against an unfair and unsafe contract and to defend the NHS?
Today 20,000 junior doctors, joined by a large number of NHS colleagues, NHS campaigners and members of the public were demonstrating in London against the government’s imposition of an unfair and unsafe contract on junior doctors. The government’s claim is that our current contract prevents a full 7 day NHS. Here I take a look at whether this argument stands up to even basic scrutiny.
In summary – we have an excellent and efficient NHS. We have a 7 day emergency service. A 7 day elective service could be possible, but without more resources it will actually result in worse patient outcomes as it will spread staff thinner across the week. The UK could resource a 7 day elective service if we wanted to – but Jeremy Hunt would need to spend a lot more and the benefits probably would be small. Our banding supplements and our current contract are not of sufficient scale to be a barrier to a 7 day elective service.
Firstly, how good is the current NHS?
The Commonwealth Fund reviewed international health care systems recently. In comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA), the NHS was rated as the best system in terms of efficiency, effective care, safe care, coordinated care, patient-centred care and cost-related problems. It was also ranked second for equity.
The King’s Fund noted that, following the Labour government’s considerable NHS investment, overall public satisfaction with the NHS rose steadily to an all-time high of 70 per cent in 2010.
Could we have a 7 day NHS?
The thing that bothered most of us doctors recently was the suggestion that the NHS doesn’t work over 7 days – it does, quite clearly as #iminworkjeremy showed.
The NHS has to strike a balance between the benefits to patients and the stress on staff. This isn’t just to be nice to staff. Overworked and demoralised NHS staff is a disaster for the health of patients.
So the NHS tries to do just emergency work on weekends, and delays routine care and GP services to the week days. This is a sensible compromise. Hunt’s plan won’t improve emergency care on weekends as this is pretty much there, instead what it will do is increase the amount of routine care done on weekends. There are no more staff available (since he won’t pay for any more) so it will just move people from the weekday to the weekend, thereby reducing the quality of weekday services.
So this is what Hunt is really saying – he wants to have a 7 day NHS for routine care (for no major public health benefit) but doesn’t want to pay for the extra staff and services this would require.
Is there space to fund a full 7 day NHS including elective care?
Yes there is, as the next two stats clearly show, we could increase spending and train and recruit more staff. But its not clear that this would benefit anyone – as it would mainly just allow 7 day access to elective care that can safely be delayed to weekdays.
Current health expenditure in the UK was 8.46 per cent of GDP in 2013. This compares to 16.43 per cent in the USA, 11.12 per cent in the Netherlands, 10.98 per cent in Germany, 10.95 per cent in France, 10.40 per cent in Denmark, 10.16 per cent in Canada and 8.77 per cent in Italy.
The UK had 2.8 physicians per 1,000 people in 2013, compared to 4.1 in Germany, 3.9 in Italy, 3.8 in Spain, 3.4 in Australia, 3.3 in France, 2.8 in New Zealand and 2.6 in Canada.
Could our contracts really be getting in the way of a 7 day NHS?
Hunt claims that our banding supplements (salary top-ups for working nights and weekends) are getting in the way of a 7 day service. Lets see if this could possibly be true. Total junior doctors salaries (assuming 50000 of us getting £35000 on average) is about £1.7bn. About 1/3rd of our total salary is banding supplements. So our banding pay package is is about £580m.
To put this into perspective, the NHS Confederation reports that NHS Trusts unintentionally overspent by £822m this year, and total NHS funding = £116 billion.
Our banding supplements are therefore around 0.5% of NHS spend, and are smaller than the unintentional yearly overspend of Trusts. Our banding supplements therefore, are clearly an order of magnitude too small to possibly be a threat to a 7 day elective service. So whats this about? Johann Malawana, chair of the BMA Junior Doctors’ Committee, is right – this about attacking us first, and then moving on to other staff. Keep Our NHS Public colleagues are right – this is about undermining staff and public confidence in the NHS so that it is ripe for further privatisation. Lets not let this happen. Please support junior doctors and the NHS today.