Devil’s Advocate: Are Jeremy Hunt’s proposed reforms to the NHS fair?

0

YES

In July of last year, three years after becoming Heath Secretary, Jeremy Hunt proposed that doctors would no longer be able to choose not to work at the weekend for non-emergency cases. Two months later this was followed by him announcing longer working hours including Saturday with a basic pay increase. This proposition seems rational, logical and allows people to get better access to the healthcare they need when they need it.

The time in which we live is fastpaced, dynamic and never stands still. There is constant access to information and worldwide communication is instantaneous. And in a world with an incessant lifestyle, we need a healthcare system to match. Hunt claims that having a 7 day 24 hour health service will reduce deaths at the weekend. Official figures by the NHS grimly support his affirmation, and data released in 2015 showed that mortality rates at the weekend can be up to 16% higher than during the week. This exorbitant percentage increase should not exist at all, as levels of care should be consistent and high throughout the week. In an environment such as a hospital, where the sole goal is to save lives, it is imperative that the quality of treatment is of a regular, fixed and high standard.

The people who go into fields of work which require direct and intense care are well aware of the demanding and erratic nature of the occupation, and when it comes down to it, a doctor’s job is ultimately a matter of somebody’s life or death. Nobody can choose when they become ill; obviously given the choice, we would choose perfect health at all times. But illness is something that we cannot control; it can be unexpected, suddenly changing and unpredictable. But the most important thing is that illnesses and sicknesses do not switch off at 4:59pm on a Friday, therefore it is fair to say that Doctors shouldn’t either. By the following Monday, a seemingly minor affliction could have escalated enormously, into something potentially life threatening. Even with an NHS walk in centre or NHS 111, nothing compares to seeing a doctor to get your symptoms diagnosed in a professional environment. Hunt directly stated that the “Monday to Friday” culture which is apparent in many jobs cannot exist with healthcare, as it is on an entirely different level to other jobs. Real lives are involved, in real time, and these demands must be met even if it requires anti-social hours. With certain jobs, it is not in their nature for them to be 9 to 5, followed by a commute home before another virtually identical working day tomorrow, and working in the healthcare profession is one such example. It is a job involved with people in need, and it is impossible to tell when their services may be required.

They are, as Hunt himself described them, ‘vocations’ rather than jobs. They are not something which can be left on the desk of a darkened office to be looked at another day. Doctors deal with real people who have all manner of problems which need attending to, often at inconvenient times. It is a matter of healthcare, and this cannot stop or become less available for two days out of the seven in a week. We already see the consequence of this with the weekend 16% hike in mortality rates. Although hospital A&E units are open at weekends, the levels of staffing are much lower, but it is of the utmost importance to provide an adequate level of healthcare for people whenever they have need it. Whether this is on a weekday or at the weekend, should make no difference to healthcare quality. With something like ill health, the initial hours are the most vital. As there is such a fine line between a mild and serious illness, there is no question of there being doctors available over the weekend. A breakdown of the proposal shows that it is not unreasonable in any way, and Hunt even went as far as to say that not every GP surgery would have to be open at weekends, but rather just enough to provide an adequate level of care. It is unfair and illogical for the standard of care to be better on some days rather than others, as no one knows when their own illness will strike. It is almost unthinkable that, given that such a large number of deaths could be prevented by having a 7 day NHS, this proposal has not been put forward before now. Jeremy Hunt’s intentions of having GP surgeries open at the weekends to ensure healthcare quality is as high as during the week seems like the obvious and plausible solution.

 

NO

 

It is unfortunate that a man with a name as punnable as his own that Jeremy Hunt continues to act like a complete and total one. But if there’s one thing you cannot accuse him of it’s constantly flip-flopping, and indeed he appears as likely to roll over on the subject of junior doctor contracts and a seven-day NHS as a sperm whale on a beach.

The idea of a seven-day NHS is of course a good enough idea, and I do not feel that many will begrudge Mr Hunt that, however the manner in which he has chosen to go about attempting to put this idea into practice has been so misguided that one almost wonders if he is somehow desperate to change cabinet positions by reason of sheer incompetence, in the same kind of logic which makes small children break plates while washing up so that they don’t have to do it again.

The NHS is one of the United Kingdom’s proudest establishments, being brought in by the work of Aneurin Bevan and Clement Attlee in post war Britain. Though it cannot be denied that Bevan’s grand plan has come somewhat undone by years of mismanagement and other forces, leading to the NHS becoming a repeated target for cut-rate comedians, it still stands as one of the great institutions we can put our name to. Hunt was the man tasked with bringing reform to it and restoring it to its former glory, and yet has managed to do a worse restoration job than that old woman’s attempt on Martínez’s fresco of Christ (you know, the one that now looks like Munch’s scream). Yet despite being told that the changes being made by the Department of Health are ill-advised by those who know so best; doctors themselves, Hunt is refusing to make significant changes to his proposals. And slowly but surely the effects are being felt.

There are a constant string of reports of falling application figures for medical schools in the UK, despite there being an upswing in numbers almost everywhere else, with reports of morale being through the floor in hospitals because of the constant circus around this new contract and even a report leaked from his own department (good man management skills once again) which suggests that fuller staffing of the NHS on weekends would not significantly affect the mortality rates for weekend-admitted patients. The last point is particularly salient as it is precisely those mortality rates which provide the statistical sand on which Jeremy Hunt built his reforms to the NHS. He even had the gall to suggest that the mortality rates are in part due to consultants opting out of weekend care, despite figures showing that less than one per cent do so. Naturally this accusation deepened the rift between them.

The fact of the matter is also that the patients coming in on the weekend are not coming in for routine operations on, for example, knee ligaments or a hip replacement. The people entering hospitals on the weekends are people who have had some kind of accident or sudden turn. To state the obvious, the nature of illness is that not all illnesses have the same mortality rates, and yet this does not seem to be something which Mr Hunt is able to grasp in the slightest. What is almost worst about the contract being imposed on junior doctors is the fact that the contract is attempting to lump together 55,000 doctors across 56 medical specialties into one neat, one-contract-fits-all whole. The task itself is almost impossible. And yet despite the first of three more planned strikes starting yesterday, still Mr Hunt insists on bashing his head repeatedly into a brick wall of his own building. And particularly galling is the vitriol being aimed by him towards junior doctors, painting them as a group of lazy, Marxist, constantly striking group of luddites seeking only personal gain. That said, the Conservative Party have always had an unimpeachable record on dealing with strikes after all.

It seems at this point the proposed reforms are not deliberately draconian, they are born out of sheer incompetence and blindness. The strong-arm tactics being used by Jeremy Hunt in this political furore are not the methods of some modern Caligula, they are those of a man who is seeing his position slide slowly into the abyss. There has been no concerted attempt to simply lump everything onto the shoulders of junior doctors, it just seems that Mr Hunt is out of any other meaningful ideas. The reforms themselves are not fair, but what is almost more worrying is that Jeremy Hunt appears to be unable to grasp that he is wrong, and even worse he is unwilling or indeed unable to change his mind.

Clearly, the gentleman is not for turning.

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