As a junior doctor I have spent the past two months feeling frequently frustrated about the sheer scale of misinformation presented to the public about what our contract row is about. Earlier this week the ballot result was announced; 99% of returned votes were in favour of industrial action. That evening I watched Tom Bradby’s interview with the Health Secretary, Mr Jeremy Hunt on ITV News. My reaction was a mixture of shock, horror and rage. I would like to take you through a transcript of that interview now.
Mr Hunt (JH): What I would urge any doctor thinking of actually going out on strike is to look at what the government’s offer actually is and see this is a way that we can deliver safer care for patients seven days a week, it will mean when you go into work at the weekends there are more consultants there, more colleagues… you can give more of the care that you want to give your patients.
Mr Hunt would like junior doctors to read the information carefully for themselves before they make a decision. I agree with him there. I can assure you I have done that already.
Mr Hunt goes on to clarify that the proposals mean when we go into work at the weekends ‘there are more consultants there’. What? Consultants? This contract doesn’t affect consultants. It’s contract for junior doctors. Even if every single junior doctor in the country signed up to the idea of the new junior contract, it would not mean more consultants at the weekend. He also says there will be ‘more colleagues’. I am not sure exactly what he means by colleagues. If he is talking about nurses and more other allied health care professionals, again this is completely unrelated to the junior contract issue. If he means there will be more junior doctors rostered at the weekend, he is also saying that there will be less doctors on week days and there are no ‘spare doctors’ on weekdays either.
Mr Bradby (TB): Yes but with respect, all of these doctors are highly intelligent human beings. They’re capable of listening to what you are saying. They don’t like it. They just don’t like it. They’re angry because they don’t like what you’re proposing
JH: Well unfortunately they’ve been told by their union a lot of misinformation and I would urge them to look at the actual facts
TB: Yes, but you saying these highly intelligent, highly trained people are not capable of working out for themselves what it is you’re proposing?
JH: Well I think it’s incredibly difficult, if you’re fed a great deal of misinformation by the BMA about what the Government is doing. The BMA is….
TB: Yes but that’s their job isn’t it? sorting out information? processing it,?understanding it?
JH: Well their job is actually to look after patients, which they do extremely well and they work very very hard seven days a week to do that, but what they have is government and a health secretary who is saying we want to help you do a better job looking after patients. If you’re working in an A&E department as a junior doctor on a Saturday or a Sunday, right now it’s a pretty stressful experience. You might not get the support that you want from your colleagues around you and we want you to know when you go in at the weekend you’ll have exactly the same support around you that you would have in the week.
Where can I start with this one? Could this be the most inflammatory thing Mr Hunt has said to date? ‘Well, their job is actually to look after patients…..they have a government and a health secretary who is saying we want to help you do a better job’. I will be frank here and say I struggle not to read those words as ‘I’m here to tell you what to do; you do it’. Is that what he meant? Is it possible that the secretary of state for health would actually announce on national television that medical professionals are not of paramount importance in leading a health service? That it is not audit, research and analysis from actual healthcare professionals that informs his health policy? Is it possible that he has willingly reduced the responsibility of my job to carrying out plans that people in Westminster have made? I certainly hope not.
But he goes on to talk about A&E. He states as a junior doctor, working there at the weekend can be a ‘stressful experience’. Yes Mr Hunt, it can be. Lets however be very clear about something: Junior doctors in A&E already work the maximum amount of weekends they reasonably can. Currently this is one in two weekends, sometimes three in four. Mr Hunt could not use the new contract to rota more junior doctors at the weekend in A&E even if he wanted to. The Junior contract proposals will not make any more A&E junior doctors available at the weekend. Training posts in A&E are already massively undersubscribed. The only thing these proposals will do is make that worse.
He goes on to say that he wants junior doctors to have support from their ‘colleagues’ at the weekend. Again, I am not sure what he means by colleagues. If he means fellow junior doctors, I have already explained this isn’t a possible outcome of the proposals. Similarly, A&E Consultants are already on the shop floor in hospitals up and down the country every weekend. I have never worked a shift in A&E either at the weekend or otherwise where I was not appropriately supported by a consultant. This of course is an irrelevancy because, like I said, the new contract proposals don’t affect consultants. If Mr Hunt is alluding to the fact that he wants to make more support services such as social care assessment, available at the weekend then that is great. It is however again entirely irrelevant to the junior contract row.
TB: Tonight, can you assure people watching this at home that on these days when there is a strike covering emergency care, that no patients are going to be at risk? That if you or I or anyone else watching this goes into a hospital, they’re going to be ok?
JH: Well, I can’t give that assurance tonight but what I can say is, now we’ve had the vote, we will be doing everything in our power to make sure that the NHS is safe for patients on those three days. We’ve started a huge, cross government process going through hospital by hospital to check what arrangements are being made, we have no bigger priority
Mr Hunt is doing everything in his power? Does he mean everything except consenting to commit to mediation? The offer to attend mediation is the single most positive thing to happen in this contract row so far and given the the state of trust between the health secretary and junior doctors it is perhaps the only hope.
TB: Nobody wants this, but there is a risk of someone not getting the care they need, in A&E on one of these days? Does that not sit incredibly heavily with you as health secretary?
JH: It does. And it also sits incredibly heavily with me that if you have a fracture and you need to have your hip replaced, the clinical guidance is that that should be done in 48 hours but 24% fewer have that if they’re admitted at a weekend
Mr Hunt has said that 100% of patients who fracture their hip should have surgery required within forty eight hours. This is of course true, but the realisation of this standard has very little to do with junior doctors. The National Hip Fracture Database is tasked with collecting information on the nation’s hip fractures. It analyses performance and makes suggestions for how we can improve upon our standards. Their 2014 report had a number of key recommendations. One striking figure was that 62% of hospitals still don’t have a hip fracture liaison nurse, 4% had no orthogeriatric consultant employed. They noted when it comes to missing the 48 hour target ‘…poorly performing hospitals lack a functional hip fracture programme in which the multidisciplinary team can rapidly optimise care and operate on the patient’. A multidisciplinary team is made up of doctors and allied professionals; specialist nurses, physiotherapists, theatre nurses, operation department practitioners, recovery nurses, radiologists, sonographers, laboratory technicians, biomedical scientists, pharmacists and doctors. There are some hospitals that do not even have a 7 day physiotherapy service available for hip fracture patients to ensure early mobilisation post surgery. In 2013 Musgrave Park Hospital took the decision to invest in a 7 day physiotherapy service for trauma patients; the number of patients who they could successfully discharge to their own home almost doubled (19 to 34%). My point in going through this is to say there are of course things we can do to improve care for hip fracture patients; but it has next to nothing to do with the junior contract. I wonder has Mr Hunt read the National Hip Fracture Audit Database report?…because if he is suggesting that sort of thing is his job and not mine, he ought to know better.
And so it ends; 2 minutes and 41 second of conversation that had almost nothing do with junior doctors or their contract. Which leaves me with nothing else to do but wonder if Mr Hunt knows what this row is about at all?