Jeremy Hunt and the hatred of an entire profession.

The things I do for you, TMS. I suffered through all 25 minutes of listening to Jeremy Hunts King’s speech, Hunt sounding like a five year old reading his brother’s essay and not entirely sure what all the words meant. In phrase bingo, jargon such as ‘intelligent transparency’ came up a whopping six times, and not once did he explain what on earth he meant. I’ve since been informed it actually means ‘the release of informing concerning expected healthcare and treatment options in a way the public can understand.’ This is, apparently, what the NHS should be aiming for.

This “intelligent transparency” should enable the development of a more patient centred system, instead of a bureaucratic system. This, Mr Hunt says, would not tolerate the current levels of never-events such as wrong site surgery (currently standing on average at 2 surgeries per week) or levels of avoidable deaths (currently around 800 per month). He uses the example of the 21 trusts that went into special measures after the publication of the Keogh report in 2013. As a group, these hospitals then recruited 125 new doctors and 871 new nurses, bringing 7 of them out of special measures and apparently bringing about a dramatic change in culture.

Hunt is pushing for patients to be more aware of their own responsibilities towards healthcare, which is why he advocates for pricing to appear on more expensive medicines. Aside from patients with long term, complex needs feeling exceptionally guilty, what is that going to do? It’s almost like he’s asking the patient to whether they are worth this expensive medicine that allows them to live a normal healthy life.

His next point was to create a culture of learning, where doctors are inquisitive and curious. He wants to provide 7 day care without increasing the hours that doctors actually work, to enable safe staffing levels. There is a new body in charge of looking at what safe staffing entails, but don’t worry team! Jeremy has jumped the gun already! This is where it gets interesting. 16 minutes into the report, he started picking on consultants. He mentioned that consultants were on ‘Opt-Out’ contracts, where they could choose not to work at weekends and how these would be abolished to make way for 7 day contracts. Consultants are currently able to opt out of weekend work only if it is non-emergency in nature, and even then they are still expected to be on call.

His exact words were: “Around 6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals. You are 15% more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday. No one could possibly say that this was a system built around the needs of patients – and yet when I pointed this out to the BMA they told me to ‘get real’. I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to ‘get real.”

This, quite understandably, has doctors up in arms. I don’t know any medics who go into medicine expecting to be able to take the weekends off.  Quite rightly, on Saturday morning, the hashtag #ImInWorkJeremy started trending on twitter, with thousands of selfies and tweets being shared showing the consultants and lower grade doctors who ARE working this weekend.

The idea of a 7 day NHS is a wonderful one, but it already exists. Doctors are already staffing hospitals, working long shifts over weekends and holidays and providing the best care they can. There was not one mention in the report of the other staff necessary for a full hospital service to be run- what about 7 day care from nurses, phlebotomists, health care assistants, radiologists, physiotherapists?  the list goes on. This speech appears to be a very targeted attack on doctors, as if we go into medicine expecting to make consultant grade and thus slack off to the golf course on a Saturday.

He states: “I have yet to meet a consultant who would be happy for their own family to be admitted on a weekend or would not prefer to get test results back more quickly for their own patients.”

Personally, I’d rather my family never be admitted to hospital and go on living forever- but I’d be intrigued to see which consultants he’s meeting and what he’s asking them to get that result. Of course doctors would like to get their test results back more quickly… but I’m pretty sure it’s not the doctors that are producing the results and lab machines can only work so fast.

The figure of being 15% more likely to die if you are admitted on a Sunday than on a Wednesday could also be due to a variety of factors, not just the chance of the consultant you need having decided not to be in the hospital that day. What if the patients admitted on a Sunday are more ill in the first place? Perhaps it is the lack of suitable end of life care in the community over the weekends that mean more die in hospital when admitted on a Sunday.

He said it was “not a war against consultants” and that “many medical directors” and professional bodies “want that sense of vocation and professionalism brought back into the contract”. I can hardly think of a profession more vocational than medicine, where doctors work longer hours for less pay than their colleagues who have had less training and work in the banking sector, for example. What is it but vocation that drives doctors to stay long after their shifts are finished to look after the patient admitted just as their shift ended? What is it but vocation that drives us to come home for the evening, only to sit and revise for hours to make sure patients are getting the very best care?

Moving on from attacking consultant working hours, Hunt then went on to detail about how the public needed to use the knowledge they were being given. They were to be able to make informed choices about the services they required, whether that’s through choosing a hospital for a procedure or choosing a GP more suited to their needs. Hunt promises to boost GP provision in under-resourced areas, and improve care in maternity, end of life and long term conditions.

This is very well-intentioned, and I don’t doubt that patient-centred care is what we strive for, but when is the level of information we’re giving patients, too much? When are we then putting decisions that need expertise into the hands of the public, whose knowledge will be entirely variable?

Hunt’s speech raised a lot of questions for me, but the primary one was “Why is this coming now?” As pessimistic as it sounds, I can’t help but think he’s trying to get the public to think we don’t care, so they won’t stand up for us when he attempts to cut the NHS down further.

His speech can be heard here or read here if you want to torture yourself some more.

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