Margaret McCartney: Pity the NHS—Jeremy Hunt has chosen the nuclear option
BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i909 (Published 12 February 2016) Cite this as: BMJ 2016;352:i909
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I was very disappointed to see the Secretary of State for Health impose a new contract on junior doctors. The 55,000 junior doctors in England’s NHS are a highly educated professionals. They are perfectly capable of looking at the contractual changes being put forward by the NHS and drawing their own conclusions about the implications of the new contract for them. To say that they have been ‘brainwashed’ by extremist members of the British Medical Association, as some journalists and Conservative MPs have been implying, is ludicrous.
We also continue to hear from Jeremy Hunt that he believes that these contractual changes are needed to tackle higher weekend mortality in hospitals. This is an area in which I have and members of my department have published extensively. I am therefore fully aware of the research on this topic and the serious problems with some of the statements issued by Jeremy Hunt and the Department of Health (for example, see http://goo.gl/CEab0N). The UK Statistics Authority has written to the Department of Health about this matter but this letter does not seem to have any effect on Jeremy Hunt or his officials.
Junior doctors are becoming increasingly disillusioned and anxious about their future. Many are considering leaving the NHS to work overseas in countries such as Australia, New Zealand or Canada. Others are considering giving up their medical careers. The UK cannot afford to lose such highly trained professionals. As well as being essential for the NHS and the delivery of healthcare in England, junior doctors are also the clinical academics and medical scientists of the future. Healthcare-related industries such as pharmaceuticals are one of the few areas where the UK is still a world-leader. The future prosperity of these industries - and the economy of the UK - will be threatened by the loss of so many highly talented professionals.
Competing interests: No competing interests
Whilst Margaret McCartney is quite correct in her analysis she misses the other half of the battle. True, the Junior Doctors are under attack by Jeremy Hunt but they have been under insidious attack for many years. To illustrate this point might I compare and contrast the Junior Doctor's lot with that of other workers.
A Junior Doctor starts on a salary of roughly £25,000 pa. A tube driver is on about £55,000 pa. A new, graduate entrant banker will also start on £55,000. Jeremy Hunt is not to blame for this disparity. In my youth, when working a weekend shift at a third of my normal rate, (because I was "only on-call", I used to console myself with the thought that the claening lady was earning more per hour than I was. This was not Jeremy Hunt's doing.)
A Junior Doctor, in my youth back in the 1980's and '90's worked between 72 hours in a good week to 123 hours every 3rd week. I see that, under new proposals, the working week for Junior Doctors is to be reduced from 90 to a maximum of 72 hours a week. These ridiculous hours plagued Junior Doctors long before Jeremy Hunt arrived in Parliament let alone became the Secretary of State for Health.
The workload has steadily increased over the years such that Juniors and Seniors are having to manage a vastly increased case load. GPs have been badly hit by mountainous work loads to the point that they are seeking to retire early or move to New Zealand and Australia. This migration started long before Jeremy Hunt arrived. When I was a GP Trainee back in 1990, we would see 15 to 20 patients in the morning, floowed by a coffee break when we would do repeat prescriptions and off then to see 4 or 5 home visits. My current GP is expected to see 16 home visits. The work load has been steadily escalating and this started long before Jeremy Hunt arrived.
It is all very well for Margaret to villify the villain of the piece. I am sure we all chuckled at the Matt cartoon of the First Aid class in which the nurse has her hands around the throat of the manikin and explains to the class how they should first place their hands around Jeremy Hunt's neck. And some of the placards have been suitably amusing. But I would argue that the real villain of the piece is not Jeremy Hunt but our own, inadequate, timorous BMA.
No other trade union would allow its members to work 120+ hours a week. No other trade union would hail it as a victory that it was reducing hours to "only" 72 hours a week! And please remember that it wasn't the BMA that reduced these dangerous hours we used to work. It was the EWTD. Where was our trade union? After 5 years at University to learn our profession, why are we not earning as much as a train driver or a factory worker or a new entrant banker? What has the BMA been doing all these years?
And now this fiasco! The BMA have lead the troops up to the top of the hill and now what. Jeremy Hunt knows that the BMA haven't got the nerve to strike. They are left in a dither from a situation that was entirely foreseeable.
It is not just the Junior Doctors, but all segments of the profession that have been failed by the BMA. If the BMA had done it's job, like its counterpart in New Zealand, we too could have had a happy and contented workforce and a well funded NHS. Instead we have demoralised doctors seeking early retirement, emmigration, leaving the NHS or just leaving the profession.
Competing interests: No competing interests
I tend to agree with Dr McCartney.
I have a dreadful feeling, that she is correct about:
'The NHS is being set up to fail. It’s easy to see how the proliferating private GP companies will profit while the NHS, starved of essential resources, is told that it’s not hitting targets and is punished as a result. It will haemorrhage even more staff who hate their lack of ability to provide good care with the resources (not) available.
The NHS will then have its bones plucked by whatever private companies are watching and biding their time. This is a disaster for everyone that cares about our NHS.'
Competing interests: No competing interests
Re: Margaret McCartney: Pity the NHS—Response to Prof Majeed
The S o S knows full well that he can send out hunting parties - and they will come back laden with juniors from abroad. Fully registered. But no knowledge of the local culture, perhaps inadequate knowledge of " English English".
Competing interests: Need the NHS and the NHS needs good , dedicated doctors