunt’s speech, deliberately or not, has also contributed to the anger of doctors – most likely due to Hunt’s implication that we do not currently have a 7-day NHS despite many of us working 7 days on a regular basis (I work 60% of weekends, for example). However, I concede that in the speech itself Hunt is generally complimentary of doctors (I had only read excerpts prior to now, so thank you for illuminating me!)

      Sadly, this does not render the speech issue-free. In particular, there are points where Hunt is either deliberately misleading or ignorant, neither of which are a good thing for the Health Secretary to be. The statistic that has been bandied about a lot by Hunt (and is also present in the government response to the petition issued today) is that ‘15% more patients die when admitted on a Sunday than when admitted on a Wednesday’. This is taken to mean that care on a Sunday is inferior to weekday care, when in fact it is an entirely different cohort of patients. Sunday admissions are emergency admissions and have a higher death rate by virtue of the fact they are more unwell. (would they have been emergency admissions if community services were adequately funded to treat them there? who knows). The paper cited shows not deaths over the weekend, but deaths in the subsequent 30 days for patients admitted at the weekend – a third of the patients who died actually died over the next 3 days, when full weekday staffing was in place. Ironically, when the paper examines chance of death for ‘people in hospital over the weekend’ vs ‘people in hospital during the week’ they are actually less likely to die over the weekend.

      Further problems identified by the BMA both from the speech and from contract negotiations include a complete absence of funding for a seven-day NHS. Even if (more) consultants were to be in every weekend, there aren’t enough consultants in the country to enable both full elective weekend cover and full elective weekday cover – somewhere, someone is going to suffer. Secondly, even with full consultant cover at the weekend, nothing will improve. The reason for this is a lack of both in-hospital support staff – porters, lab techs, specialist nurses/pharmacists and physios – and community support for complex discharges. A consultant cannot, by his or her mere presence, cause a CT scan to happen if the radiographer isn’t in to protocol the scanner. Nor can they discharge a patient who needs care at home from hospital if such cannot be arranged at the weekend for a lack of staff. What Hunt has effectively proposed is: more consultants at the weekend will improve weekend mortality (which he has incorrectly inferred from a paper, although I completely agree that weekend services need improvement regardless of mortality). What he hasn’t proposed is how isolated extra consultants will achieve anything, nor how he will fill the gaps in the rota generated by bringing them in at the weekend. The elephant in the room, as always, is funding; the government has provided NO reference to how the additional consultant hours required will be funded, which consultants will appear (and where from) to fill the rota gaps, and how they government will train, hire and continue to pay for the allied healthcare professionals that will be needed to make a ‘7-day NHS’ a reality.

      Finally I’ll take it that your last paragraph is a further push towards privately funded/insurance based healthcare. We’ve been over this a number of times, so I won’t repeat it all. What I will say is that if private healthcare will lead to better working conditions (and lets be honest, heaps more money) for doctors, and better care for all patients (not just ones who can afford it) – why do doctors not support it?

      Clearly we do not believe that it will lead to better care, and we don’t care enough about the extra money to sell out our patients to it. If you want private healthcare, right now, you can have it; for everyone else there is the NHS. I for one want it to stay that way, even if it would be nice to blast off from traffic lights in a ludicrous tesla and spend all my holidays in faraway lands.

      • You actually don’t need to convince me that his speech has issues, or that the proposal may not be a great idea; the purpose of my comment wasn’t to defend what he was saying. My point was that you were putting words in his mouth, by extending it to cover all doctors and alleging that he called consultants lazy. It’s perfectly fair to point out the flaws in the idea, as you’ve done in the most recent comment, but breathless hyperbole and putting words in someone’s mouth just doesn’t seem right to me.

        As I noted in my initial comment, we have to bear in mind that this is a politician making a speech as part of a union negotiation. This is most likely a bargaining chip, a way to try get a better deal with the BMA. It’s how politics works, so we shouldn’t take it as fact until the actual proposals come out. Perfectly fair to say “this is a terrible idea”, just bear in mind that it’s not actual policy.

        “Finally I’ll take it that your last paragraph is a further push towards privately funded/insurance based healthcare”
        I’ve never argued for a privately-funded healthcare model. I think 99% of people in the UK agree that publicly-funded healthcare is a good thing, the argument is around how best to provide that. I contend that allowing more private provision – still paid for by the state – is a good way of doing this. You often point out that the NHS is run at (or over) capacity, what will be the harm with a private hospital being contracted to treat some of those patients so that both hospitals run better? Politicians also don’t have control over the running of non-NHS hospitals, so they wouldn’t be able to, say, radically change staff contracts to include weekend-working at a whim.

        “What I will say is that if private healthcare will lead to better working conditions (and lets be honest, heaps more money) for doctors, and better care for all patients (not just ones who can afford it) – why do doctors not support it?”
        Because there’s no evidence to suggest it’ll lead to heaps more money? More employers means a more flexible labour market; this would mean that employers have to consider things like staff retention, so working conditions are likely to improve. But it’s also going to open up competition, and that’s likely to reduce wages as you move up the hierarchy; probably lead to fewer consultants on £75k+. Perhaps doctors oppose it for the same reason they oppose extending normal working hours?

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