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December 17, 2015

Private Eye Medicine Balls 1346
Filed under: Private Eye — Dr. Phil @ 11:56 am

What is a ‘truly 7 day NHS?’

Jeremy Hunt’s belated U turn on ACAS mediation with the BMA over the junior doctors’ contract postponed strike action but came too late to prevent the cancellation of 600 operations and 3,500 outpatient appointments. This could have been avoided had Hunt taken up the offer of ACAS talks on November 19, rather than a week later. Hunt may have been teasing George Osborne, using the threat of a strike to force a better than expected deal for the NHS from the spending review. Or he may simply have blinked first when he realised junior doctors were serious about strike action.

Osborne was also pressured by NHS chief executive Simon Stevens who publically asked for £4 billion of the £8 billion promised by 2020 to be ‘front-loaded’ next year, and then secured himself a slot on ‘Any Questions’ on Friday in case it wasn’t. Osborne had the last laugh by claiming to give £3.8 billion next year and making lots of absurd claims about how many more doctors, nurses and operations it would buy. In fact, £1.5 billion has been stolen from existing Department of Health budgets, cutting the budget for public health (such as smoking cessation and sexual health) and clinical training (including the cost of junior doctor placements and nurse bursaries).

Stevens wanted additional funding for ‘a seven day NHS’ but this has now to be found from existing budgets. Overall, 2010-2020 will be the tightest 10 years of in the history of the NHS, with an average annual increase of under 1%, and lagging further behind GDP health spend of France and Germany. £3.8 billion will just about pay off this year’s debt and keep the lights on for another year. Hunt may have to choose between being remembered as the Health Secretary who prioritised patient safety but failed to stick to an impossibly tight budget or trying to please Osborne and risk harming patients.

Hunt’s further difficulty is that the government has made a manifesto pledge about a ‘truly 7 day NHS’ that no one understands. The NHS already provides round the clock emergency services that doubtless could be better staffed, but not for free. If the government demands 7 day non-emergency services with identical outpatient appointment times, operation slots across all specialties every day, and GP surgeries open 7 days a week, that clearly has significant resource and staffing implications that Osborne won’t pay for. Hunt and David Cameron have repeatedly sighted Salford Royal NHS FT as a hospital that already provides ‘truly 7 day working’ but the staff on the ground are less convinced. These quotes from SRNFT doctors were collected by GP and journalist Dr Faye Kirkland:

“I work at Salford. They do not have 7 day working yet. The weekends are ‘on call’ cover only.”
“There is excellent daytime anaesthetic cover at the weekend but the only lists are emergency lists.”

“Neurosurgery is 7 day full emergency cover and elective ops only take place Monday to Friday.”
“We do not do what Hunt claims. We have also not told him that we do. I doubt the trust will rebut & risk both sides turning on them. Don’t get me wrong – I am immensely proud to work at Salford and think we do a load of things brilliantly. But there’s loads we don’t and we have to save money now so definitely can’t expand into weekends in the way the press reports.”

Dr Pete Turkington, Salford Royal Medical Director, said: “Our vision of a seven day service has been primarily focussed on providing reliable and standardised emergency care (non-elective) every day of the week. It has never been our intention to have a full seven day elective service. We’ve made enormous strides in delivering a safe and effective emergency service to our patients across the entire week.”

If Hunt and Cameron are to regain the trust of doctors and other NHS staff, and avoid the huge risk of strikes in the middle of January, they must stop spinning and start telling the truth. Staff and patients need to know exactly how much is available and what services can safely be provided at a time of such austerity without spreading them so thin that they collapse entirely. A ‘truly 7 day NHS’ is a pipe dream, the focus must be on providing the best emergency care, 24/7, including Christmas.

MD’s book, Staying Alive – How to Get the Best from the NHS – is available here