Doctors Staffing
box choccies
Time to revisit that pledge, otherwise patient safety becomes a

“Life is like a box of chocolates” is an old proverb. It famously appeared in the 1994 film Forrest Gump, when the lead character Forrest Gump says “Mama always said life was like a box of chocolates. You never know what you’re gonna get.”

It is well known that the Conservative Party expected to be in a coalition, if the Party won. The logic was that all the different manifesto pledges would become negotiated away in arduous post-election negotiations. Unexpectedly, due to the incredible campaigning skills of Sir Lynton Crosby and/or a fear of a Ed Miliband and SNP government, the Conservatives won with a majority government.

The precise manifesto pledge is as follows.

pledgeBut note the precise drafting of this pledge: “with hospitals properly staffed“.

It has long been argued that the term ‘7 day services’ has never been defined. Indeed, the reasonable expectation would be to have all the ancillary services present at the weekend ranging from radiographers to do imaging investigations to secretaries to keep up with the discharge letters.

Junior doctors have a primary duty to promote patient safety, and to let the regulator know if resources are inadequate for delivery of patient safety. The regulator currently is the General Medical Council (“GMC”).

The regulatory clause underpinning this is s.1(1A) Medical Act (1983), reproduced here for ease of reference.

MA 1983

But this clause acts in concert with the regulatory code of conduct from the GMC, called “Duties of a Doctor”.

See in particular clauses 24 and 25:


But like a box of chocolates, Jeremy Hunt appears rather to have adopted an approach which can best be described as “pick ‘n’ mix”.

For example, the Secretary of State for Health is well known about his selective use of the evidence. Dr Peter Holt was one of the co-authors of that famous paper referred to as the “Freemantle paper”.

The Independent writes as follows.

“A doctor who was part of a study on links between staffing and deaths in the NHS has accused the Government of “continually misrepresenting” the findings to support its push to change junior contracts.

Dr Peter Holt, a vascular surgeon at St George’s University of London, said he had written to Jeremy Hunt, the Health Select Committee and shadow Health Secretary Heidi Alexander raising his objection.

In a post on the Junior Doctors contract forum Facebook group, he wrote that the research published in December “could never have shown that higher staffing on weekends reduced mortality”.

Leading #juniordoctors campaigners have tried to remedy this ‘knowledge gap’.


Yesterday, Dr Johann Malawana (Chair of the JDC for the BMA) concluded with the following paragraph in a Facebook group.

Johann MalawanaAnd surely that’s the point. David Cameron has always boasted that the buck stops with him, and he is doing ‘what’s right’. It is time for Cameron, not Hunt, to explain what exactly this pledge means, and how a full 7-day service was ever going to be budgeted for. It is clear, whatever, that for the pledge literally to have been fulfilled there was actually a requirement to train more #juniordoctors or Consultants, unless compelled to observe austerity even with the economy recovering, aka “the Nicholson efficiency savings”. After all, #juniordoctors, powerful though they are, were never responsible for the financial crash on Wall Street.

Otherwise, it very much is a #Cams7daysscam.

First published on the Socialist Health and Wellbeing Society blog