How did NHS England get to be one day away from first Junior Doctors strike for 40 years?

Jeremy Hunt finally agreed to go to the Arbitration service ACAS to try and resolve the Junior Doctors dispute and avoid England’s first Junior Doctors strike since 1975. With a day to go before the strike was about to start, an outline agreement has finally been reached. However, this is only a temporary reprieve as the British Medical Association (BMA) has until 13 January to start industrial action if the next round of talks does not reach a permanent deal.

How did it come to this? The most charitable reason I can determine is that Jeremy Hunt, Secretary of State for Health in England, was trying to appear as a bit of a ‘hard man’.

During the summer Mr Hunt erroneously claimed people were dying at the weekend due to consultants having opted out of out-of-hours care – having developed a ‘Monday to Friday’ culture. This was despite the fact that most hospital doctors already work nights and weekends.

He decided to throw his weight around and gave the BMA just six weeks to negotiate change, threatening to impose a new contract on both consultants and junior doctors if they didn’t come to heel.

His actions were incendiary, impugning the entire medical profession – questioning their dedication and professionalism. It was hardly the most constructive way to bring about change.

The foundation for Mr Hunt’s claims on weekend mortality was an academic article in the British Medical Journal (BMJ). The editor of the BMJ has written to Mr Hunt making clear the Secretary of State had “publicly misrepresented” the article.

The BMJ article was an analysis of 30 day mortality after admission to hospital. The BMJ’s editor’s letter to Mr Hunt explains that when considering weekend deaths that the article does not “apportion any cause…Despite the authors’ very clear statements to this effect in the paper and elsewhere, you have repeatedly told MPs and the public via media interviews that these deaths are due to poor staffing at weekends, with a particular emphasis on medical staffing.

The letter ends “We all want the very best health service for patients and the public. Misusing data to mislead the public is not the way to achieve this.”

The BMA, and indeed the profession, have expressed a willingness to work to improve the current situation, but Mr Hunt quickly added in the wish to have totally routine services running at weekends as well. While this might be attractive and certainly convenient for some patients who work, it’s simply not feasible to deliver when NHS England is struggling with debt and, more importantly, does not have enough doctors to deliver such a service.

Bizarrely in this discussion, junior doctors already work shifts spread over seven days.

Thankfully, in Scotland we are not facing such a strike, the Scottish Government have been working with the profession over many years to strengthen our emergency service. This has allowed patients admitted at the weekends to access diagnostic radiology, if required. In addition, many of our largest hospitals have moved to full seven-day consultant shift work to support the emergency service.

The main concern over the new junior doctors contract in England is that it takes away the financial penalties that would be paid by a Hospital Trust if junior doctors are forced to work too many hours.

Having worked over 100 hours per week on a regular basis as a Junior Doctor myself, I would not like to see a return to those dark days; they were not just unsafe for doctors, but were unsafe for patients as well. I think this is the reason that so many consultants of my generation are supporting their junior doctors despite the fact that any strike action will mean extra work for them.

While the NHS in Scotland shares the challenges faced by all health systems in the western world to adapt to an ageing population, it’s worth remembering that on a host of measures it is performing way ahead of the other three nations in the UK. Not least in terms of elective procedure waiting times, financial performance, and nurse to patient ratios.

Those in the acute specialities, such as A&E and acute medicine, already work considerable out-of-hours and weekend shifts and, yet, these are the very people who are likely to face a reduction in their pay under this new contract in England. Given that these specialties are the hardest to recruit, this simply does not make sense.

The anger of junior doctors in England is visible on social media and in them taking to the streets. I have received multiple emails and messages from young doctors from all over the UK who are anxious about this and, indeed, some of them are considering applying to Scotland where there is not this antagonistic relationship between politicians and the medical profession. I should stress they would be most welcome in Scotland’s health service.

The question now is whether it is possible for Jeremy Hunt to rebuild any sort of decent relationship with doctors in England.

While junior doctors in Scotland have demonstrated in solidarity with their colleagues south of the border, they have been quick to recognise that it is a totally different landscape in Scotland.

In Scotland, we have a much more collaborative approach between Government and NHS and we do not face the additional challenges of fragmentation and loss of cooperation due to privatisation being faced by the NHS in England. This may well be a contributory factor in why, currently, NHS Scotland is performing 5% better on A&E waiting times and with markedly higher public satisfaction.