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I keep reading about how I’m blocking the way to improved patient care. That my colleagues and I are selfishly thwarting radical change to health services. That somehow doctors are responsible for stifling a transformation in the NHS that would make its mere invention in 1948 seem mundane.
I’m exaggerating slightly, but hardly more than some of the newspapers have been. Once again politicians who want to be seen supposedly taking on ‘vested interests’ in public services – implying that NHS workers are deliberately standing in the way of change that will improve the NHS, for their own selfish reasons.
The trouble with that narrative is that it’s still pretty unclear what it is that the Government is trying to achieve. Lord knows I have no idea, and I spent 18 months in negotiation meetings with two different sets of teams from the Department of Health and NHS Employers.
Conceivably, it might be something to do with mortality figures for emergency patients coming in at the weekend being higher than for weekday admissions. But difficult questions remain about what that means. Why do patients admitted on Fridays not also do badly, if it’s about weekend staffing? What can be done about it?
It could be about patient access to planned, elective care at times more convenient for them, particularly at weekends. That’s the other thing Jeremy Hunt mixes into his treacle of words.
But I’m wading through trying to work out what that has to do with emergency admissions at weekends. Why does he always mention the two issues in the same breath, when it just confuses and conflates two separate matters? It’s like they’re trying to bewilder.
Yet more questions continue to well up from the deep, like the decaying carcasses of benthic sea monsters floating to the ocean’s surface, baffling and frightening sailors: If we tried to provide elective services six or seven days a week, where would the necessary staff come from to staff the necessary theatres, wards and clinics?
I’m just reflecting on the fact that in most hospitals I have ever worked in, theatre cases are not infrequently delayed or even cancelled because of a lack of staff or beds or both.
No-one thinks we can afford a full seven-day service of the breadth and depth of the Monday-to-Friday service we have now, not with hospitals struggling financially and GPs stretched to the limit. So what does it mean when ministers talk about ‘seven day services’?
Better emergency care out of hours? More outpatient clinics and GP surgeries open at weekends? Operations late into the evenings? CTs after sunset? MRIs at midnight? 24/7 physiotherapy? We just don’t know. I’m not entirely sure the ministers do, either.
The Government is trying to force the BMA to agree to significantly negative changes to our working lives in order to make this mysterious seven day thing happen, while at the same time impugning doctors’ professionalism. They have tried to suggest that a limit for consultants of working ‘no more than’ one in four weekends isn’t too bad because ‘it’s only 13 weekends a year’, as if that were somehow okay, then.
They have dismissed junior doctors’ concerns about the need for financial penalties to encourage hospitals to keep their working hours under control, saying that junior doctors should be expected to work ‘professionally’, as if they weren’t already. And they have suggested that doctors aren’t already working late into the evenings and at weekends all the time anyway, sparking general outrage from doctors online and a huge petition calling for the health secretary to go.
And all for the sake of achieving what? We just don’t know. But whatever it is, apparently we’re in its way.
Tom Dolphin is a consultant anaesthetist in London.
Support our call for David Cameron to define his seven day plan by signing our letter and following us @TheBMA
Is there a button to allow easy sharing of this onto social media?
With you all the way!
There's not a Share button that I can find, no, but you can use a shortlink like this one: http://bit.ly/1g5aIBb for Twitter to save on characters.
I don't know why that was anonymous - it was me, Tom Dolphin, sharing the shortlink just then.