NHS War: Where the Winning Side Deserts

UK Health Secretary Jeremy Hunt addressed parliament February 11 with a speech outlining the negotiations on the Junior Doctors’ contract, an ongoing debate which has defined parliamentary politics during the first months of 2016. In his speech, Hunt tried to put to rest claims of severe pay cuts, overstretched doctors and the resulting increased danger to patients; these fears were sparked by an analysis of the contract by the British Medical Association (BMA). The contract, which Hunt has linked directly to the future implementation of a 7-day NHS, was presented by the government as a ‘reasonable’ demand in the quest for a healthier NHS.

Image courtesy of Ted Eytan © 2013, some rights reserved.
Image courtesy of Ted Eytan © 2013, some rights reserved.

The response of Heidi Alexander, Labour MP for Lewisham, was nothing short of scathing. She not only highlighted the over-simplification of Hunt’s linking of the contract to the future 7-day NHS, but outlined the grievances of junior doctors which had been utterly ignored by the Health Secretary during negotiations. By underlining the absurdity of said proposals, which included an effective pay cut for current junior doctors by roughly 26 per cent, the obvious flaws were finally revealed to both parliament and the public. Yet in spite of this revelation, the forced imposition of the contract is due to take place later this year, despite the agreement of the BMA to only 90 per cent of the proposals involved.

Is it any wonder then that an overwhelming majority of the 37,700 junior doctors balloted about the industrial action voted in favour of striking both in 2015 and early this year? These strikes, held in November 2015, along with 3 strikes within the first 2 months of this year have been damaging, but not enough to shift the government’s position. Despite a call for full labour withdrawal from medical unions on 10 February, Hunt refuses to budge when it comes to this new contract, the imposition of which is officially opposed by the Royal College of Surgeons, the Royal College of Obstetricians and Gynaecologists and the Royal College of Paediatrics and Child Health.

Given Mr Hunt’s attitude towards the NHS, it will come as no surprise that under the current Health Secretary, the financial status of the NHS is quite frankly anything but satisfactory. Figures in the Independent for the financial year 2014-15 show that the deficit in NHS funding by region for the UK is vast, with acute trusts in regions such as East Anglia racking up £96.3 million in debt and the capital, London, sitting £110.8 million in the red. In fact, according to these figures, only 5 of the 25 regions surveyed showed that the acute trusts holding NHS finances did not exceed their budgets.

With this uncompromising governmental line towards the junior doctors’ contract and the crumbling financial infrastructure of the NHS, it is the effect on recruitment and retention of medical professionals which now begins to worry parliamentary opposition. Quoting a poll conducted earlier this month, Ms Alexander reported that no less than 90 per cent of junior doctors would be prepared to leave the NHS if [such] a contract were imposed. ‘How can it possibly be right’ she continued ‘for us to be training junior doctors and the consultants of tomorrow, only to export them en masse to the southern hemisphere?’

Indeed, it is this supposed mass exodus of junior medical staff to countries such as Australia, where their qualifications are officially recognised, which seems to have become an ever-increasing and worryingly overlooked phenomenon. Long before the imposition of the junior doctor’s contract was raised in Parliament, reports of over 5,000 doctors applying to leave the UK in the summer of 2014 were practically disregarded in policy making circles. Dr Krishna Kasaraneni, chair of the GPC’s training committee, confirmed in 2014 that GPs of all ages and levels of experience are being lost to the healthcare systems of foreign countries. ‘I don’t blame any of my colleagues for wanting to leave,’ he added, ‘the workload in general practice is getting more and more every day without the resources to try and cope with it. It’s about self-preservation.’ In 2011, the UK provided Australia with 13 per cent of its GPs and 22 per cent of its specialists, where GPs can expect to be paid on average between 10 per cent and 50 per cent more than the standard NHS salary.

In the absence of any official data, the issued number of Certificates of General Standing (CGS), which permit doctors to practise medicine outside of the UK, stands as the most reliable indicator of how many doctors are considering leaving the country. This figure has increased dramatically from 3,913 issued in 2009 to 4,741 in 2014, and in the 10 days after the Hunt contract was confirmed, 3,468 requests for a CGS were made, in comparison to the normal 20 to 25 requests a day. a a 50 per centrage between 10 per cent sis was constructed/prioritized – role o (not rational)reeloaderse bit.?f agriculture taDespite the relatively low number of CGSs held by current medical professionals, the imposition of the junior doctor’s contract could, according to the BMA and associated unions ‘become war’—a war in which the winning side deserts.

Is this supposed mass exodus a real threat to the health of the NHS any more so than the industrial action which has already taken place? It cannot be denied that the loss of numerous medical professionals just as the government attempts to implement a 7-day NHS can result in nothing but overstretched, overworked and underpaid staff, whose exhaustion would both reduce efficiency and increase possible danger to patients. In fact, a review published in November found the UK would need 26,500 more doctors and 47,700 nurses to match the OECD average – how can Hunt expect to retain this figure whilst imposing a contract the junior doctors oppose?

In short, and in the words of Heidi Alexander, Jeremy Hunt ‘needs to stop behaving like a recruiting agent for Australian hospitals, and start acting like the Secretary of State for our NHS.’

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