Mind the Rota Gaps

The NHS is facing a £30 billion black hole in its finances by 2020, caused by 10 years if flat-line funding and a 4% year on year increase in demand for its services as people persist in living longer that they used to. Prior to the last election, NHS England chief Simons Stevens said – in the best case scenario – the NHS could recoup £22 billion in efficiency savings without damaging patient care, something MD (amongst many others) said was highly unlikely. This would leave the government with just £8 billion extra to provide over £5 years, enough to just about keep the lights on. Lib Dem expenses expert David Laws is now alleging Stevens asked for £16 billion from the government and was sent packing. True or false, the NHS is now being sucked into a huge black hole of debt and services and waiting times are suffering.

The demand on the NHS is made worse by 20% cuts in social care as patients can’t be discharged from hospital or stay well outside it. Poverty causes ill health too, and cuts in welfare payments add to the burden on the NHS. A sure sign

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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

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The junior doctors dispute explained simply and in context…

It is not possible to explore the Terms and Conditions of the proposed contract in detail because they have not been published yet and may still not have been finalised. The announcement of the imposition of a contract that has yet to be finalised and can’t be scrutinised by the junior doctors who are be imposed upon has been highly counterproductive. Irrespective of the content of the final contract, I believe imposition is wholly wrong.

This is not a dispute about Saturday pay, it’s about safe staffing. Safe staffing requires both safe rotas and a safe number of staff to fill them.

Junior doctors have not asked for more money, but for a better, safer NHS. However, a better safer NHS will cost us more because it needs more staff at all levels and occupations The government’s manifesto promised ‘a truly 7 day NHS… to ensure you can see a GP and get the hospital care you need 7 days a week by 2020.’

Urgent NHS care is already available 24/7, but this commits the NHS to providing the routine care you need 7 days a week, in general practice and in hospital.

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Huntonomics

There is no urgent need to change the junior doctors’ contract. It probably could be improved, but the complexities are such that it’s impossible to tell whether a new contract would be better without a proper comparative trial. Both the government and the BMA have put forward new contract proposals. They need to be properly tested in a variety of hospitals against the existing contract. Bad science is at the heart of the junior doctors’ dispute with health secretary Jeremy Hunt. His unsubstantiated conclusions about weekend mortality rates were inflamed by the fact that he appeared to have privileged access to this data before it was published in a peer reviewed journal. This may sound trivial but the scientific process is very clear that data should not be made public before it has been peer-reviewed. It made junior doctors very suspicious that NHS England was ganging up against them too. Hunt then quoted outdated data on variation in stroke care to justify imposing the new contract as part of the Tory election pledge of ‘a truly 7 day NHS.’

This uncosted pledge may yet undo the government. A ‘truly 7 day NHS’ has the same high quality routine and

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