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March 21, 2016

Private Eye Medicine Balls 1413
Filed under: Private Eye — Dr. Phil @ 11:18 am

Safe and Legal

The irony of health secretary Jeremy Hunt organizing a global summit on patient safety while his junior doctors were striking over patient safety was not lost on the audience. Two junior doctors, Dagan Lonsdale and Alex Gates, tried to get into the summit at Lancaster Gate, mindful of Hunt’s invitation that ‘my door is always open.’ They were told their names weren’t on the list, noted the armed police officers and left for their own safety.

Hunt’s refusal to meet junior doctors who have begged for a meeting is shameful. When Sir David Nicholson resigned as chief executive of NHS England, he said his biggest error was refusing to meet the Mid Staffordshire protesters and realising how distressing their concerns were. For all the laudable patient safety structures, systems and initiatives Hunt is championing, they will only make the NHS safer if they are properly piloted and assessed, and if enough staff are motivated to use them.

The government and junior doctors agree that hospital care at weekends would probably be better and safer for patients if there were more staff around. Many patients and carers marooned on understaffed wards would agree. The government believes that the same number of junior doctors can be spread more thinly over 7 days at no extra cost to improve weekend cover. The junior doctors believe that we need more doctors. Spreading the same number more thinly would make weekday cover less safe for patients and the shift systems required to do it could be harmful for both doctors and patients.

Jeremy Hunt is no fool and understands that – as a champion of patient safety – there needs to be an independent assessment of his new proposals before they are rolled out, and they need to be agreed not imposed. Until such an assessment is done, no one can say whether the new contract will be better or worse for patients than the existing one. Medicine is littered with examples where expert and political opinion has trumped proper scientific evaluation, at huge cost to patients. Hunt’s hands are tightly tied. Six years of flat-line NHS funding is taking its toll. Demand rises inexorably ay 4% a year, waiting times targets are missed again and many staff are finding it so stressful they don’t want to work in the NHS anymore. 9% of nursing posts lie vacant. There are thousands of empty doctor jobs, many of which attract no applicants at all. Gaps in rotas for the most stressful jobs that keep the NHS afloat 24/7 such as emergency medicine, ITU and paediatrics are already alarming. Doctors rightly want assurances that any changes to their contract will make it safer, not less safe, for patients. Only a proper, real world, safety evaluation can determine this.

Instead Hunt announced imposition of a contract on February 11 that still only exists in summary form. The final terms and conditions have probably not even been decided and yet for 55,000 junior doctors in 60 different medical specialties the devil is in the detail. For a cost neutral contract, there will be winners and losers, and from the summary it seems the biggest losers will be doctors in those emergency specialties where there are the biggest rota gaps.

Hunt and Cameron are in this hole because they won’t be seen to be turned over by a union. But as a government fond of airline analogies for the NHS, it is sheer folly to ignore the views of the pilots. MD does not doubt that Hunt’s commitment to a safer NHS is genuine. He is trying to introduce the ‘fair blame’ culture and an NHS crash investigation team that MD has advocated for 20 years. MD has also encountered many committed, eloquent junior doctors that Hunt should meet. Rachel Clarke, Roshana Mehdian, Ben White, Nadia Masood, Fran Silman and Marie-Estella McVeigh are equally passionate about patient safety. But passion has to be guided by evidence, and both sides need to call a ceasefire and allow a thorough independent, evidence based review of the proposals.

Hunt closed his safety conference by saying ‘Never mind supporting doctors to admit mistakes, how do we support politicians to admit theirs?’ Any such admission would be graciously received by doctors, and the BMA should return the courtesy. In the meantime, some inspirational junior doctors are raising funds for a legal review of the imposed contract and safe staffing in the NHS, and MD is supporting them. Junior doctors are taught to demand evidence & think critically. They won’t sign a contract with no evidence base, no testing and no proper scrutiny. We all need to know if Hunt’s actions are safe and legal.

MD is performing at the Edinburgh Fringe