Friday 27th November 2015 Evening Standard and on-line
Lord Winston, the world-renowned fertility expert, was today among more than 300 consultants at one of the UK’s biggest NHS trusts to give their public backing to junior doctors.
As talks resumed at Acas this morning in a bid to avert three days of strikes due to start next Tuesday, senior clinicians at Imperial College Healthcare criticised the Government for a “lack of understanding” over its proposed imposition of new junior doctor contracts.
A total of 321 Imperial consultants signed a letter to the trust’s junior doctors, vowing to ensure that patient safety is maintained in the event of any walkout and telling them: “You have our full understanding and practical and moral support.”
The letter is signed by some of the most eminent clinicians working in the NHS, including Lord Winston, a professor of science and society and emeritus professor of fertility studies, cardiologist Professor Petros Nihoyannopoulos, kidney expert Professor Charles Pusey and cancer surgeon Professor Nagy Habib.
Another signatory, paediatric consultant Dr Bernie Borgstein, told the Standard that she had never seen the medical profession so united in her 34 years as a doctor.
“I have heard some people say it’s unethical for doctors to strike,” she said. “I think it’s unethical for them not to in a situation where there is a long-term threat to patient safety. In my mind, it’s a form of whistle blowing.”
The letter states: “We would like to publicly register our concern regarding the new contract and its impact on junior doctor morale, clinical and academic training and retention, patients safety and the very future of medical research and of the NHS.”
Dr Antonio de Marvao, a junior doctor who helped to organise the letter, said: “At such a difficult time it is crucial to know that we can count on the strong support from our consultants and to know that they will ensure our patients will remain safe.
“It should also be a reality check to the Department of Health when such a large number of experienced clinicians and distinguished academics stand with their juniors in saying that this new contract is unfair, unsafe and unworkable.”
If the Acas talks fail, junior doctors are due to walk out for 24 hours from 8am next Tuesday – though not in emergency departments – and between 8am-5pm on December 8 and 16.
This was the view looking down on 20,000 protesters - 90% junior doctors - filling Waterloo Place at the south end of Regent Street on Saturday mid-afternoon. It was so packed that you could hardly squeeze between the shoulders of the young men and women, a sea of NHS blue placards held aloft.
Around twenty SOH campaigners supported the junior doctors' protest on Saturday and we learned a lot from the many thousands of medics marching.
We heard British Medical Association Chair Dr Malawana explain that government proposals threaten pay cuts of 30% for some, with "normal hours" defined as 7.00 - 22.00 every day but Sunday. We learned that following Jeremy Hunt's decision to impose a contract the BMA has voted to ballot its junior members for industrial action.
We saw what a misleading term "junior doctors" is - the dispute affects all hospital doctors who are not consultants and many medics yesterday were spending a precious Saturday off with their children demonstrating to defend the already limited family time off they have. The chants made it clear this was a dispute about the quality of NHS care as well as pay and hours and the slogans were witty: "NHS - Not Hunt's Slaves" "We're not Witches Stop the Hunt" "We need to talk about Jeremy".
Lots of medics and students from Imperial were there and hopefully links are being made that will strengthen the side of all those committed to our local NHS.
This is a slim volume of 70 pages sets out in 10 short chapters the legislative changes and the 30-years history of creeping privatization which are crippling our NHS.
The main points are:
- In the 1980s the NHS internal market was introduced: Primary Care Trusts as "purchasers" and NHS hospitals trusts as "providers". The politicians wanted "competition" despite all medics saying that what you really need in healthcare is collaboration rather than competition.
- At about the same time John Major introduced PFI deals for new hospitals, which makes the final bill for a new hospital at least 7 times the original cost (and sometimes up to 50 times!) And it comes with strings for expensive "facilities management" (maintenance).
- Corporate takeover:
Primary Care Trusts could commission care from Alternative Providers of Medical Services, i.e. companies employing salaried GPs (e.g . United Healthcare, Atos and Virgin). Out-of-Hours care contracts were won by Harmoni, Serco and Take Care Now.
- From 2003 hospital trusts could become "Foundation Trusts": this meant that they became financially free-standing, independent businesses. But with that came intense pressure to cut costs, leading to dangerously low staffing levels at Mid Staffs.
- A "Payments by results" - a national tariff of fixed prices - was introduced. Since 2010 the Gov has reduced (by 3% year on year), not increased, the prices paid for each completed treatment despite the increase in population and the average age of the population. Revenue to hospitals could only increase if hospital doctors completed more and more treatments. And of course admin costs soared. Hospitals and doctors were working harder and harder to push more patients through.
- The reduced tariffs and the freeze on all medical salaries for 5 years has produced "efficiency gains" - but at the cost of exhausted and frightened medical and management teams, and dangerously unstable finances (collapse of South London hospitals trust and the near-loss of Lewisham hospital).
- To plug the gaps in staffing hospitals trusts have paid through the nose to agencies for temporary staff.
- What incentive is there for even the most dedicated registrar to stay in a system which is demonstrably financially unstable?
- In an attempt to meet the targets and understand the new environment, hospitals trusts have employed expensive management consultants to guide them - draining even more money out of their budgets.
- In a move related to uncontrolled immigration not to NHS problems, the Home Office is kicking out non-EU nurses if they are not earning at least £35K after 3 years. More fees to agencies.....
- It seems very likely that "personal health budgets" for social care will be extended into medical care, and then "co-funding", and then... private medical insurance will be essential to ensure adequate medical care. "Free NHS care at the point of delivery" will have finally gone!!!
- There is ample evidence that Jeremy Hunt, Virginia Bottomley, Stephen Dorrell, Patricia Hewett and almost the entire past and present Conservative and Labour governments have had or still have financial links to private providers to the NHS. The "revolving door" between a senior cabinet appointment and directorship in the private sector is active. The present CEO of the NHS, Simon Stevens, is a life-long health manager, but he spent 13 years working for United Hospitals in the US.
- It also seems very likely that the new and very complex contracts with private companies will provide plenty of opportunities for healthcare fraud at the expense of the patient. Fraud is difficult to detect and expensive to prosecute.