Guest debate: The imposition of the new junior doctor contract
Posted on: Thu 18-Feb-16 16:15:41
(324 comments )
Last Thursday, I cried for our NHS.
I was listening to Jeremy Hunt explain why he had to impose a hugely unpopular contract on doctors. Just 24 hours earlier I had been buoyed by public support on the picket lines, and now here I was, left frustrated and incredulous at the government's action. Despite the Royal Colleges disagreeing with imposition, despite multiple demonstrations and overwhelming polls demonstrating public support against an unsafe contract, the government decided to unilaterally impose a contract that would supposedly allow them to fulfil their party manifesto. Even the Patients Association, usually staunch adversaries of doctors, spoke out against the government's imposition, calling it 'unacceptable'.
We keep hearing the Conservative Party pledge to deliver a 'truly seven day NHS'. This sounds like a lovely idea, which in theory every doctor would support (and, of course, we do already provide a seven day service, routinely working nights and weekends). However, without the necessary extra funding and resources it is frankly dangerous. The government has failed to fully examine the effect this contract will have on patient safety or staffing levels, focusing instead solely on how they can stretch a service without spending more money.
This was never about politics for the doctors. We are driven by concerns for the safety of our patients and the NHS workforce; we want to preserve the NHS for future generations. It is becoming increasingly laughable to hear the Conservative Party call themselves the party of the NHS. Our own Health Secretary refuses to engage and debate with junior doctors. Our Prime Minister has stayed eerily silent throughout this whole dispute, despite presiding over the first doctors' strike in four decades.
This was never about politics for the doctors. We are driven by concerns for the safety of our patients and the NHS workforce; we want to preserve the NHS for future generations.
Our rotas are already under-filled. Many specialities face retention problems as more doctors leave to work overseas having struggled to maintain a safe work/life balance in the NHS. This contract will see many more doctors resign in despair, leaving a thin workforce spread ever thinner across seven days. We are being asked to do more for less and this is breaking a generation of doctors who are already on their knees with the continued underfunding of the NHS. Currently, one in two junior doctors chooses not to continue with their speciality training. The rate of mental health problems in doctors is worryingly high; it is only likely to get worse. All of this coupled with less robust safeguards on working hours will inevitably result in patient safety being compromised.
I never thought that I would have to strike as a doctor, but I know that any short-term disruption to my patients will be outweighed by the damage this contract will have on patients in the long term.
The government is set on changing the meaning of a weekend for all NHS workers, starting with us, the junior doctors. I have been a junior doctor for five years and have a little boy who is 20 months old. Under this contract, I could be forced to work every other weekend and more nights, spending more time away from my son. My husband is also a medic – many people marry within the profession – and we're already worried about juggling childcare under the new contract. If we end up working alternate weekends, we won't have any weekends together, but if we're in sync we'll have to find someone to look after our son during that time. We already struggle to arrange childcare to cover our night shifts, and the proposed weekend hours will only put a further strain on our finances, and our relationship.
The NHS is not perfect, but it is there for us in our time of need. Speak to any doctor and they will name you 101 things which need improving in the service before embarking on the alleged 'truly seven day NHS'. Our accident and emergency departments are crumbling under the weight of admissions; our mental health services are letting down the most vulnerable people in our society. Our GPs account for 90% of all NHS patient contacts and yet receive only 9% of the funding; our hospitals are filled with patients who we cannot discharge safely because funding to community services has again been slashed.
The government has used its nuclear option and we have been left reeling. We will slowly discover what the fallout will be for you - our patients - and for us - your doctors. Stand with us: your junior doctors need you more than ever.
By Paola Rodriguez
The new contract is a good deal for doctors, patients and the future of the NHS says health minister Ben Gummer
MP for Ipswich
Posted on: Thu 18-Feb-16 16:15:41
(324 comments )
Last week we announced that we will bring in a new contract for junior doctors, a contract that is a better deal for doctors as well as safer for patients.
In our election manifesto last year, this government committed to an NHS that operates seven days a week. We want an NHS where it doesn't matter which day of the week you get ill - whether you need to see a consultant, have an urgent diagnostic test, or get the green light to be discharged from hospital. All patients deserve the same level of care any day of the week and we want to make this happen.
We have now had eight independent studies in the last six years which show that more people die when admitted to hospital at the weekends than during the week. No responsible government can ignore this.
Junior doctors are the backbone of our hospitals in the evenings and at weekends. The work they do is invaluable and we know that we need to get the right number of people working at the right time. The new contract will make it easier for hospitals to make sure there are enough doctors at weekends and will also protect doctors from working two weekends in a row, or even more hours than they do at the moment.
Some people have said that the new contract may be risky for doctors and risky for patients. This is absolutely not true. This contract will protect doctors and their patients.
Junior doctors are the backbone of our hospitals in the evenings and at weekends. The work they do is invaluable and we know that we need to get the right number of people working at the right time.
The new contract reduces the absolute maximum hours a doctor can work in a week from 91 hours to 72 hours – with most doctors working a maximum of 48 hours. It also limits the number of nights that doctors can work in a row with no break to four, down from seven, and the number of consecutive long days that junior doctors can work will be reduced from seven to five. Every hospital will now have a 'Guardian of safe working', a brand new role to make sure hospitals stick to these new working hours and do not ask junior doctors to work longer than is safe.
Hospitals who do not stick to these new safer hours will be fined, and this money will be put straight back into doctors' training. Also, no doctor will be ever be expected to work two weekends in a row. We hope this will improve work-life balance - an issue we take very seriously.
Under the contract we have at the moment, doctors can get the same wage for working different 'unsocial' hours. For example, a doctor who works just one hour over the maximum shift length can trigger a 66% pay increase for all the other doctors on that rota. This is not a fair way to reward doctors for the hours they work, and is putting a real strain on our NHS.
Everyone wants doctors to feel rewarded for the essential work they do.
We have listened to junior doctors' concerns about pay and the increase we've offered in average basic pay has risen from 11% to 13.5%. Greater basic pay will also mean higher contributions to pensions from their employers and the potential for higher maternity pay. And let's not forget that no other public sector workers will see this level of basic pay increase this year.
Junior doctors did raise some concerns about how we defined these 'unsocial hours', so we listened to them and revised our offer. Now, all doctors working nights (9pm-7am) on any day of the week will be paid time and a half. Doctors working Sundays (7am-9pm) and Saturdays (5pm-9pm) will be paid an extra 30%, and regular Saturday daytime workers (those who work more than one weekend in four) will receive an extra 30%. In order to make the NHS a truly seven-day service, trainee doctors who work less than one in four weekends between 7am-5pm on a Saturday will be paid at normal rates. Other essential public sector workers, such as police officers and fire fighters, already work in this way – at plain time on Saturdays.
This new contract is necessary, safe and fair. It is a good deal for doctors, but importantly it's also a good deal for patients and for the future of our NHS.
By Ben Gummer
I'm a long-standing MumsNetter so I haven't joined just to be part of this debate, or have a pop, or whatever your SPADs are now going to say.
I have a massive investment in the NHS in that I've had an emergency entry through A&E (a pulmonary embolism) and I have ongoing gynaecological health problems, and I have children and elderly relatives, and our lifelong health needs are not going to go away.
Please ask me how I intend to fund this. Please ask me for a penny or pound more in NI or tax.
But please do not, ever, patronise me again, or patronise the doctors upon whom people like me will rely (again and again), with your utter nonsense about this contract being safe and fair.
The contract is not safe and it is not fair.
And imposition of it makes me wonder about your advisors' intelligence and ethics, frankly.
Thank you for reading this. I daresay your remit is not an easy one. But please do think again.
Ben gummer, to say the max hours allowed to is dropping from 91 to 72 is a bit of a spin isn't it? The new contract removes the financial penalty to trusts if over 56 (?) hours are worked.
The drs I work with me tell me they currently never work more than 56 hours (rotered) because the trusts don't want to pay the fines.
So isn't there now a danger the hours worked per week will increase from 56 to 72? An increase of 16 hours a week which equates to an extra 2 days work!
I seriously doubt any MP works this amount of hours and that is at a cushy job sat down listening to debates, etc. Not rushed off your feet operating on people.
No other public sector worker will see this level of basic pay rise of 13%? Well MPs aren't far behind are they? Was it 11 or 12% you got?
You lot are stupid if you think people can't see through this!
And I don't believe your studies saying more people die if admitted at a weekend. The initial study could also be said to show more people die at on a Thursday than at a weekend. So why aren't you saying to increase staffing on a Thursday!
Back in 2015 the govt put a bill through parliament to remove doctors and health care professionals from the protection of the European working time directive.
It was a minimum 10% pay rise for MPs as reported in July 2015, Simon. and that was with no extra duties, no reduction of pre-existing contractual limits on hours, no removal of fines for breaches of the former by the Trusts, no re-branding of weekends to non-weekends having worked those punishing hours and shifts, no danger to patients, no messing with hours and rotas.
Just a nice, clear pay increase for MPs for doing ... the same job.
The statistics on deaths at the weekend only make sense if understood as emergency / non-emergency admissions, surely?
It just disgusts me that MPs can spin this rubbish with a straight face. They're either total liars or they're thick enough to actually believe it and not understand the issue. Neither of which paints them in a good life.
The only comfort I have is that no matter what private health care Hunt et al have in an emergency or an accident it will be an nhs hospital they're taken to. It will be an nhs doctor who is wielding the scapel in an emergency operation and I hope that Dr is knackered and on hour 70 of a 72 week.
I might be just a boring accountant but perhaps Ben can explain the numbers to me.
The govt want a seven day service (no clarity as to what exactly this is, but let us assume more than the current emergency only service).
Hunt has already said that they will not increase overall wage bill to cover this.
Govt says that doctors will actually be safer because there will be fewer hours overtime worked and restrictions to ensure this happens.
New doctors take a long time to train and universities have said that there is no increase in the medical school trainee numbers to increase the supply.
1. Where are the additional hours coming from to cover an enhanced seven day service?
2. If these are expected to come from doctors how does this marry up with the statement that doctors hours are not being increased but overtime is actually being more restricted?
3. If the extra hours are coming from doctors then if the overall wage bill is not being increased then the doctors must be correct in saying that they are being expected to work longer hours for the same/less money.
4. If there is no actual increase in doctors hours then is the intention just to spread work from weekdays to weekends? Why would that help and why would you go through all this upheaval to deliver no more services?
5. If you are standing by both statements (is that doctors hours will in fact be reduced and that the current seven day service will be enhanced) where are the doctors coming from to make that possible, given that there is no new money being pledged to fund this and that even if there was there are no spare doctors hanging around nor an increased pipeline of them coming through medical school.
6. In trying to analyse the various statements made by the government, I have reached th conclusion that they cannot All be true. So which of them are true and which of them are lies?
7. Ben, please can you attach links to the original studies as references, so that we might read them and draw our own conclusions rather than the selective quoting that has taken place in your link.
In conclusion, I am unable to place any credibility on the governments various statements and my feeling is that someone is lying and it is not the junior doctors!
Ben Gummer - junior doctors generally do not work 91 hours a week. Hours monitoring already exists following the EWTD. This is not about protecting junior doctors.
Junior doctors are not just the backbone of hospitals at the evening and weekend, they are part of the backbone all day every day. Your new contract will reduce the number of doctors on the shop floor further, backing up waiting times for patients to be discharged, to be seen in A&E.....
I also missed the part where you mentioned the increase from11 to 13.5% pay rise was on top of the overall paycut doctors will get when you reclassify "unsocial hours" and also where you mention that for many doctors about one third of their pay is made up from unsocial hours pay, meaning and overall net loss.
I have a question though - once you have pushed this through, who is next? My guess is the definition of unsocial hours for nurses, but I am open to alternative suggestions, which is more than your party seems to be.
Mr Gummer, I'm not a junior doctor or related to one. I can't really understand the government's position on this as I am sure that doctors ARE on duty in hospitals 7 days a week. How will this work if you don't have all the other departments such as diagnostics etc. In for 7 days as well? Or do you intend to force these people on even lower wages to work weekends on plain time as well. If that's the case I would like to see mps do a constituency surgery each Saturday. Its a bit rich when mps have just had a 10% payrise.
clopper you'll be told that MPs do run weekend surgeries.
My former MP for example used to run a constituency surgery every Saturday morning for two hours. However it was staffed by his (tax-payer paid) office manager and researcher for three weeks out of four.
Not a junior doctor, not related to one, long term mumsnetter.
Ben, can I call you Ben? I feel now that you've lied to me and patronised me, we should be on first name terms. Call me Chris
The figure about weekends being more dangerous have been discredited over and over again. They are lies, Ben. Lies. I've seen the maths (I put away my silly lady things for a day and concentrated real good) and your numbers don't add up.
If I was told tomorrow that my department (not NHS) was now running every section 7 days a week, with no additional funds, I would think you an idiot.
Are you an idiot, Ben? I'm not.
My daughter was admitted to hospital on a Saturday. She nearly died. It was awful. But the only awful bits were due to cuts. There was no intensive care for her. There was no specialist for her condition. So we had a long journey to people who could help.
The one thing I didn't see was anyone slacking. I saw commitment. I saw care. I saw doctors working hard to save her life.
In my silly moods I shall bring it all down to, who would you trust more? A politician or a doctor?
There's only one of those I want to see with a scalpel. Can you guess which?
Forcing this contract on junior doctors will result in deaths. I hope your conscience is prepared for that.
I support the Junior Doctors in striking. Every step of the way.
So is Ben reading these comments MNHQ?
Or does he post and run?
Can we please have him for a webchat? Ideally on a weekend?
"In our election manifesto last year, this government committed to an NHS that operates seven days a week." Ben Gummer
Have you ever gone to hospital on a Saturday and found it closed?
And if Dr Paola Rodriguez is reading: thank you and best wishes to you and all your colleagues in the face of such obfuscation.
"We have now had eight independent studies in the last six years which show that more people die when admitted to hospital at the weekends than during the week. No responsible government can ignore this."
Lies! People who are admitted at the weekend are more likely to die at 30 days post admission. None of the research backs this governments claims that this is because of unsafe staffing.
The government have been informed by the authors of the studies themselves, saying that to suggest this to be the case and that these deaths are preventable is "rash and misleading". The government continue to lie to scare our patients and the public. They should be ashamed of themselves.
"Some people have said that the new contract may be risky for doctors and risky for patients. This is absolutely not true. This contract will protect doctors and their patients." Ben Gummer
Who do you trust? A politician who knows nothing about healthcare or the doctors on the front line?
Just because Fact B is true doesn't mean Fact A causes it.
It's like that old chestnut that 100% of serial killers have drunk water. Does water turn someone into a serial killer? Of course not! And the bollocks you spout is just as laughable.
I second Liney, Dr Rodriguez, keep fighting the good fight.
I don't know anyone personally who is anything but horrified by what the Government are trying to force on you. You do an amazing job and we do appreciate you. We really do.
Please don't let Hunt and his cronies convince you that the public think you're money grabbing. You're fighting for us. You're fighting for our NHS. And I for one am so very proud of our Junior Doctors for doing so.
Definitely, thank you to you Dr Rodriguez and all your doctor colleagues.
Adding my thanks to Dr Rodriguez and all the Junior Doctors. We appreciate you and I for one think the government are treating you all abysmally.
I don't understand how such a massive change to our NHS can be decreed from on high with a proper consultation or any real engagement with either the public or the healthcare professionals.
How can claim to represent us when they're too scared to answer our concerns?
Where are you Ben? Why don't you actually engage with the people you claim to want to help?
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