Dear Mr Hunt
I am writing this post as the debate about providing 7-day NHS services rumbles on. Recently on the radio I heard a report reminding us that you are ‘disappointed’ that BMA (British Medical Association) is refusing to engage in talks with you about extending the working hours doctors (consultants is particular). The report also reminded us that you intend to give them until September to agree to your demands and if they continue to refuse you intend to force them, with the new working hours coming into force in April 2017.
As a nurse married to a junior doctor your plans for a 7-day NHS service have been the subject of many a heated rant in our household. In particular your claim that the NHS is a service that ‘starts to wind down after lunch on a Friday’ made us hugely angry and we would love to know what evidence you have to support it.
Clearly you have visited many of the UK’s hospitals in order to put on scrubs, shake some hands and engage in photo opportunities that breach patient confidentiality but between us we have worked in dozens of different hospitals and departments in Trusts spread throughout the UK and have yet to see any evidence of staff winding down after Friday lunchtime. On the contrary, Friday is the day where doctors are more likely to stay late as they ensure that everything is set up for the weekend, only leaving when they are sure that everything is in order and the patients will receive the best care possible.
You might argue that with a 7-day NHS, the need for doctors to prepare for the weekend would no longer been an issues and you may even claim that this weekend preparation supports the need for your proposed reforms. However, I am far more inclined to agree with Dr Mark Porter (the head of the BMA) when he states that it’s just not that simple.
By forcing consultants to work more hours at the weekend you may well find that routine decisions about patient care are indeed made sooner. However, the fact that many services such as x-rays and laboratory tests will only cover emergencies at the weekend means that regardless of how many hours the consultants work, many interventions will still have to wait until Monday.
You see, preparation for the weekend doesn’t consist of more junior doctors frantically chasing their consultants before they all disappear for two days to return on the Monday. Instead they are attempting to deal with the huge influx of referrals from GPs and other community practitioners (the majority of whom do not work at the weekend) who feel that their patients would be safer in hospital than in the community where services will not resume until Monday.
In comparison to this, hospital consultants are almost always available at the weekend in case of emergencies. Clearly I can’t speak for the NHS as a whole but my husband or I (or anyone else we know) has yet to find themselves in a situation they feel unable to deal with and unable to contact the consultant on call. The consultant may not physically be on hospital grounds but they are only at the other end of the telephone and if the more junior doctor feels it’s necessary the consultant will come into the hospital to review the patient themselves.
As I can only find one new article relating to a patient reportedly dying because the on-call consultant apparently refused to come into the hospital (although the patient was treated by another consultant) I have to conclude that it is something that rarely, if ever, happens. Therefore I fail to see how forcing consultants to work more hours at the weekend it actually going to save any of the 6,000 lives that you claim are lost each year.
One of the biggest bones of contention for us is the much quoted study, carried out by University College London and featured on the NHS choices website which appears to be the basis for much of your reforms and the subsequent headline grabbing news stories. The study itself has produced the statistic that patients are 16% more likely to die if they are admitted to hospital on a Sunday than on a Wednesday. Straight away I would like to draw attention to the fact that only two of the days of the week are mentioned here and there are no statistics available for the number of patients who die after being admitted on a Saturday compared to a Tuesday, for example.
The study is indeed large, having collected data from over 15 million patient admission during a one year period, from which it produced various statistics in addition to the one mentioned above. One of these additional statistics that both you and the media have failed to include in your various articles and speeches is that the study also shows that the day that these patients, despite having been admitted to hospital during the weekend, are actually more likely to die during the week.
Yes, the patients who you claim will benefit from consultants working more hours at the weekend are more likely to die during the week when the majority of consultants are actually working.
The study freely admits that they did not actually examine the reasons why patients were more likely to die after a weekend admission and states that ‘no assumptions should be drawn about staffing levels or the availability of senior staff.’ One theory put forward by the researchers was that people admitted to hospital over the weekend were more likely to die following that admission was because the severity of their condition meant that they were unable to delay coming into hospital until Monday. Equally the researchers suggested that patients with less severe illness or injury may well be more likely to wait until after the weekend before actually going to hospital.
Mr Hunt, if you have any further evidence with which to support you claims you should probably make it known because if this is the study you are basing the need for your reforms upon, you are either woefully misinformed or willfully manipulating the statistics to support your own ends. While you will not be the first or last person (never mind politician) to do this we resent the fact that you describe the BMA as ‘a roadblock to the reforms that will save lives’ when you are deliberately choosing to misunderstand the recommendations made by researchers to try and flatten the objections made by medical professionals who dedicate their careers to saving lives and caring for patients.
There are also a few things I would like to ask you about how exactly you plan to implement these changes, based upon the fact that you appear to be planning to run this new 7-day service without actually hiring any more doctors, spending any more money, increasing the weekend hours of other medical services and by actually reducing antisocial hours pay.
In order for consultants to work more hours at the weekend and still work within the constraints of the European Working Time Directive, surely this means that they will work fewer hours during the week? I may be wrong but if having consultants work more hours at the weekend will save lives then I imagine having them work fewer hours during the week will start to risk lives? Equally, if you don’t have any plans to dramatically increase the number of consultant posts in the UK so that there are more staff to work these increased hours then, instead of improving patient outcomes you are going to be faced with exhausted, disillusioned doctors who make mistakes which may cost the lives you claim to be setting out to save.
As far as I can see it’s a lose:lose situation.
The vast unpopularity of your proposed reforms Mr Hunt should have become obvious to you when the petition to ‘Debate a Vote of No Confidence in the Health Secretary the Right Hon Jeremy Hunt’ reached over 210,00 signatures. The General Medical Council (GMC) states that there are just short of 240,000 doctors registered in the UK with approximately 85,000 of those being consultants. Put another way, if every single person who has signed that register is a doctor, then 88% of all the UK’s doctors (not just consultants) disagree with your proposed reforms. In the highly likely event that not everyone who has signed the petition is not a doctor, there is still the inescapable fact that over 200,00 people (potentially including those whose lives you claim your reforms will save) are so unhappy with your ideas that they feel you should be removed from office.
Surely that is the most convincing statistic of them all?
Louise is a full time mum and a part time neonatal nurse who has battled depression for many years but particularly during her pregnancy. She lives with her husband (the Northern One) their little boy (Squidge) and their three guinea pigs who live in the kitchen.
Louise blogs at 23weeksocks (http://23weeksocks.com) about lots of different (and seemingly unconnected) topics that she’s passionate about, including mental health, antenatal depression, neonatal care and baby loss.
In 2015 she was shortlisted in the ‘Fresh Voice’ category for the BIB (Brilliance in Blogging) Awards and the ‘Bereavement Worker’ category for the Butterfly Awards. She was also one of the keynote speakers at BritMums Live reading’Twinkle Twinkle’ which was her account of caring for a premature baby on the day that he died.