Is the health secretary deliberately pushing the NHS to breaking point?
Yesterday’s announcement that doctors would be forced to work weekends under plans for a ‘seven-day NHS’ ignited furious debate.
Directly associating the 6,000 extra hospital deaths recorded during weekends with consultants’ working hours, Jeremy Hunt ‘went to war‘ with the British Medical Association, who responded with claims that the speech amounted to a ‘wholesale attack on doctors‘.
Of course, it’s easy to sympathise with Hunt’s concerns regarding hospital weekend services. But this is no ordinary union dispute over pay and working conditions. Closer inspection of the health secretary’s plans reveal an alarming tactic of style over substance, and a thirst for confrontational ‘reforms’ rather than any measured policy.
Consider Hunt’s justification for these reforms. His claim that ‘you are 15 per cent more likely to die if you are admitted on a Sunday compared to a Wednesday’ is one that he has cited on numerous occasions. The argument is clear; that higher death rates at weekends are a result of care that is substandard when compared to weekdays.
Yet this haphazard conclusion is far from definitive. It is entirely plausible, for instance, that these statistical discrepancies arise from weekend admitted patients being more likely to present with a severe health complaint, since patients with more moderate symptoms are likely to be admitted during the week, after visiting their GP first.
Hence, it is possible that patients admitted on a weekday will generally be healthier and so fare better regardless of the treatment they receive in hospital. This explanation was even noted as a possibility in the journal which Hunt derives his statistics from.
Likewise, the study found that when analysing the total number of hospital admissions, patients were safer on weekend days compared to the midweek days of their stay, which raises further doubts over Hunt’s use of statistics.
Even more doubt is cast if we consider death rates for each individual day of the week, rather than as a crude comparison between Wednesday and Sunday. The rise in death rates from Friday to the weekend is in fact smaller than the rise in death rates from Monday to Friday.
Although the exact reason for this is unclear, a survey revealing that 38 per cent of hospital consultants view their workload as unmanageable and 41 per cent feel at risk of ‘burnout’ does suggest that fatigue may harm patient safety just as much as weekend service provision.
Despite this, the health secretary has announced plans to futher stretch the NHS rather than committing to investment in its current services.
Indeed it is this desire, to legislate for increased service provision at a time of NHS crisis, which worries so many healthcare workers. The British Medical Association actually supports the concept of a seven-day NHS, and has done since 2013, but they oppose this week’s announcement because they know that such an aim is not achievable without the necessary funding.
By Hunt’s own admission his plans involve no increase in the total number of doctors nor any increase to ‘the total number of hours worked every week by any individual doctor’. It’s a simple question of mathematics; under these proposals, every extra hour a consultant works on a weekend will be an hour less worked on a weekday.
In a year which has seen waiting times at their worst levels since targets were introduced, those working in the health service know that such a plan is inconceivable; the NHS simply cannot afford to lose staff from its core services.
Other areas of Hunt’s seven-day NHS plans are equally counter-intuitive. For instance, the proposed changes to doctors’ contracts will apply to all consultants, regardless of their speciality. Quite how forcing consultants who perform routine podiatry operations to work weekends will improve the death rates he so often cites is a source of much bemusement.
Likewise, the fact that his announcement made no mention of the other hospital staff required for a successful seven-day NHS – such as nurses, radiographers, theatre managers and admin staff – serves only to further reinforce the notion that Hunt doesn’t understand modern healthcare.
Just as in 2012, when the government ignored almost unanimous opposition from medical professionals while implementing its NHS reforms, you have to question the motivations behind the Conservative Party’s health policy. Optimists might blame ignorance for these confused and confrontational announcements.
Cynics might argue that these policies are designed to purposefully overstretch the NHS in order to pave the way for future reforms (interestingly Hunt refused to rule out the introduction of patient charges in yesterday’s speech).
However, one thing is certain. For as long as the health secretary is able to shift the blame for death rates and missed targets away from a crippling funding crisis and onto a dispute about doctors’ working hours, the NHS faces a bleak future.
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