This of course caused a deluge of negative comment in all areas of the media, printed and social.
I’m not a great fan of direct attacks on individuals. I try to remember to play the policy and not the politician (sometimes it’s hard and I fail). Not just because it’s a bit rude and not the way my parents brought me up but also because it is probably counter productive. I don’t know where the policy and then manifesto pledge came from for ‘7 day services’, I think there’s every chance it came from someone medical rather than a politician (although the politicians would desperately like the public to think that great out of hours emergency care is a politicians idea). I also think that if you asked the average consultant or junior doctor if we would like to improve emergency out of hours care that most would say yes. Few of us have an argument with that bit. Where I do think we have an argument however is how we get there and the dichotomy between emergency and routine 7 day services.
Has there has been a DOH change in the focus of 7 day services? Kathy McLean wrote in May to medical directors regarding the implementation of the quality standards www.nhsiq.nhs.uk/media/2746158/clinical_standards_feb_2016.pdf (go and read them, they apply to you!). In her letter she made the point that public demand for routine services is currently low and therefore urgent and emergency work should be the priority. I think most would roll with that. Although the next section which said ‘with diagnostics, some cancer treatment and day case procedures in the future to maximise choice and convenience’ would probably not be supported in the same way.
There is no doubt that we have a lot to do over the next few months; the juniors contract was rejected by the majority of juniors and final year medical students but is still going to be ‘introduced’; The consultant contract is still under negotiation and when finished will be balloted on. There remain huge questions over the actual practicalities of 7 day services, who’s going to do the work, who’s going to fill the gaps in the week, has any body actually listened to us repeatedly saying that the issue isn’t contractual but about support staff, services and resources? We need to direct our energies toward holding the Department of Health and Jeremy Hunt 2.0 to account on the facts rather than personalities.
My guess is that the autumn is going to be choppy in the NHS for multiple reasons. The new contracts, the application of NHS Improvement CEO Jim Mackey’s comments on the stretching of nurse ratios from 1 in 8 in order to save money. If this heads in a toxic direction then that may be the time for a new health secretary with the government hoping that the current incumbent would take the poison with him.
When it comes to filling jobs it’s not just the prime minister who has had some difficulty. My wife, who’s a gasser tells me that the anaesthetic junior rota for August has more holes in it than than an NHS cellular blanket. Some are covered by doctors of other grades but it’s unlikely to be sustainable. In the medium term probably similar to the tenure of the man involved in causing the staffing crisis in doctors and nurses in the first place, but whatever the name of the minister the root cause seems clear; the NHS remains under resourced.
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