The longer the saga continues, the more confused we are all becoming about what exactly is going on. Unfortunately, due to the involvement of various media sources, untrusted information from the Department of Health and often unclear messages from interviews with junior doctors, many of us are left very confused. As a medical school applicant, you need to keep the key facts in mind and we will sum these up.
1. What are the main issues about the contract?
- One of the policies of the Conservative Government’s election campaign a number of years ago was David Cameron’s 7 day NHS.
- We already have a 7 day NHS for emergency care but this policy meant extending elective, non emergency care to weekday evenings and weekends.
- Elective care includes routine outpatient clinics and elective (non-emergency) surgeries.
- Doctors WANT a 7 day NHS. They agree that extending services would be good but their frustration is that no extra funding or staffing is available to ensure this expansion can occur safely.
- Rota gaps already occur across 5 days with many departments understaffed leading to closure of many A&E departments, maternity departments and more across England over recent months.
- Doctors are therefore arguing that extending an already over-stretched NHS without proper planning and funding is ludicrous and ultimately unsafe for patients.
- Recent documents leaked by the Department of Health highlighted severe risks associated with these developments leading to the most recent outcry that this imposition on junior doctors has not been sufficiently planned or worked through and is risking patient safety.
2. Is pay a factor in the dispute?
- The pay of doctors is undeniably a factor in the contract but it is definitely not the main one.
- Junior doctors are currently paid a standard rate for shifts where the hours fall between 7am and 7pm on Mondays to Fridays.
- They earn an extra supplement for hours worked outside of this called ‘banding’.
- Currently, junior doctors boost their basic pay anywhere between 40 to 50% because of banding – reflecting the antisocial hours worked.
- It has been proposed that the hours which are considered as ‘standard’ will be increased by 30 hours per week to include 7am to 10pm on Mondays to Saturdays.
- This means that junior doctors will be paid the same rate for working on a Saturday evening as they would on a Tuesday morning.
- The government is increasing the standard pay of a junior doctor which is currently just over £22,000. However, the loss of banding will result in a pay cut for the majority of junior doctors.
- A typical salary of a Year 1 junior doctor in Australia begins at £55,000.
- Many worry this means junior doctors will be discouraged from choosing specialties where there are a high number of antisocial hours required such as A&E or GP - both of which are facing huge recruitment crises as it is.
- Therefore, doctors believe that the pay issues could deter people from essential specialties and ultimately affect patient safety.
3. Is the NHS sustainable?
- The NHS is dreamy - we all want it to work, we believe in it. In principle it is brilliant - healthcare available to all from every background.
- However, the NHS was established in 1948 - just after world war two. Since then there have been two big changes.
- Demand is increasing - there has been a huge shift in the disease burden on the NHS from acute illness to chronic disease. Obesity, cancer and conditions of the ageing population are on the rise, these cannot be solved quickly or cheaply and these patients are long term users of health services and expensive drugs and treatments.
- Expectation is increasing - patients now expect pain free existence for as long as possible. They go to their doctor with minor ailments that never were deemed necessary just after the war when the NHS was established. Society expect more and that is ok! We should expect a better quality of life - we have discovered treatments, drugs and methods to increase our life expectancy and we are far better educated about how to recognise the signs of disease and seek help.
- However, the money is not increasing.
- It is very simple: if demand and expectation increase but the money available to provide the service does not, it is not sustainable.
- This is not even including the desire to EXPAND the non-emergency services to 7 days and still not increase the funding going in.
4. If more people are dying at weekends, do we not need to do something about this?
- In July 2015, Jeremy Hunt claimed that 6,000 excess deaths occurred due to the ‘weekend effect’ in our hospitals.
- Hunt claimed that according to a study based on an analysis of hospital records, it was found an admission on Fridays led to a 2% increased risk of death compared with Wednesdays, on Saturdays it was 10%, on Sundays 15% and Mondays 5%.
- These statistics underpinned the push for a 7 day non emergency NHS.
- However, the author of the paper wrote to Jeremy Hunt saying: "I am writing to register my concern about the way in which you have publicly misrepresented an academic article published in The BMJ. This clearly implies that you believe these excess deaths are avoidable which cannot be confirmed without much further research”.
- Moreover, research by Oxford University in May 2016 showed that the data used for this study was flawed.
- Patients admitted during the week were for routine, non-emergency cases and therefore had a lower risk of death following operations.
- This is compared to hospital in-patients at weekends who were more sick because they were had undergone emergency procedures and therefore, were more likely to die.
- This discounted the weekend effect as false, tearing apart the motivation for the shift to a 7 day non emergency NHS.
5. Even so, Is a 5 day strike really the best option?
- According to the GMC, the first duty of a doctor is to their patient and keeping this in mind there are two sides of the argument regarding whether a strike is the right thing to do: short term vs long term.
SHORT TERM: Of course, short term the risk to patients should be avoided.
- It is not right to grossly understaff the NHS for these 5 consecutive days 9am to 5pm.
- The risk of huge emergencies and the vulnerable state that hospitals would be placed in is not acceptable.
- However, only non-emergency care would be cancelled to allow all emergency care to still be covered with sufficient staff levels from consultants who will be working.
- That said, a lot of scheduled operations would be cancelled leading to huge turmoil for patients scheduled for non-emergency (but necessary) operations during the 5 day period.
LONG TERM: Does the long term risk to patient safety outweigh this short term risk?
- If the already understaffed NHS is stretched further in order to expand non emergency care to all 7 days of the week, patient safety could be at a far greater risk.
- An understaffed hospital environment means the standard of care will reduce and ultimately patient deaths could rise.
- Doctors are trained in evidence based medicine: research into drugs to ensure they are the best for a certain disease; the 7 day NHS has not been researched, funded or staffed appropriately for it to be a safe consideration.
- A staffing crisis in the UK could lead to the closure of many A&E units and by further expanding an already under-funded, under-resourced and under-staffed NHS, the emergency care that is most important could crumble leading to the dissolve of the NHS.
An excellent overall summary infographic:
1. The 7 day NHS for emergency care already exists. This contract is about increasing non-emergency care to weekday evenings and weekends.
2. These changes are being pushed through without increased funding or staff which is concerning due to the understaffing crisis that is already occuring.
3. There is no model for how this is going to be rolled out and all research by the Department of Health has highlighted 5/5 severity risk of a staffing crisis suggesting more planning, funding and staff are required before this can become a reality.