From seven-day NHS to junior doctors, the Health Secretary is trampling over patient safety
The government’s capacity to deliver a seven day NHS has been questioned extensively. Up until now, those concerns have largely fallen on deaf ears.
But this week’s leaked Department of Health document, in which civil servants set out their own worries about the project’s sustainability, should surely now be enough for Jeremy Hunt to sit up and take notice.
The document, obtained by the Guardian and Channel Four News, is a difficult one for the Secretary of State to simply bat away. Contained within it are thirteen major risks identified by civil servants which could jeopardise the smooth and effective delivery of seven day care.
Mandarin’s concerns range from the possibility that the seven day service will not be launched on time to the prospect that patients may not notice a difference in their services.
But most notably, at the heart of the document, are concerns about the very real possibility of workforce overload. And it is that very issue that clinicians, unions, and many others have been warning Mr Hunt about all along.
Few people would dispute the appeal of a seven day health service. Long before the policy passed the lips of the Health Secretary, there was no shortage of advocates for extended hours and better weekend care.
Horror stories about clinical errors during weekend hours were underpinned by increased concerns about the ‘weekend effect’ – a reference to the disproportionate mortality rate in hospitals at the weekend.
Meanwhile, with General Practice acting as the primary point of access for the majority of NHS patients, insufficient access to primary care has also resulted in calls for seven day services.
Last November, the National Audit Office reported that a fifth of patients said their GP opening hours were not convenient, and one might assume that many more would welcome the prospect of weekend appointments.
It’s clear that the problem is not with the idea of a seven day service; the problem rests with the Health Secretary’s failure to provide a comprehensive, deliverable strategy for its implementation.
The crux of this failure is Jeremy Hunt’s unwillingness to acknowledge that adding more duties to an already over-burdened workforce, without making it clear how this would be resourced, was never going to result in better care for patients.
Junior doctors had their integrity questioned by some following their decision to strike – albeit for the first time in forty years – over the Health Secretary’s imposition of a new contract.
But this wasn’t solely about receiving a real terms pay cut brought about by the demand for doctors to work more weekend shifts for less pay.
Doctors with knowledge of frontline pressures were clear in their indignation that overtired, overstretched clinicians would only result in poor treatment for patients. After reading this leaked report, they must now feel vindicated.
It’s not just those in secondary care that have concerns about overstretching under-resourced services. As a practising GP, my response last year to the Health Secretary’s pledge to deliver out-of-hours GP services was this:
‘We would all welcome round the clock GP services, but this isn’t deliverable unless it’s matched by the funding necessary to recruit, support and retain hardworking GPs.’
I wasn’t a lone voice among colleagues when I voiced these concerns. 34 per cent of GPs are set to retire by 2020 and many more want to work part-time, practice abroad, or leave the profession altogether.
And it’s not hard to see why. To keep up with the increase in demand alone, the Royal College of GPs estimates the need for 8,000 new GPs, far more than the 5,000 the Health Secretary promises to deliver by 2020.
In London, primary care is already overstretched. For each full-time equivalent GP in Camden there are 1,241 patients. This is the low end of the scale. In Hounslow, the GP to patient ratio is 1:2,067.
Few would dispute that it makes little sense to ask already over-burdened services such as these to deliver seven-days-a-week care, without the appropriate funding to match. But this is a message to which Mr Hunt has thus far been resistant.
Many will question why the Health Secretary has been so ham-fisted in his approach to moving to seven day care. Even those on the government’s backbenches have expressed their concerns, with Dr Dan Poulter MP and Dr Sarah Wollaston MP publicly critiquing the government’s proposals.
It seems Jeremy Hunt has fallen victim to the age old mistake of rushing out an electoral pledge without a solid blueprint for delivery. When you push a policy for the sake of a headline, you’re taking a massive gamble.
But in this instance, it’s not just the Health Secretary’s reputation that’s a stake; it’s the wellbeing of an entire workforce and, most importantly, the health of a nation.
It’s time Jeremy Hunt listened to his civil servants and went back to the drawing board.
Dr Onkar Sahota is Labour’s London Assembly Health spokesperson and a practicing GP in West London. Follow him on Twitter @DrOnkarSahota
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