NHS reforms

Hunt ‘at war’ with doctors over seven-day contract

Health secretary Jeremy Hunt has been accused of launching an attack on doctors by issuing a contract ultimatum over seven-day working today (16 July).

He said the British Medical Association (BMA) has six weeks to negotiate to agree new terms, or doctors will face a new mandatory contract.

If negotiated changes to the contract cannot be agree by September, he will impose new terms by April 2017.

He suggested that the BMA’s attitude may be contributing to 6,000 deaths a year because of the NHS’s ‘Monday to Friday’ culture.

Hunt told BBC Radio 4’s Today programme: “If you are admitted on a Sunday, you are 15% more likely to die than if you are admitted on a Wednesday. We have 6,000 avoidable deaths a year.

“If you look at the evidence of what is causing those avoidable deaths, lack of senior consultant cover at weekends is one of the critical points. When you turn medicine into a Monday-to-Friday profession, you end up with catastrophic consequences for patients.”

Daniel Mortimer, chief executive of NHS Employers, backed Hunt’s decision.

He said: “Today sets a clear direction for reform which is good news for patients and we now need to work together with our medical colleagues and their trade union, the BMA, to implement the changes the secretary of state had indicated.”

Katherine Murphy, chief executive of the Patients Association, also defended the statement.

"Patients should have easy access to 24-hour, 7 days a week care. The NHS is a publicly tax-funded service and should be built around the needs of patients. The Patients Association do not believe that it is for the doctors' unions to decide how a public-funded service should be run.

"The NHS is not there for the benefit of professionals. Patients can't pick and choose when they need to use it and doctors can't pick and choose when they want to work in it. The public need to have confidence that when they are in need of care that it is easily accessible. Why should we have less care at weekends than the rest of the week? Patients need access to appropriate services, diagnostic services, x-rays and scanners, but also need access to most appropriate professionals," she said.

However the BMA said the NHS “does not have the resources” to let consultants to work over weekends without damaging other treatments.

BMA council chairman Dr Mark Porter called the news a “wholesale attack on doctors” and told Hunt to “get real”.

He said earlier today: “Despite whatever the health secretary may claim, his simplistic approach ignores the fact that this is a much broader issue than just doctors’ contracts.

“Today’s announcement is nothing more than a wholesale attack on doctors to mask the fact that for two years the government has failed to outline any concrete proposals for introducing more seven-day hospital services.

“The health secretary has questions to answer. How does he even plan to pay for it? How will he ensure there isn’t a reduction in mid-week services or fewer doctors on wards Monday to Friday? Yet again there are no answers.

“This is a blatant attempt by the government to distract from its refusal to invest properly in emergency care. So, I say again to the health secretary, get real and show us what you mean.”

The BMA released a survey of 2,000 adults who did not believe the NHS could afford weeklong services.

It said in a June report: “As we do not have enough GPs to cope with current demand, forcing practices to provide routine services over seven days will be at the expensive of quality, stretching GPs even more thinly and replacing continuity of care with impersonal shift work.

“This will inevitably reduce our availability for older and vulnerable patients, many of whom need to be visited at home. It is vital that the government uses our overstretched NHS budget wisely and prioritise quality over political headlines.”

Patients’ rights group Patient Concern had similar views claiming Hunt was in a “dream world”.

Roger Goss, group member, said: “He must be living in a private dream world. NHS England is playing pass the parcel with responsibility for ensuring a safe minimum ratio of registered nurses to patients on every hospital ward, despite the recommendations of the Mid Staffs inquiry.”

Hunt is adamant that the issue is long-standing and pressing, telling the BBC: “The problem dates back to 2003 when the then-government gave consultants the right to opt-out of working at weekends. That’s a right that nurses don’t have, midwives don’t have, paramedics, ambulance drivers and so on don’t have – and that has created a Monday-to-Friday culture in many parts of the NHS; with tragic consequences for patients.”

He backed his views by claiming many medical directors and professional bodies “want that sense of vocation and professionalism brought back into the contract”.

He added: “We are not asking any doctor to work longer hours or unsafe hours, but there will be times where we do need that senior consultant cover at weekends.”

He also said that the morale amongst doctors and consultants is higher in hospitals with seven-day contracts, citing Northumbria and Salford as examples.

Hunt is currently speaking at the King’s Fund in London and has told attendees that he is determined to “set out the direction of reform for the NHS not just for the next five years but the next 25”.

“This is my offer to the NHS today: more transparency in return for fewer targets.”

He said that he expects the majority of doctors to be on seven-day contracts by the end of this parliament.

Back in December 2013, NHS England medical director Sir Bruce Keogh launched a plan to drive seven-day services across the NHS, starting with urgent care. The working group was originally launched in December 2012.

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