With junior doctors dominating the news, Impact Features tries to give you the key facts about the current debate between the medics and the government.
The reasons for the recent junior doctors’ strikes are many and complex, but they fundamentally stem from Health Secretary Jeremy Hunt’s plan to make a ‘Seven Day NHS’. Already this phraseology causes issues, as the NHS is in fact operational seven days a week, 365 days a year. As Jeremy Hunt has been elusive about what this ‘Seven Day NHS’ might entail, doctors have speculated that perhaps this means that routine services and surgery and scans for problems that are not urgent will take place over the weekend – currently, such routine tasks are only practiced on weekdays. Emergency work on weekends already happens.
“The idea of a ‘Seven Day NHS’ is based on research which supposedly suggests that more people die in hospital over the weekends”
Whilst this appears to be positive on the surface, the truth is that the same number of doctors will be working over seven days, rather than five, which will lead to a detrimental, rather than a positive, effect on waiting lists and, more crucially, doctors’ abilities to perform.
Furthermore, the idea of a ‘Seven Day NHS’ is based on research which supposedly suggests that more people die in hospital over the weekends. However, NHS doctors have disputed this – if there are proportionally more deaths on the weekend, this is due to the fact that most people admitted into surgery on weekends are urgent cases, while people with non-serious conditions who are also admitted on weekdays are more likely to survive. However, doctors are even sceptical about this – the authors of the research paper which led to belief in this so-called ‘weekend effect’ have pointed out that their statistics have been misrepresented, and that risk of dying within 30 days of admission is actually higher if patients are admitted midweek than on the weekends. Indeed, recently an anonymous doctor publicly declared on BBC television that “11,000 more people do not die on the weekend”, pointing out that these stats also cover Friday and Monday – as well as declaring that the most amount of deaths in hospital happen on a Wednesday.
Even if this ‘weekend effect’ was real, the truth is by making doctors – indeed, the same amount of doctors – work longer hours, these doctors will grow tired, and fatigue in surgery inevitably leads to higher fatality rates. While some aspects of the mainstream media try to present junior doctors as greedy, many stand by the fact that they are striking on the grounds of safety and the health of patients, as well as doctors. Having said that, junior doctors are also facing a decrease in pay – though before we get on to that, we must point out that under Hunt’s new contract, the safeguards which currently exist that place a cap on the amount of hours junior doctors can work in a single shift will be taken away, leading to junior doctors potentially being made to work unbearably long hours.
Monetarily, the contract promises a 13% higher flat rate for junior doctors’ pay. However, the contract also proposes that 7am-5pm on a Saturday will become ‘normal’ hours, while currently these weekend hours – and any time before 7am or after 7pm on weekdays – are considered ‘unsociable hours’. Currently, doctors can earn between 20-100% more pay for working these ‘unsociable hours’ or if they work more than 40 hours a week. While, under the new contract, the government offers doctors 1.5x times the pay for night shifts and 1.3x the pay for Saturday evenings and Sundays, with the fact that ten extra hours on the weekend are now being considered ‘normal’ hours, some have calculated that under the new contract junior doctors may realistically face up to a 30% reduction in overall pay – junior doctors are expected to work more and be paid less. It should be noted that the government has promised that doctors won’t be allowed to work more than 72 hours over any seven day period or more than four consecutive night shifts however, though doctors believe this is simply not enough compared to the current safeguards and banding system of pay which the government wants to scrap, which makes it more difficult for junior doctors to achieve pay rises.
“The ‘Tired Doctors Make Mistakes’ campaign has shown that doctors are also concerned about their patients’ safety”
Doctors have complained that, given the amount of years they spend in training (leading to at least £45,000 of tuition fees) and the hours they are already expected to work, the new contract is quite simply unfair. However, one would be mistaken to believe that this is all about money – the ‘Tired Doctors Make Mistakes’ campaign has shown that doctors are also concerned about their patients’ safety.
According to the Independent, over 125,000 procedures – including operations – had to be cancelled in the latest wave of junior doctors’ strikes. This has obvious health implementations for those in need of medical care – but then again, so do tired doctors.
Embedded image: Presidencia de la Republica Mexicana via Flickr. Featured image: Jeff Eaton via Flickr