Is the government’s focus on weekend mortality doing more harm than good?

Edmund Stubbs, 11 February 2016

The BMA has rejected the government’s final offer for the new junior doctors’ contract. Linked with the recommendation from Sir David Dalton, the chief negotiator in the dispute and chief executive of Salford Royal NHS Foundation Trust, that the government now does ‘whatever it deems necessary’ to end the uncertainly of the situation to the service, it seems almost certain that the health secretary will impose the new contact regardless of junior medics’ dissatisfaction.

After years of negotiation neither side is willing to compromise on certain key issues and especially on weekend working. Jeremy Hunt holds that as people become ill at all times during the week, doctors cannot expect to be rewarded differently for the hours they work at the weekend. However doctors understand the work they do at weekends as being outside those accepted as normal and social by most of their friends and family. The common requirement for medics to skip breaks and work over set shift times are additional issues that cause much dissatisfaction for them as for all NHS staff who often have no choice but to stay on the ward to ensure patient safety if no appropriate cover is available. Certainly it would seem that the time for truces and further negotiation in the contract dispute is over, the government, by taking the ‘nuclear option’ of imposition, has ensured that it is now at war with a large proportion of its medical workforce.

Despite dissatisfaction with the government’s declared intention that the proposed contract will remove some financial sanctions against trusts making doctors work ‘extra’ hours, the BMA has seemed willing to accept a proposed guardianship scheme instead, providing breaks would be better protected. But this is as far as agreement in negotiations has reached.
So what will happen once the new contract is imposed? The public can certainly expect to witness more strikes, possibly growing in severity and even including emergency cover walkouts (although the BMA seems to have been reluctant to sanction this escalation due to a perceived lack of public support).

With more doctors thinking of leaving this country each year, and with many medical students (in some surveys amounting to almost half) claiming they will not continue to work as doctors under the imposed contract conditions, the NHS might witness a noticeable reduction in UK medical graduates working for it. This is worrying when the costs of putting a medic through British medical training can surpass £270,000, with no safeguard in place to ensure they continue inside the training organisation.

The NHS is one of the top five largest employers in the world. Staffing is by far the largest item of expenditure within its budget. The organisation depends on its workforce and, with the obvious blow to staff morale from the present dispute, which has been closely observed by other NHS staff groups, the government risks alienating itself from the majority of its workforce.

Jeremy Hunt made a manifesto commitment to instigate ‘a truly seven-day NHS’ with the stated noble aim of reducing weekend mortality, however, as John McTernan claimed in a Civitas seminar on the topic last autumn, there are many other causes of mortality, beside weekend increases, that need addressing within the NHS. Solely focussing on excess weekend mortality rates, with no new funds available to employ more staff on these days could simply prove counterproductive; especially so if it alienates yet more NHS employees.

With other staff groups’ contracts coming up for periodic renewal, the government needs to decide whether focussing on weekend working is the most sensitive way of illustrating the difficulties facing the NHS. Should they not instead tackle the issue of delayed discharges, the continual winter crises in A&E or try to further reduce patient waiting times?

Sir David Dalton, after involving himself in the contract dispute now recommends a review of NHS morale. The government might be well advised to learn from such an ugly disagreement when deciding the focus of its health reforms for the next few years.

Edmund Stubbs is Healthcare Researcher at Civitas, @edmundstubbs1