Standing up with Nurses – Not on our watch

Care, compassion, competence, communication, courage and commitment. Do you recognise these values? I do, they are the values I witness my nursing colleagues display every day. They are the values that our NHS relies on to look after it’s most vulnerable patients. They are the values of my nursing colleagues.

How much are these values worth to you?

Let me tell you that from my point of view they are worth more than my job. They are the foundation on which every single bit of medical advice I dispense relies on. Without them, none of my work would matter. Without them very little I do could make a difference and without them the NHS would cease to be.

What do we say to the tens of thousands of young and mature students that wake up each day of their studies with the hope of carving out a career committing themselves to each of these six values? Do we say thank you, we know you are battling against staff shortages and increasing complexity of patients? Do we say we know that we are depending on you to deliver more specialist skills then every before? Do we say thank you for choosing to study something at university where you will give back to the tax payer, more than we could ever give you every single day of your working life? Do we say thank you for doing a course where you will be on placement carrying out up to 37.5 hours per week of actual work and care for patients on a daily basis? Do we say thank you for wanting to be an asset to our NHS?

Apparently what we will be saying is here are tens of thousands of pounds worth of student debt and next to no help with looking after yourself while you do this work for free. But don’t worry nurses because when you do graduate, we will put you on a starting salary that you probably didn’t need a degree to get in the first place. I for one will not stand by and let my nursing colleagues be subject to the same types of crippling student debt I took on to do medicine.

Care, compassion, competence, communication, courage, commitment. Say them in your head. Think of what sort of person it takes to want to be a professional who stands for those values. Remember who it is that is more likely to make an immediate difference to your loved one and how they feel in hospital, because I’m big enough to say that it isn’t me.

Today George Osborne announced that his Government will no longer be supporting a system of bursaries for student nurses. As a doctor I am saying no. This is not good enough for my colleagues. I hope you will join me.

Please sign the petition against this injustice here: https://petition.parliament.uk/petitions/113491caring_community

Jeremy Hunt – Does he actually know what this row is about?

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?

The BMA says YES to progress- Why does Mr Hunt say no?

Today the British Medical Association announced that 98% of over 35,000 junior doctors vote yes to strike action. Strikes are due to take place on the 1st, 8th and 15th December. The message is clear; we stand together. The events of the past two months have thankfully awakened many junior doctors to a responsibility to engage with healthcare policy. Today we have added strength and unity to the tools of our trade.

CRjVvUWWEAEPosdFighting our cause in the media was never going to be easy. The Department of Health has persistently tried to conflate the junior contract issue with their wider plan for a ‘truly 7 days NHS’. They claim they’re coming through on their democratically elected manifesto promise. Junior doctors say that the Department of Health have in fact no idea what they mean when they say that. Their plan to radically alter one profession’s employment terms has no firm evidence base, is seated on faulty logic and don’t in any way address the support services needed to keep patient flow steady across 7 days.

Junior doctors say that the purpose of this push is to allow the current government to look like they have delivered an election promise they made, but had no intention of ever properly defining, planning or funding. The Department of Health say they are looking for the best value for taxpayer’s money. Junior doctors say the proposals are a false economy.

So yes, the battle lines are drawn and perhaps it was starting to look like we would soon reach the point where we could no longer see each other above our respective trenches.

This fight is of course about protecting what we know our NHS needs to thrive in the medium and long term. Patient care however is our business and we will always continue to respect that there are millions of vulnerable, sick patients and their families who do not have the luxury of prioritising anything but their next few hours. As doctors we know that effective leadership cannot rely on ultimatums. The British Medical Association (BMA) have therefore coupled their cry of strength with a call for progress; the Advisory, Conciliation and Arbitration Service (ACAS) have been approached for mediation. Am I surprised? Of course not. Contrary to what some media outlets would have you believe, junior doctors are in the business of high moral standards, accountability and integrity. I would expect nothing less of my profession. We always wanted to talk.

Many people may ask; why not just talk with the Department of Health? Why the need for ACAS? The unfortunate truth is that we simply do not currently trust Mr Hunt. We have repeatedly heard him repeat mistruths to the public. As Einstein said “whoever is careless with the truth in small matters cannot be trusted with important matters”. Am I happy to be proved entirly wrong? Of course I am, this battle is about more than my pride and there is in fact nothing that I would like more going forward than to be able to trust the Secretary of State for Health. I sincerely hope I am wrong.

Mr Hunt has however suggested he has no current plans to accept the BMA’s invitation of mediation through ACAS. Can you think of a worthy justification for that? I certainly can’t. The BMA want to talk. If the Department of Health are as they say, open to real negotiation, we can move forward. Mr Hunt has been very clear that he thinks striking will risk patient safety. If this is indeed his opinion then surely he is bound to do everything in his power to exhaust the other options? That’s not to mention that for imposition of a contract to be legal, I would presume an employer needs to have been seen to exhaust all consultation options. Even if these tens of thousands of junior doctors are wrong and the Department of Health’s proposals would improve care in the NHS, mediation would give them the a wonderful opportunity to help us understand that. The suggestion of mediation by the BMA is the single most positive thing to happen since the junior contract row erupted.

To the people that rely on the NHS we want to say thank you for sticking with us through our battle this far. We want to say this vote means that we are united in standing up for our profession but we are also united in standing up for you. We will find a way through this, because we sincerely feel your future care depends on it.

To Mr Hunt we want to say come to mediation and prove us wrong. We are all ears.

Yes for our patients, Yes for our NHS, Yes for Progress

Today the British Medical Association announced that 98% of over 35,000 junior doctors vote yes to industrial action. The message is clear; we stand together. The events of the past two months have awakened many junior doctors to a responsibility to engage with healthcare policy. Today we have firmly added strength and unity to the tools of our trade.

Fighting our cause in the media has not been easy. The Department of Health’s appear persistent in their efforts to conflate the junior contract issue with their wider plan for a ‘truly 7 days NHS’. The Department of Health say they’re coming through on their democratically elected manifesto promise. Junior doctors say that the Department of Health have in fact no idea what they mean when they say that. That their plan to radically alter one profession’s employment terms has no firm evidence base, are seated on faulty logic and don’t in any way address the support services needed to keep patient flow steady across 7 days. Junior doctors say that the purpose of this push is to allow the current government to look like they have delivered a promise they made but had no intention of ever properly defining, planning or funding. The Department of Health say they are looking for the best value for taxpayer’s money. Junior doctors say the proposals are a false economy.

So yes, the battle lines are drawn….and one would be forgiven for concern that we may soon reach the point where we can no longer see each other above our respective trenches. As doctors however we know that effective leadership cannot rely on ultimatums. This fight is of course about protecting what we know our NHS needs to thrive in the medium and long term. Patient care however is our business and so we will continue to respect that there are millions of vulnerable, sick patients and their families who do not have the luxury of prioritising anything but their next few hours. The British Medical Association have therefore coupled their cry of strength with a call for progress; The Advisory, Conciliation and Arbitration Service (ACAS) have been approached for mediation. Am I surprised? Of course not, because contrary to what some media outlets would have you believe, junior doctors are in the business of of high moral standards, accountability and integrity. I would expect nothing less of my profession. We always wanted to talk.

For the people that rely on the NHS we want to say thank you for sticking with us through our battle this far. We want to say this vote means that we are united in standing up for our profession but we are also united in standing up for you. We will find a way through this, because we know our NHS depends on it.

Today’s vote is a YES for patients and YES for progress and a YES for the future of the NHS

Imposition – Why ultimatums fail, ultimately

2015-11-18-1447858531-9338860-FullSizeRender-thumbJunior doctors like me have been crying out injustice for over two months now. The idea of an imposed contract has, unsurprisingly not been met with a warm reception and so in addition to a plea for genuine opportunity to negotiate, The BMA have been clear that withdrawing this threat is crucial for progress. Personally, I have been pretty vocal about my negative feelings regarding the idea of an imposition….but is it reasonable?

Employment law makes it clear that unilateral imposition of a contract on employees is a last resort and to play this game puts the employer at risk of legal proceedings for constructive dismissal, breach of contract and unfair deduction of wages. If an employer however genuinely believes they are unable to reach agreement, they reserve the right to serve notice and offer re-employment under the new contract terms. The central value however remains that this can only be condoned as an absolute last resort where full and thorough consultation has failed. An important point here is that for any junior doctor who has read the DDRB report, its appears that consultation cannot have been conducted appropriately. This is of course not just because they don’t agree with it, but because it contains too many wildly ill judged plans and too many unjust statements. The report reads to junior doctors like a recipe for disaster, both for patients and the sustainability of quality of care within the NHS. The case for adequate consultation is further hindered by the Department of Health’s persistent effort to conflate the junior contract issue with their wider plan for a ‘truly 7 days NHS’. The Department of Health say they’re coming through on their democratically elected manifesto promise. Junior doctors say that the Department of Health have in fact no idea what they mean when they say that. That their plan to radically alter one profession’s employment terms has no firm evidence base, are seated on faulty logic and don’t in any way address the support services needed to keep patient flow steady across 7 days. Junior doctors say that the purpose of this push is to allow the current government to look like they have delivered a promise they made but had no intention of properly defining, planning or funding.

The question remains however; are we realistic in our demand that the threat of imposition is removed? The answer I think lies in the difference between what is implicit and what is explicit…and yes I believe that it is more than just semantics. The law tells us that the option is there for our employer. Yes, there are strict terms, but essentially it is a card they can choose to play. Setting a date for imposition however makes the threat explicit. August 2016 is my immediate future and I can feel the threat dangling over my head.

To think of it in another way…. Mr Smith and Mrs Smith are having some marital issues. Mrs Smith can tell her husband “I really want to work this out”. She could also tell her husband “I really want to work this out, and if we don’t I’m going to divorce you”. I’m sure you can guess which statement is likely to get the better response? Neither is incorrect, of course Mrs Smith may in the end divorce her husband in either scenario. It is implicit in her rights. Using it as a rod to drive progress however makes it a threat and it doesn’t take a qualified marriage counsellor to tell you that if you want a relationship built on mutual respect, that sort of behaviour is a bad idea.

So are we reasonable to request that the threat of imposition is withdrawn? I will have to keep thiking but my initial feelings are that perhaps I would settle for retraction of the planned immenent and explicit imposition, because in the end the threat will always been implicit.  If I could in the meantime speak to Mr Hunt I would probably say that imposition is not your trump card; your trump card would be to acknowledge the insult in that explicit threat. Your trump card is facing up to the reality that tens of thousands of doctors are finding it impossible to trust you. Your trump card is remembering that imposition would be at the expense of everything that is possible for the NHS if we worked together. As Dwight Eisenhower said ‘leadership is the art of getting someone else to do something you want done because he wants to do it’. He believed in inspiration, not intimidation.

And what of our trump card? Our trump card is remembering to hold most dear all those things which make us a valued and trustworthy profession. Our trump card is remembering that patient care is our business. Our trump card is to be strong enough to continue to stand up for what is right for our patients and our profession but to remember that Dwight Eisenhower’s advice of course applies to us too.

Impossible things – How it all came good for #JuniorContract

‘Why sometime’s I’ve believed as many as six impossible things before breakfast’ The Red Queen said to a bewildered Alice and being a supporter of believing the impossible, she advised young Alice that she must practice, just a little bit every day.

This morning I decided to believe that the junior contract row was behind us. I believed that I was sitting in a cafe catching up on clinical evidence base on my morning off. I believed I was going to work the following day happy and content in the knowledge that the NHS was going to support me to give my patients the best I had to offer them. It was a nice day dream. The past eight weeks have been tough going, battle lines are drawn just a little bit deeper every day and perhaps it has gotten to the point where we cannot even see each other above our respective trenches. For what it is worth, I will tell you how it all came good. At least in my dream anyway.

It started when one junior doctor realised we all wanted the same thing. It doesn’t matter who it was, but they were strong enough to stand up and say we both want excellent patient care and we both want a happy workforce. There were many other voices that scoffed and rightly pointed out all the evidence to the contrary and that the actions of the Department of Health, from the outset had spoken louder than words. That person was adamant however, that acknowledging the good, no matter how small, on both sides was the way forward and after all ‘forward’ was somewhere that was better than we they were now.

After that something unexpected happened. A group of people at the Department of Health, feeling safer in the knowledge that the medical community didn’t in fact see them as intrinsically evil saw what was staring them right in the face all along. That they had handled this entire situation very badly. They looked at each other and thought, ‘how did we get here?’ and more importantly they thought ‘how do we get out?’. It was at that time that strike action loomed, junior doctors lamented that they had been left with only this option and each day their trust in the Department of Health, guardian of their NHS, dwindled further and further. Fifty thousand angry and frightened junior doctors are not easy to approach and so that group of people in the Department of Health knocked on a door.

It opened.

‘Mr Hunt’ they said ‘we need to know what it is that we can do to make this situation right, we are the guardians of the NHS and we owe to it the workforce and millions of people reliant on them to fix it. We must be able to say we did all we could’

Mr Hunt was silent for a time. He had been used to taking on the weight of difficult decisions, something which oddly enough those tens of thousands of doctors had a unique understanding of. Nevertheless, the past eight weeks had been a trying time for him. He looked down and then looked at his colleagues and said ‘we will invite the BMA to fresh negotiations, this time there will be no preconditions and we will remove the current threat of imposition pending outcome of these talks’.

That evening the BMA junior doctor’s committee chairperson received the invite; no preconditions, no imminent imposition. A clean slate was in itself unnerving. Now that they had reached a point where they could actually be listened too, what suggestions did they have? Supported by thousands of junior doctors however, he took up the challenge of negotiating an outcome that was right for both sides and most importantly for patients. The rest, as they say is history.

Albus Dumbledore told us, ‘it does not do to dwell in dreams, and forget to live’ and for my part, I think he has a point. So for now, I will continue to live the reality of this junior contract row. And I will give it everything I have got.

PS – for those of you who are upset by my dreaming, you will have to excuse the temporary break from reality (‘a little nonsense now and then….’ ). Normal service will resume presently.

Hunt’s Thirty Pieces of Silver

Today is the day the ballot for junior doctor industrial action begins and it comes on the back of an eleventh hour ‘firm, not final’ proposal from Mr Hunt, Health Secretary.

Junior doctors however will have been largely disappointed yesterday that Hunt chose to break this current proposal via the media. Some have billed it as a last ditch attempt to avert the possibility of industrial action. If that is true, it is more surprising that Hunt chose not to send the proposal direct to the British Medical Association (BMA). As it stood, they were second in line to the media, giving them very little time to digest the complex proposals in time for the media storm that broke yesterday. Perhaps that was the plan. As a junior doctor my biggest fear is that by condoning the grossly misleading headlines ‘junior doctors to get 11% pay rise’, Hunt has firmly put to bed any hope of gaining back the trust of junior doctors. That’s of course a sad and unhelpful situation for everyone; doctors, the department of health, our NHS colleagues and patients.

Disappointing as those tactics are, cutting off the nose to spite the face is never wise and generally serves to stand in the way of progress. So with that in mind, it is worth looking at what actually is in this ‘firm, not final’ offer. The document starts by once again suggesting that the BMA have mislead it’s members. A tactic which is odd in every sense; not only because it suggests to tens of thousands of doctors that they haven’t the faculties to understand the issues in their own right, but also because starting an offer by under mining the mandated union seems like a very risky move. They then swiftly make it clear that they have refused to concede to the BMA’s first demand; to remove the threat of imposition.

It is worth making very clear that junior doctor have not asked for a pay rise, in any shape or form. Like other public servants, we have been subject to real term term pay cut year after year and now we will not allow the government to add further to this. At this point, if I thought writing ‘I’m not looking for more money’ across my forehead would help get that message out, I would do it.

judas_takes_moneyThe first surprise in these proposals is the caveat; for trainees already employed ‘transitional pay protection arrangements’ have been made. Alarm bells ring. Hunt is now saying that for those of us already senior enough to be registrars on speciality training programmes, we will switch to the terms of the new contract but continue to be paid by the old banding system until 2019. For those who are more junior than this, should it be the case that their new pay system leave them worse off, they would be offered ‘cash pay protection’ until 2019. Is this an attempt to divide and conquer? It certainly feels that way. Balloting for industrial action requires unity, what Hunt appears to be sowing here are are seeds of doubt. My sympathetic eye says, hang on, maybe it is because Hunt believes in his plan so much that he is willing to put his proposals to the test in this way. It is of course a move reminiscent of supermarket tactics; shop with us, if you could have gotten a better deal somewhere else we will give you the difference back. My sensible side says that if Hunt’s proposals were so fair, he wouldn’t be trying to bribe his current staff, presumably at the expense of those doctors not yet in a training programme or still in medical school. I cannot help but feel like I am being offered thirty pieces of silver…..and I will not be Judas in this tale.

The proposals do not concede either to offer what the BMA will view as sufficient protection to less than full time trainees. With respect to female doctors, they are clear that they plan to subject their proposals to a full ‘impact assessment’. Alarm bells ring. If I was about to impose a contract on 50,000 junior doctors, I’d have sorted out that impact assessment first!

Junior doctors have been clear that de-incentivising less than full time training at a time when there is a already a recruitment crisis is short sighted. We have also been clear that these plans will further damage specialties really struggling to retain their staff; accident and emergency (A&E) medicine for one. Hunt says that he has an answer for that; cash incentives remain the order of the day. His plan for ‘flexible pay premia’ of £1,500 per year to registrars choosing A&E is again misguided. If you ask an A&E trainee what would make their life better, they will not ask you for £31.25 a week extra. The will tell you they would like to feel valued, supported and be given more opportunity to achieve a decent work-life balance. They would probably ask you extend and the same support to their nursing colleagues. They would probably also ask you for more doctors and more nurses. But they would not ask you for £31.25 a week.

In general terms however, their approach is not surprising. There is continued failure from department of health to recognise that this row is not solely about money. The government again yesterday lauded that they were “removing financial incentives….that encourage junior doctors to work unsafe hours’. I am a doctor, please believe me when I say that the only thing that will keep me in work past my hours is your loved one who genuinely needs me. 50,000 junior doctors are frightened that when they are forced to spread themselves more thinly across seven days, that patients will be affected. They are frightened because they know having to ‘ask your line manager’ in advance of a staying late to help a patient is not only insulting to our profession but an entirely ludicrous idea. Junior doctors are frightened because they fear these plans will disrupt continuity of care, team structure and the quality of training experience available to doctors the NHS relies on to be world class.

I am desperate for progress, I am desperate for talks and I am desperate for the Department of Health to realise that extra money is not my motivation for working extra hours now, nor will it persuade me into accepting these proposals. As a junior doctor I am saying, keep your thirty pieces of silver Hunt; but please, lets talk about patients.