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The Guardian view on the junior doctors’ dispute: diktats and discord in the National Hunt Service The Guardian view on the junior doctors’ dispute: diktats and discord in the National Hunt Service
(35 minutes later)
The brute imposition of a new contract on junior doctors by Jeremy Hunt is a reminder of everything that hasn’t changed in the NHS, as much as everything that has. For a generation, health secretaries have talked of holding back the interfering hand of Whitehall; of diffusion and choice, in place of command and control; and, of setting the institutions of healthcare on independent foundations, where they no longer dance to central diktats, but instead operate with a quiet hum of self-improvement. And yet here we are in 2016 – long after foundation trusts gained the right to hire on their own terms – with the secretary of state as the great protagonist in a furious row about the smallprint of overtime rules. The brute imposition of a new contract on junior doctors by Jeremy Hunt is a reminder of everything that hasn’t changed in the NHS, as much as everything that has. For a generation, health secretaries have talked of holding back the interfering hand of Whitehall; of diffusion and choice, in place of command and control; and, of setting the institutions of healthcare on independent foundations, where they no longer dance to central diktats, but instead operate with a quiet hum of self-improvement. And yet here we are in 2016 – long after foundation trusts gained the right to hire on their own terms – with the secretary of state as the great protagonist in a furious row about the smallprint of overtime rules.
Forget Andrew Lansley’s delusional promise of his reforms taking the politics out of healthcare. With the hands-on Mr Hunt, we are back in Aneurin Bevan’s world in one sense at least: dropped bedpans in hospital corridors will again reverberate around Whitehall. A health secretary, first brought in – don’t forget – to smooth things over after the chaos of the Lansley upheavals, is taking very personal ownership of myriad and fast-multiplying problems of the NHS. Telltale indicators, which often defied alarmist predictions over the coalition years, are now flashing red. Only today a new bundle of figures indicated a near-record number of misses on A&E waits and transfers of care and, most ominously, the first ever fail on the iconic commitment to get patients treated within 18 weeks of the GP referring them on. The root cause of these problems is not Mr Hunt’s abrasive approach to haggling, nor even Mr Lansley’s reforms, but rather the mismatch between the growing weight of demand from an ageing population and a squeezed supply of funding. After declining to blink in the face of the British Medical Association’s final ultimatum – the established custom of health secretaries since the 1940s – Mr Hunt now has to navigate a way through these formidable difficulties in a mood, not of consultative professionalism, but industrial antagonism. Forget Andrew Lansley’s delusional promise of his reforms taking the politics out of healthcare. With the hands-on Mr Hunt, we are back in Aneurin Bevan’s world in one sense at least: dropped bedpans in hospital corridors will again reverberate around Whitehall. A health secretary, first brought in – don’t forget – to smooth things over after the chaos of the Lansley upheavals, is taking very personal ownership of myriad and fast-multiplying problems of the NHS. Telltale indicators, which often defied alarmist predictions over the coalition years, are now flashing red. Only today a new bundle of figures indicated a near-record number of misses on A&E waits and transfers of care and, most ominously, the first ever fail on the iconic commitment to get patients treated within 18 weeks of the GP referring them on. The root cause of these problems is not Mr Hunt’s abrasive approach to haggling, nor even Mr Lansley’s reforms, but rather the mismatch between the growing weight of demand from an ageing population and a squeezed supply of funding. After declining to blink in the face of the British Medical Association’s final ultimatum – the established custom of health secretaries since the 1940s – Mr Hunt now has to navigate a way through these formidable difficulties in a mood, not of consultative professionalism, but industrial antagonism.
The consequences could be serious, and not only for that minority of already-overworked junior doctors who will be severely hit by a new contract, which has good features as well as bad. No, there will be important effects on patients, too, if Mr Hunt’s dictation betrays a new willingness to tell medics how it’s going to be. The BMA has historically often been wrong, and has on occasion been decidedly overindulged. Some may say it is high time it was treated as just another trade union. It is, however, rash not to respect a profession whose dedication in going the extra, non-contractual mile, is something on which the NHS heavily relies. The lure of cushier terms overseas is already contributing to a collapse in applications to first specialist posts, and the forced settlement will do nothing to reverse that. Recent efforts to bridge the old divide between medicine and NHS management have come to little: few GPs have grabbed the purse strings with the enthusiasm Mr Lansley had hoped for, consultants are as disengaged as ever, and there are only a handful of chief execs with any medical training. Industrial strife could sear an even deeper chasm between the two worlds. Given the doctors’ continuing advantages in status, public affection and expert knowledge, one would not want to bet against them coming out on top.The consequences could be serious, and not only for that minority of already-overworked junior doctors who will be severely hit by a new contract, which has good features as well as bad. No, there will be important effects on patients, too, if Mr Hunt’s dictation betrays a new willingness to tell medics how it’s going to be. The BMA has historically often been wrong, and has on occasion been decidedly overindulged. Some may say it is high time it was treated as just another trade union. It is, however, rash not to respect a profession whose dedication in going the extra, non-contractual mile, is something on which the NHS heavily relies. The lure of cushier terms overseas is already contributing to a collapse in applications to first specialist posts, and the forced settlement will do nothing to reverse that. Recent efforts to bridge the old divide between medicine and NHS management have come to little: few GPs have grabbed the purse strings with the enthusiasm Mr Lansley had hoped for, consultants are as disengaged as ever, and there are only a handful of chief execs with any medical training. Industrial strife could sear an even deeper chasm between the two worlds. Given the doctors’ continuing advantages in status, public affection and expert knowledge, one would not want to bet against them coming out on top.
The big question, then, is why Mr Hunt has been tempted into this provocative show of strength. He holds up his perfectly proper ambition for better weekend hospital care, but it is hard to feel entirely convinced that this is the only motive. Yes, the out-of-hours service need to get better in all sorts of ways; yes, manifesto commitments are involved. It is entirely plausible that he found the BMA’s intransigence on the Saturday rotas infuriating. But if the only concern were a “7-day NHS”, would he really go to war on this point? There are, after all, already NHS institutions which operate very well at the weekend, from which much could be learnt. Even in those which are not good enough, the bottleneck is more often diagnostics and ancillary staff than junior doctors – who have been raised to such fury precisely because they already work so many weekends.The big question, then, is why Mr Hunt has been tempted into this provocative show of strength. He holds up his perfectly proper ambition for better weekend hospital care, but it is hard to feel entirely convinced that this is the only motive. Yes, the out-of-hours service need to get better in all sorts of ways; yes, manifesto commitments are involved. It is entirely plausible that he found the BMA’s intransigence on the Saturday rotas infuriating. But if the only concern were a “7-day NHS”, would he really go to war on this point? There are, after all, already NHS institutions which operate very well at the weekend, from which much could be learnt. Even in those which are not good enough, the bottleneck is more often diagnostics and ancillary staff than junior doctors – who have been raised to such fury precisely because they already work so many weekends.
Indeed, when many things already happen on a Sunday and many others never will, the whole 7-day slogan is overblown. The cynical reading would be that Mr Hunt has concluded that such are the pressures on the NHS that a political row has become inevitable. He may prefer, however, that this is not about the whimper of declining performance and stretched budgets, and instead about the thwarted big bang of his reforming ambitions.Indeed, when many things already happen on a Sunday and many others never will, the whole 7-day slogan is overblown. The cynical reading would be that Mr Hunt has concluded that such are the pressures on the NHS that a political row has become inevitable. He may prefer, however, that this is not about the whimper of declining performance and stretched budgets, and instead about the thwarted big bang of his reforming ambitions.