Jeremy Hunt vs junior doctors: antisocial hours will continue to be antisocial even in a truly seven day NHS
Edmund Stubbs, 1 October 2015
There has been much dissatisfaction among junior doctors since they became aware of the main proposals for their new contracts. Most of the outrage is provoked by what the contract deems to be ‘normal working hours’, the hours doctors work without receiving overtime payments. These will be extended from the current 7am to 7pm to end at 10pm. Saturday will also in future be classified as a normal working day and will no longer qualify for antisocial remuneration. The term junior doctor denotes all those who have graduated from medical school and are completing their postgraduate training to become consultants.
The proposed contract further includes ending the necessity for junior doctor’s working conditions to conform to the European Working Time Directive (EWTD); originally intended to ensure that they did not work dangerously long hours. The EWTD has received only limited approval, with some praising its protection from working unsafe, excessive hours while others claim that junior doctors often have to work longer hours than its provisions allow, but that hospitals can no longer pay them for this ‘extra’ time without breaking the law. Some, who are now consultants, even believe it is too hard for junior doctors to gain all the experience they need to make good consultants if their training is to be limited to EWTD hours.
The proposed new contracts clearly show a change of attitude on the part of Jeremy Hunt and the Department of Health, given the Conservative party manifesto’s commitment to a ‘truly seven day NHS’. The fact that Saturday, under the new scheme, will be remunerated at the same rate as week days is evidence of a political initiative to separate British healthcare working conditions from other public sectors in which the majority of work is carried out between Monday and Friday. Similarly the move to extend normal working hours later into the evening reveals an expectation that the medical workforce should now be prepared to work antisocial hours; that this is part of the job.
We cannot ignore that fact that patients do not only get sick Monday to Friday, 9am until 5.30pm. Studies undertaken around the world – as well as showing increased mortality rates at weekends – have revealed a heightened danger to patients admitted or treated outside normal working hours even on weekdays. The majority of medical professionals acknowledge this fact, and recent surveys have shown high levels of support amongst NHS staff to provide more even care seven days a week.
Nevertheless, two factors in the way the Department of Health is addressing the issue of increasing round the clock care seem offensive to NHS staff, and especially to its doctors, who are the target of the majority of the health secretary’s intended changes so far.
Firstly, the trending twitter tag #iminworkJeremy, in which doctors posted pictures of themselves working in hospital at weekends, is intended to demonstrate that essential services are already being carried out at a high level during weekends. It suggests that doctors fear being kept unnecessarily in hospital over the weekend if they are contractually compelled to do so.
Secondly, the perceived lack of recognition on the part of government of the sacrifice doctors will have to make in working more antisocial hours seems to cause a lot of friction.
When we live in a society which, as a majority, works a set five day shift pattern, especially those who have embarked on a stable career, it seems unjust not to recognise the sacrifice doctors make when de-synchronising their working lives with those of friends and family. Further, it should be understood that doctors are powerless to upgrade out of hours care unless they have adequate NHS resources and particularly other NHS staff supporting them. From porters to lab technicians, all groups are needed to ensure that safe care can be delivered and rapid action taken at any time of day or any day of the week.
Antisocial hours will continue to be antisocial even in a ‘truly seven day NHS’. We cannot degrade staff conditions in order to upgrade our health services. While it seems clear that Mr Hunt wants to keep his party election promises and ensure NHS patient safety by reducing higher morality rates at weekends, his current strategy risks demoralising, perhaps even loosing, large parts of the workforce whom the NHS has trained at great expense, to other counties.
As is often said, politicians must not ignore the huge funding gap in the NHS budget. If we want even more from the NHS then, as a country, we must be prepared to pay for it and award fair contacts to our doctors and healthcare staff.
Edmund Stubbs is Healthcare Researcher at Civitas, @edmundstubbs1