Two weeks ago at Hinchingbrooke
Hospital we witnessed the
incredibly sad sight of junior
doctors driven to the extremes
of taking industrial action in
their ongoing battle against the
imposition of an employment
contract which is unsafe and unfair.
Both the Government and the
doctors support the aspiration of
world class healthcare services.
The soundbite of a ‘seven-day NHS’
is a worthy ambition. The United
Kingdom already has a world class
‘seven-day NHS’ emergency service
but if we also want to electively
access all hospital care at weekends
we are going to need more staff.
We can all agree on the aspiration
of a ‘seven-day service’ but not at
any cost and not without a clear
explanation of what is required.
To be very clear – junior doctors are
not asking for more money, but for
a better, safer NHS.
Inevitably to achieve this ambition
the Government needs to invest in
increasing staffing numbers at all
levels and all occupations to cover
the massive increase in workload
and patient expectation.
A key tenant of imposition is ‘cost
neutrality’ to the UK taxpayer.
With no more money accessible to
employ more staff, those already
employed will inevitably be
distributed over the seven days
Staffing on wards during the week
will fall in order to redistribute to
the weekends. The NHS could end
up being less safe for patients, not
Hospitals already have significant
issues with vacancies in multiple
areas. Staff in these departments
already work well above their
contracted hours. Before embarking
on this jump into the unknown,
there needs to be reassurance
to all staff that excessive hours,
mistreatment and bullying will
be prevented. Put very simply,
exhausted NHS staff make mistakes
that can harm and kill patients.
The new junior doctors’ contract
changes the current safeguards to a
new system which is neither robust
or practical in its proposed form.
A variation in the number of
deaths in hospitals during the
week is well recognized across the
western world. It is not specific
to the UK and most importantly
no paper has ever been able to
say exactly why.
Jeremy Hunt has
been accused of the deliberate
manipulation of data and statistics
to describe an unusually prolonged
‘weekend effect’ stretching over a
predetermined 96-hour time frame
of Friday to Monday.
Counterintuitively in the very same paper
the highest mortality admission
rates over a single 24 hours were
reported in the middle of the week
on a Tuesday. As ever, it is clear
that statistics used in isolation can
be manipulated to prove arguments
on both sides. It is possible that
with safer staffing levels there
would be a reduction in avoidable
deaths. However, to reinforce the
point this can only be achieved with
more staff and not by distributing
current staff the more sparsely.
Doctors are guided by the General
Medical Council Rules of Good
Practice. There is an absolute duty
to protect patients and to speak out
if they believe care is not safe. It is
clear to me that the new contract
for junior doctors will make the
NHS less safe for patients, which
is why I like so many of my fellow
consultants and GPs are supporting
The continued march towards
imposition means that junior
doctors now believe that the
only option is further escalation
of industrial action and the
withdrawal of emergency cover.
Please be reassured that senior
doctors will not be sitting back in
this unprecedented development.
24/7 emergency cover will remain
in all hospitals and GP surgeries
across the country be it with some
slightly older, very experienced
doctors as the first point of
contact. The elective work will
In summary, there is a direct
conflict between a doctor’s
professional duty not to harm
patients balanced against the
detrimental effects of contract
imposition which will do greater
harm to huge patient numbers in
the long run .
A new junior doctors’ contract,
is not being introduced in Wales,
Scotland and Northern Ireland.
Why risk prolonged industrial
action and huge disaffection within
the medical workforce? The UK
risks a whole generation of doctors
deciding that a continued career in
medicine is not for them.
Collaborative working is required
not confrontation. Imposition
was an unnecessary first shot in
an escalating stand-off between
junior doctors and the Government.
We have a compassionate and
articulate junior doctor workforce
who are willing and capable of
playing their part in the survival,
development and growth of a
modern seven-day NHS
I remain hopeful that a solution
can still be found using the guiding
principles of sound evidence
and sensible funding whilst
maintaining an unswerving focus
on achieving the very highest
quality care at all times.
I have recently met our local
Conservative MP, Mr Jonathan
Djanogly, in a combined role
of a concerned member of his
constituency whilst also acting on
behalf of the local Labour Party.
He listened and promised he would
speak directly to representatives of
the Department of Health, ideally
Mr Hunt, to articulate the above
concerns. I am awaiting feedback
from that meeting.
I am hoping that my own
representations will not have
fallen on unsympathetic ears and
further industrial action can still
be avoided. We all need to stand
shoulder to shoulder with our
junior doctor colleagues to ensure
the long term future of our NHS
both local and nationally.
DR NIK JOHNSON
Consultant at Hinchingbrooke
Hospital /Vice-Chair of Huntingdon