Junior doctors and the fight for the NHS

https://www.theguardian.com/society/2016/jul/06/junior-doctors-and-the-fight-for-the-nhs

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The pretence that this contract will enable seven-day working undermines trust as “junior doctors” already provide emergency care every day and without more doctors or increasing working hours this cannot be achieved (Junior doctors reject government’s final offer to settle contract dispute, 6 July). In addition doctors know that unless ancillary services and extra staff from porters to nurses and radiographers and lab technicians are employed a truly effective elective service will not happen. The contract envisages a new and untried system to prevent doctors working excessive hours with these “guardians” being appointed this month. The proposed workload for these new posts appears onerous and may be unworkable.

Lastly, there are two legal challenges in the pipeline questioning the legality of imposing the contract and the discrimination against women (which the Department of Health considered was a proportionate price to pay for the legitimate aim of a seven-day service). Dr Johann Malawana, chair of the BMA’s junior doctors committee, worked hard against the intransigent Jeremy Hunt but as his advice was rejected he resigned on Tuesday. I hope the new team can negotiate with renewed energy as the contract is not right. Professor Wendy Savage President, Keep Our NHS Public

• The no vote to the junior doctor contract is symptomatic of a medical workforce exhausted by having to bear the brunt of ill-thought-out, top-down reform imposed by government. Most doctors would agree with the government that acute services do not work perfectly at weekends – but themselves work tooth and nail to keep them running and would gladly engage in a constructive process to improve them. Instead they find themselves the victims of ham-fisted reforms that penalise those who give up large parts of their lives to keep the NHS afloat without any evidence of delivering improvements for patients.

It is frustrating to be on the frontline of the NHS workforce, seeing what needs to be done but being unable to do it. The attitude of successive health ministers has widened the gap between doctors, nurses and other health professionals and the Department of Health at the precise time they should be engaging with, embracing and supporting the people who can make a real difference.Dr Will WatsonSpecialist registrar in cardiology, Addenbrookes Hospital, Cambridge

• Jeremy Hunt claims that the junior doctors’ vote against their new contract is undemocratic. 58% voted against the deal, only 42% voted for it, turnout was 68%. Ah democracy – one week one thing, the next week completely different! Rachel EdwardsKidwelly, Carmarthenshire

• Vera Koenig (Letters, 5 July) highlights the ill fortune that befell many of the survivors of the Great War. The “homes for heroes” never materialised; medical help for those damaged physically and mentally by war was left to charitable provision. These people went on to suffer further as the depression and another world war wrought greater havoc. The pain and hardship suffered by Vera Koenig’s father and uncles, and millions like them, was remembered in May 1945. Their treatment after the Great War was recalled by many of those voting for a Labour government and the birth of Beveridge’s welfare state. We need to do our utmost to prevent politicians (from all parts of the political spectrum) stealing this great undertaking from us. Baby boomers, unlike Vera’s mother, have never had to ask: “Can we afford the doctor?” My mother, aged 14 when the NHS came into being, thought this question had been killed at that very moment. She did not expect to see it return in her lifetime. For Vera Koenig’s father and millions like him, the NHS is their living memorial. It should not become a corporate revenue stream.Steve ElliotLondon

• Allyson Pollock’s opinion piece presents an unrepresentative picture of the role independent hospitals play in the NHS (This deadly debt spiral was meant to destroy the NHS. There is a way to stop it, 5 July).

Independent hospitals are a vital support to the NHS at a time of huge demand and financial pressure. They provide additional capacity at a tariff set by the NHS which helps to reduce waiting times. Care delivered through private medical insurance also helps moderate demand for NHS services.

Despite the government’s frontloaded funding settlement over the course of this parliament, the NHS provider deficit is predicted to reach £550m by the end of 2016-17. Without the income generated through private patient units in NHS trusts this would undoubtedly be greater.

Strengthening partnership between the NHS and independent hospitals provides patients with a choice over their care while ensuring it remains free at the point of use. By drawing on the expertise and capacity from a diverse range of providers, the NHS is able to benefit from innovative treatments and new ways of working. This is the way to meet Britain’s growing healthcare needs.

We need to put more momentum behind this partnership, not put it into reverse. Fiona BoothChief executive, Association of Independent Healthcare Organisations

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