London march supporting junior doctors, October 17 2015. Photo: Garry Knight (under Creative Commons)
This is a full-scale attack on the NHS, the junior doctor contract is just the start
Let’s be crystal clear (something the Secretary of State for Health has been consistent in failing to do), the junior doctors’ contract dispute is about much more than the terms and conditions for junior doctors.
My name is Dr James Plumb; I am a junior doctor (I cringe a bit at the term ‘junior’) currently in my 10th year as an anaesthetic and intensive care doctor. That’s 5 years of medical school and 9 years of the best postgraduate training in the world. I have 2 degrees and have passed 3 sets of postgraduate examination (all paid for personally). I qualified in 2006 and was lucky enough to be in the last year of junior doctors to get free hospital accommodation, a right of passage taken away effectively resulting in an overnight pay cut of around £6000 for first year doctors.
So when I was informed recently that I would be paid a lot less for working a lot more unsociable hours I was naturally infuriated. When I found out that the proposed changes would actually put patients at risk and would jeopardise the quality of medical training, and discourage academics and part-time trainees I was livid.
What has happened over the last 3 months has been unprecedented. It has highlighted the gradual, perhaps subtle erosion of what it means to be a doctor. The entire fabric of who we are and how we work has changed for the worse in the short time I have been qualified. For the first time I told this year’s work experience students not to bother applying. This government has literally put us on our knees. We are over worked, tired, demoralised and angry.
The unity however has been staggering with 99.4% of us voting for industrial action, even though we’re hardly a group of ‘militant doctors’ as the Secretary of State has so charmingly referred to us.
Mr Hunt has dressed this contract dispute up as an attempt to improve care at the weekends due to the so called ‘weekend effect’. The mixed up thinking and lack of understanding of medical research here is grotesque, out of interest the paper he refers to actually says that you’re less likely to die at the weekend! It looked at the rates of death at 30 days if admitted on a Friday-Monday compared to a Tuesday-Thursday.
So let’s look at some cold hard facts.
- The NHS is in crisis, recruitment to acute medical specialities it at is lowest for years. Half of A&E training posts remain unfilled.
- There has been an exodus of skilled junior doctors, which is set to rise.
- Spending on health as a percentage of GDP is actually falling.
- Despite this the Commonwealth Fund study found that the UK ranked 1st (yes 1st) on markers of quality, efficiency, equity. Interestingly the USA ranked last, and Mr Hunt wants to move to a system more like theirs.
- Mr Hunt says that he will reduce the maximum number of hours that junior doctors can work. Yet the proposed contract would remove the financial penalties in place for trusts that rota doctors for more hours than they are contracted to work. Hunt wants to remove the safeguards – akin to reducing the speed limit but then removing the speed cameras and telling the police to turn a blind eye.
- He says that he is giving us a pay rise of 11%, although whilst basic pay will increase under his proposals, overall pay will dramatically reduce due to cuts to unsocial hours payments.
So let’s be clear – Mr Hunt is threatening to impose an unfair and unsafe contract on junior doctors.
Five years of an unprecedented funding squeeze has left the future of the NHS in the balance. As we saw with colleagues in nursing, midwifery, radiography, ambulances and other parts of the service last year, the Health Secretary has a blatant disregard for NHS staff, imposing pay freezes and changes to conditions in order to squeeze more for less out of an increasingly under-valued workforce. The attack on the junior doctors contract is the latest manifestation of this. We need a fair deal for all NHS staff.