The Tory government and Jeremy Hunt are ideologically opposed to the NHS and the imposition of the new contract is just one step towards a privatised NHS, argues Alex Robinson, Holloway Ward Registrar in Emergency Medicine at Homerton Hospital, Hackney.
The junior doctor’s strike action is about more than pay, we never asked for a pay rise! It is resistance to the imposition of a contract that the vast majority of doctors don’t want, and is not needed.
Our current contract pays a basic wage, with a fixed “banding” of additional payments depending on the number of hours worked outside normal working hours (0700–1900); the maximum is normally 50%. As an emergency medicine doctor working in A&E, 50% of my work is done out of hours, so I get an additional 50% of my basic pay for the evenings, weekends and nights I work. The government wants to reduce the number of hours classed as “out of hours”, including evenings and Saturdays. It is offering an 11% rise in basic pay, but for many of us this would still result in a large pay cut at a time when there is a recruitment crisis in A&E, the main reasons for which are the high intensity and the hours. It is foolish to cut the wages in an area where there is already more than a 50% shortfall in the number of senior doctors training to become consultants.
The premise for the contract changes is that the government wants to create “a truly seven-day NHS”. A laudable aim, but what does it mean? We already have 24/7 emergency care; although there are improvements to be made, they do not require the imposition of a new contract. Does the government want elective surgery performed at the weekends? Would you want your knee operation on a Sunday evening? It may be convenient for a very small number, but for the average elderly patient – the people who use hospitals the most – it is unnecessary. There will be no admin staff, no physiotherapists, poor public transport and expensive taxis. This has not been thought through, and nobody has explicitly set out what the government actually wants.
The contract would remove hospital trusts’ safeguards that currently ensure that we do not work excessive hours. We have come a long way from the old days of 90-hour weeks. That was not safe then and, with a rise in the number and complexity of patients (elderly people are often on as many as 20 medications), and a greater number of treatments available, it is even less so now. We need well-rested, empathetic doctors who know their patients well. We do not need an already creaking, understaffed service stretched more thinly. We need more doctors, not fewer doctors working more hours.
Jeremy Hunt and the government have used spurious data to justify their soundbites. First, a claim from a study that purported to show that patients are more likely to die at a weekend, in fact showed that there was a small rise in the 30-day mortality. This is a complex issue, with many factors at play, and is the case in most health systems around the world. The authors of the study specifically stated that they were unable to attribute it to any one factor – and there is no data to show that the imposition of a new contract would reduce the 30-day mortality.
Second, the data Hunt has used about stroke care was taken from 2009-2010. In the interim we have gone though a radical change in stroke care, with the establishment of hyper-acute stroke units that can give drugs to dissolve a clot in the brain. This state-of-the-art service is available 24/7 with consultants on hand to deliver it. Stroke care in this country has improved dramatically, without the imposition of a new contract. Much of the improvement in care comes from better access to specialist nurses, physiotherapists and a multi-disciplinary approach, none of which the new contract addresses.
The Tory government and Jeremy Hunt are ideologically opposed to the NHS. Hunt co-authored a book, Direct Democracy, stating just that. The imposition of the new contract is just one step towards a privatised NHS. Working in A&E, I see the problems caused by cuts to social care first hand, with people living in what are practically Victorian levels of poverty. They could not afford health insurance.
Many of you, if you have any chronic health problems, may not get health insurance. Were the NHS to be fully privatised the Tories would have accomplished their aim to create a two-tier society, in which the rich can take full advantage of the infrastructure of the NHS, paid for by taxes and workers’ NI contributions for the past 60 years, while the poor are excluded from the healthcare they need, and deserve.
Please support the actions of the junior doctors. I believe that the current situation gives us hope: the Tories have transformed a fairly conservative, Tory-voting, established profession into what the Tories themselves, have termed “militants”. People are finally seeing through the Tory lies. I do not want to strike, but I cannot allow a party, many members of whom stand to profit personally from the destruction of the NHS, to accomplish their ideological goal.