Jeremy Hunt Can Avoid a Strike – But Will He?

The British Medical Association’s offer of ACAS mediated negotiations with Jeremy Hunt and NHS Employers to try to solve the junior doctor dispute was met with predictable reluctance by Hunt. The health secretary was doubtless smarting from the overwhelming vote of junior doctors to strike (98% of a 76% turnout said yes), but also because so many consultants and GPs have publically expressed their support. Hunt’s charge that doctors must resist the lure of the radicals seems all the more absurd given the medical profession has never been more united around its 53,000 junior staff (many of whom are far from ‘junior’).

Hunt has not ruled out using ACAS at some later stage, but by refusing the offer immediately he knows he is allowing the strike action to go ahead, perhaps hopeful of the damage it might do to the reputation of junior doctors and the BMA. Theoretically, patients requiring urgent care would not be harmed as that care should safely be provided by consultants and non-consultant grade specialists, but some patients may suffer from delayed diagnosis due to the cancellation of out-patient clinics and delayed surgery as non-emergency services are suspended.

This short term harm would be far less than the damage caused to the NHS by the mass exodus of junior doctors, but it’s hard to envisage how a solution can be found with the government’s insistence that more services can be extended over 7 days in the NHS whilst keeping the overall budget for junior doctor pay the same and making £22 billion efficiency savings elsewhere in the NHS by 2020. Even Simon Stevens, the normally unflappable chief executive of NHS England, has warned that ‘considerable more progress is needed to get a workable funding settlement for the NHS’ in the next 2 years. George Osborne has offered £3.8 billion this year, but how much of this is new money, and how much has been clawed back from cuts elsewhere? At a little under 1% a year in a service starved of funding for 5 years, it will just about soak up the debt and keep the lights on. When will UK citizens be offered the choice to fund their health service at the same level as, say, France or Germany?

Juniors just don’t believe the same number of doctors can be stretched further over the working week without making their working conditions unsafe, and it’s up to Hunt and NHS Employers to convince them otherwise. Hunt’s belief that stretching the same number of doctors over seven days would reduce the higher mortality rates observed in hospitals between Fridays and Mondays is entirely hypothetical (Eye last), and it’s his bad science that infuriates doctors most. He was at it again this week, claiming that in only 10% of hospitals are patients seen by a senior doctor within 14 hours at weekends. GP Faye Kirkland asked three statisticians to review the same NHS data. They concluded ‘the average percentage of patients assessed by a senior doctor within 14 hours – across all hospitals, specialties and the whole week – is around 79%. The available data are only for emergency admissions and they cover the whole week and not just the weekend. It is not possible to cut the data by weekday/weekend.”

Hunt keeps spinning but it simply doesn’t wash with doctors. Drawing unsubstantiated conclusions form complex data is how newspapers are sold and political arguments are won bit it won’t win over the hearts and minds of NHS staff, many of whom simply distrust him. That’s why ACAS is needed – a sensible suggestion put forward by a number of Royal Colleges in the hope of avoiding strike action.

Will Hunt accept the offer? And if he does, will he remove the threat of imposition? The threatened strike is at least providing useful cover for the looming winter crisis and has allowed the government to push ahead with its mandate for the NHS in England for 2016/2017. Citizens could in theory contribute to this but the process received no publicity and closed on November 23. As MD predicted, Virgin Care has won a £64m contract to run the entire community child health services in Wiltshire. Virgin already holds nearly 330 NHS contracts. Across England, community hospitals and services for pathology, sexual health, end-of-life and cancer care are being put out to tender. A draft NHS England Whistleblowing Policy is horribly inadequate and the Cities and Local Government Devolution Bill could land the NHS with another huge untested bureaucratic mess. So maybe Hunt is wise to keep the focus on junior doctors.

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