You are on page 1of 4

The Government response to petition 104334 of almost 200 000 signatures calling for a vote of

no confidence in the Rt. Hon. Jeremy Hunt MP, Secretary of State for Health is disappointing.
The response plainly avoids the question at hand, making no mention of Jeremy Hunt or a vote of
no confidence. Instead it focuses on seven day working, assuming incorrectly that this is
the signatories only concern.
The Government wants to talk about seven day working
It must first be made quite clear that NHS healthcare workers are absolutely committed to
improving the quality and safety of NHS care on many fronts, not least better seven day working
practices. On this we are in complete agreement with the Government. However, it is the detail of
how reforms have been proposed and potentially unilaterally imposed that has caused serious
concern.
The Government response, as has been the case for much of their evidence backing seven day
working, is both flawed and misleading.
The Government are deliberately using poorly evidenced, inflated figures to win headlines and
generate fear. To fully understand it, the reader requires in-depth statistical knowledge. A lack of
references leaves the reader unable to verify the accuracy and robustness of the statistics used.
Weekend mortality statistics
The Government claim there is a 16% higher chance of dying if admitted to hospital at the
weekend this is misleading. 1 The actual data show there is a 16% increase in absolute risk of
death if admitted on a Sunday instead of on a Wednesday. The figure for Saturday is 11%.2
That is an absolute risk reduction on an absolute risk of death of 1.32%. Thus the risk of death is
increased from 1.32% to 1.53%. The authors of the original study did not describe how the
severity of patients illnesses were taken into account, potentially seriously confounding the
results.
The figures above demonstrate an association but do not explain the cause.
There are likely to be many reasons for this difference in mortality, but these have not been fully
explored. They may well include the fact that patients probably present with more advanced
illness and so are more unwell at the weekend, though clearly more study is merited.3
In fact the original study found that in patients who were already in hospital, the chances of dying
on a Sunday were 8% less than a mid-week day. Ironically, they are more likely to be on longer
stay wards and therefore much less likely to see weekend consultants than those newly admitted
to acute care. Besides all that, using mortality is not an effective marker of care quality.4
The consultant opt-out clause
The response is fixated on the consultant opt-out clause of the 2003 NHS consultant
contract. This clause covers non-emergency (elective) work only. The responses argument
focuses on making hospitals safer at the weekend this relates to emergency work and
highlights the critical lack of understanding of what actually happens in the NHS. It is again
emergency work to which the above mortality figures relate. There is no opt-out from emergency
work, but it is critically underfunded and poorly resourced.
A Freedom of Information request responded to by 13 acute NHS trusts so far has
revealed just one consultant opting out of a total of 3755 consultants (0.027%).5 Thats equivalent

to just 12 out of the roughly 40,000 consultants working in the whole of England.6 This destroys
the Government argument that the opt-out clause is a major barrier to a 7-day service. The
opposite is true, it is no barrier at all.
Furthermore, the response claims that the opt-out clause allows doctors to charge for expensive
out of hours payments. The FOI data shows that this is not the case. These extra charges are for
additional work hours needed to fill gaps in staffing due to an overall lack of consultants, NOT
because consultants are opting out.
Consultant pay
Naturally, the report moves to highlight consultant pay. It quotes an average consultant salary of
118,000. Where has this figure come, how was it calculated and what are we comparing it to?
The NHS consultant pay scale for England is 75,249 rising to 101,451 after 19 years as a
consultant.7
Can consultants work more? Most full time consultants work 10, 11 or 12 programmed activities a
week (40-, 44- or 48-hour week) as a routine. On-call work happens on top of
this. Therefore most consultants already work in excess of a normal 40 hour week from the
outset to cope with the demands of the NHS even before on call commitments.
For example, a consultant might work five days a week. Their on-call weekend occurs on top of
this time. They still come back to work again the following week, often enduring a 12 day stretch.
They dont have Monday and Tuesday off to compensate, and if they did who would do their
elective work on these days?
It is difficult to see how current working patterns of 40-48 hour weeks (plus on calls) have any
space for manoeuvre. Police officers, firefighters (note: not firemen as per the government
response) and prison governors who demonstrate admirable seven day working, are not
expected to work in excess of 40 hours a week to do so.
The NHS is in a state of chronic staffing shortage and this affects patient safety. Acute care had
its worst winter crisis for years with worse predicted this winter. There is a shortage of health
professionals and a shortage of beds. Every day hundreds of unfilled shifts remain empty forcing
already overworked professionals to do the work of far in excess of one
person, compromising safety, quality and dignity.
Discharging a patient requiring social care during the week is like wading through treacle, let
alone at the weekend. The catastrophic cuts in health and social care mean that patients wait
weeks for a care package or an urgent fast-track palliative care placement as this cannot be
done over a weekend. These, and emergency care are far more pressing issues for the
Government to tackle, rather than picking a fight with doctors on an issue on which we all agree
needs improvement.
The determined Government focus on forcing consultant seven day elective working is not based
on any evidence that the opt-out clause is any major barrier to seven day working. It is
unworkable in isolation and may have catastrophic consequences for the NHS. Jeremy Hunt is
focusing on the wrong entity; far bigger issues affecting patient care are being ignored and swept
under the carpet.
Why do NHS staff have no confidence in Hunt?
If seven day service proposals and some belligerent remarks about doctors were all that had
angered NHS professionals, there would be no petition.
Jeremy Hunt has a track record of bad decisions, poor policy and failure to engage with

professionals. This was the last straw. The NHS sat up, took note and decided enough was
enough.
Outlined below are just some of the many reasons NHS workers have signed to support a vote of
no confidence in Jeremy Hunt:

Co-authorship of a book advocating the denationalisation of the NHS

An enduring lack of engagement with NHS professionals and a refusal to involve them in shaping
the future of the NHS

A non-existent understanding of what happens on the shop floor and how the NHS really
functions as a health service

A promise of seven day GP working services with no credible plans for addressing
the GP workforce crisis

Suspension of the NICE safe staffing programmes focused on minimum safe nursing levels for
inpatient wards

An acute care crisis with deteriorating accident and emergency performances, closure of inpatient
beds and personal haranguing of NHS trusts repeatedly missing targets

A calamitous lack of understanding of evidence based medicine leading to the promotion of


homeopathy as an evidence based intervention (its not) and misleading information about drug
advances such as dementia drug solanezumab

Lack of apology for patient breach of confidentiality despite his own introduction of Duty of
Candour regulations if this had been a health professional there would have been a disciplinary
proceeding likely leading to a Fitness to Practice hearing

Persistent lies, propaganda and misinformation to the public about the NHS

Complete lack of experience in the healthcare sector

Closure of emergency services such as West London Accident & Emergency departments and
attempted closure of Lewisham Accident & Emergency despite the A&E crisis

Overseeing progressive privatisation of the service which clearly does not work

Six-fold exaggeration of costs incurred by foreign nationals using the NHS

Public health budget cuts of 200 million despite a focus on public health and prevention
Regarding Mr Hunt, the message is becoming even louder and clearer. NHS staff and the
public have had enough.

Dr Daniel Furmedge, Dr Benjamin Dean, Dr Hugh Harvey, Dr Natalie Silvey, Dr Mohsin Khan, Miss Stella Dilke, Miss
Stella Vig, Dr Clive Peedell, Mr Vimal Gokhani and Mr Mike Henley on behalf of 196 900 signatories. Supported by GP
Survival. 20:00 Sunday 26th July 2015
#iminworkjeremy #weneedtotalkaboutjeremy

1 McCartney M. The zombie statistic behind the push for seven day working. BMJ 2015;351:h3575
2 Freemantle N, Richardson M, Wood J, Ray D, Khosla S, Shahian D, Roche WR, Stephens I, Keogh B, Pagano B. Weekend hospitalization and additional risk
of death: An analysis of inpatient data. J R Soc Med. 2012;105:74-84

3 Mikulich O, Callaly E, Bennet K, ORiordan D, Silke B. The increased mortality associated with a weekend admission is due to increased illness severity and
altered case-mix. Acute Med. 2011;10(4):182-187

4 Hogah H, Zipfel R, Neuburger J, Hutchings A, Darzi A, Black N. Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective
case record review and regression analysis. BMJ 2015;351:h3239

5https://www.whatdotheyknow.com/user/kiara_vincent?utf8=%E2%9C
%93&user_query=consultants+opt&request_latest_status=successful&commit=Search+contributions+by+this+person Accessed 26 July 2015

6http://www.hscic.gov.uk/searchcatalogue?
productid=18205&q=monthly+nhs+hospital+and+community+service+workforce+statistics&sort=Most+recent&size=10&page=1#top Accessed 26 July 2015

7 http://bma.org.uk/practical-support-at-work/pay-fees-allowances/pay-scales/consultants-england Accessed 25 July 2015