Hunt's Long Game

Last weekend there was a twitter tag #iminworkjeremy which got big enough to be picked up by the mainstream media. My Twitter feed being a small left wing microcosm (after the general election Labour twitterers were so confused "but all my followers voted  Labour and we still lost!"), I didn't think it would go very far but the independent and the BBC picked up on it. My tweet was included in the buzzfeed article but not the independent one. Probably because it was such a terrible selfie! My vanity aside, the whole thing was a response to criticism of hospital doctors by the Health Secretary Jeremy Hunt.  Now his plans for 7 day working have been rebutted in depth by much cleverer people than me here and here. Funny that, doctors might be smart and well researched and be able to analyse a flimsy paper on which you hang the weight the entirety of the 7 day NHS reforms.

Now the first question is "Do we need 7 day a week care?". The answer is clearly yes, you can't have parts of the service close at weekends as it is inconvenient and potentially risky, as some of the government analysis shows. Most of the doctors on the #iminworkJeremy were engaged in emergency work which continues 24/7 as my 3am laparotomy patient can attest. However the solution to provide more services isn't to make doctors work harder.

I worked as on call registrar for general surgery last Saturday and for some of the day the senior decision maker for patients potentially needing surgery. One of my patients I decided  needed an ultrasound scan. This couldn't happen until Monday. The next patient needed an endoscopy. This couldn't happen until Monday. The next patient needed to see a stoma specialist. This couldn't happen until Monday.

This is in no way a dig at my colleagues in radiology, endoscopy or stoma care. Quite the opposite. They work as hard as the rest of us. Medicine is a team sport and it can't work if only one cog in the wheel is made to spin harder. I'm useless as the surgeon if there isn't a whole array of specialists and technicians to support patient care.  All the other services including scans, scopes, bloods, portering, wound care, community which are not funded to work at weekends, need to be, with enough recruitment and funding to cover this. You can't expect a 40% increase in productivity with and 8% increase in funds. But that won't happen, as it would be expensive.

The next, more interesting question is "Do we need 7 day a week Elective care?" A more difficult answer. In my opinion, No, we don't. Firstly, is there any evidence that performing routine care at evenings and weekends improves patient safety? I can't find any. Does it improve access and patient satisfaction. To an extent yes. But would spreading services to weekend without extra money force us to lose service provision in the weekdays thus making patient safety worse off? In my experience the only clinics I used to do which were underbooked were evening and Saturday clinics. This is because people want to use  their leisure time not in the doctors surgery. I don't think it would be a good use of resources risk patients in the week by making us work more at weekends. What is proposed is a massive increase in provision of service without the same level of investment.

Which leads me onto what I think would happen.

Many people have commented on how naive or inept Hunt is. I do not believe this for a second. I think he is a very clever man with a very clear aim. He wants to privatise the NHS and open it up to becoming a more US style system. Not only due to his donors and previous publications on the subject see Direct Democracy 2005, but the tactics being employed stink of a plan to privatise a service.

Firstly, defund. Check. There is potentially a £20bn shortfall in NHS funding despite the challenge to find the same in efficiency savings. An £8bn pre election promise and £500m winter pressure payments are sticking plasters. To say we spend a lot on our health service is interesting when we spend as a proportion of GDP less than most other developed nations.

Secondly, demoralise. Check. First the GPs by trying to get them to make more sausage with less meat, by getting them to open 8-8 7//7 with no proportional funding increase. Criticising them through CQC, print media and press releases. Making promises of extra GPs which anyone who could see GP  application numbers falling could see was nonsense. Funny how this was shelved immediately and quietly after the election. Next by telling consultants and hospital staff that they are not working hard enough or long enough. This is patently untrue. Myself and my consultant bosses are as dedicated and present as ever as shown with the huge outpouring for #iminworkJeremy. My 12 years of training, numerous hours in the NHS goodwill fund after my shift finished as well significant personal and financial sacrifice has enabled me to provide decent care for my patients, to be told I don't have a sense of "vocation" would be laughable if it didn't anger me so much.

Lastly, and this is the best part of the plan. Get the doctors to destroy the NHS. Privatising the NHS openly in the UK is political suicide. It will be for the forseeable future. It is one of the few things this country has to be proud of. Therefore in order to execute the plan, the only group powerful enough to resist changes need to be the ones to destroy it.

Here is how it might go. Try to enforce an inferior contract on doctors. Either the BMA roll over like they did for the pension reforms or Industrial action ensues as the only option for an oppressed workforce; despite the weakness of the BMA there must be a line somewhere. (If the RMT were in charge of us, we'd have downed tools already!). Media blame money hungry doctors as the cause of strikes and worsening conditions in NHS hospital. Mass resignations  by doctors and serious patient safety incidents in understaffed hospitals would leave the government no choice but to introduce a pay it yourself service and blame the doctors for not willing to work for free or have more sense of "vocation". And there he has it. A nice juicy service ripe for the picking so he can go and advise the  board at private healthcare plc and make a tidy pension.

What am I doing about it other than moaning on social media. I've joined the BMA for what it's worth as well as a non government political party, to at least get my views out there. I don't want money to play a part in whether patients get care, no-one should profit from ill health directly and I think the ideals of NHS is what keeps me in the UK at all. Of all the country's family silver it should be the shiniest, well looked after piece and not for sale, covert or otherwise.