The first doctors’ strikes for 42 years have resulted from the intransigence of the Department of Health (DH) led by Jeremy Hunt in insisting that Saturday is treated as a normal working day thus reducing overtime payments and doctors’ pay. Opposite my new flat they are constructing a new building and work from 8am-6pm Monday to Friday so the weekends are mercifully quiet – non-consultant doctors (NCD) work from 7am to 7pm Monday to Friday. The removal of financial penalties for ‘Trusts’ who roster doctors for more than 48 hours a week has led to fears that they will be forced to work longer hours which could lead to tiredness and unsafe practice. The announcement on 23rd February that further strikes are planned and the BMA are seeking a judicial review of Hunt’s decision to impose his preferred contract suggests this dispute will not be resolved soon.
The fragmentation of the NHS is highlighted by the fact that Foundation Trusts cannot be directed by the DH whereas the DH can issue a direction to non-FT Trusts to impose the new contract. Several Chief Executives have distanced themselves from a letter from the lead negotiator which they had apparently signed and said whilst they thought the new contract was fair they disagreed with its imposition.
A contract is between two willing parties and ultimately the NCDs can walk away leaving the NHS in a parlous state in August when newly qualified doctors are due to start work. Most doctors would be reluctant to do this although some have said they will leave the NHS if the contract is imposed. Some FTs have said they will not impose the new contract and Wales and Scotland who are not governed by the English DH or subject to the infamous Health and Social Care Act 2012 (HSCA2012) are looking to recruit doctors to their health services. All this contributes to the ‘creative destruction’ beloved of neo-liberals who want to see our NHS turned into an insurance based system as outlined by Oliver Letwin and John Redwood in a paper published in 1988.
The BMA want to keep national bargaining on pay and conditions which since 1948 has contributed to reasonable staffing levels to run hospitals in poorer areas and has contributed to the good standards throughout the NHS.
There is also a crisis in General Practice which has seen their share of the NHS budget reduced from 8.4 per cent in 2012/3 by 1.3 per cent per year and is predicted to be only 7.3 per cent by 2017/8 despite increasing workloads. GPs are talking of early retirement, trainee places are unfilled and practices are finding it difficult to recruit partners.  A recent meeting of the Local Medical Committees voted to canvass GPs about mass resignation. This would plunge the country into chaos as 90 per cent of patient contacts are with GPs.
In addition the effect of restricting pay rises to 1 per cent has led to nurses leaving the NHS and working for agencies at great cost. The proposed cuts to in – work benefits will hit some nurses hard and may lead to further loss of staff. withdrawal of student bursaries will reduce the future workforce and recruitment from abroad is needed owing to the disastrous decision to cut nurse training places in the 1990s.
Despite the government rhetoric that money going to the NHS is ring fenced and more is being put into the NHS the amount spent as a proportion of GDP will fall from 6.5 per cent 2012-3 to 6.2 per cent in 2015-6.
In addition to this the amount of money wasted on the market is not collected by the DH and estimates range from 4.5 per cent Centre for the Health and Public Interest to 10 per cent by Jacky Davis of Keep Our NHS Public and £30bn by a Liberal Democrat working party.  The amount spent on private providers has risen to over £10bn and the effect of section 75 of the HSCA 2012 in forcing Clinical Commissioning Groups to put all services out to tender makes it likely that this proportion will continue to rise. There is no evidence that private companies provide better services than the NHS and the problems of destabilising services and companies submitting unrealistic tenders which undercut the NHS who know how to run services is exemplified by the failure of the Hinchinbrooke Hospital contract and the Cambridgeshire elderly care contract which failed because they could not deliver what had been promised. What all this adds up to is an attempt to destroy the NHS by stealth by underfunding the work that hospitals do, underfunding the GP services, and cutting the grant to local authorities so that patients cannot be discharged from hospital because of a shortage of suitable care in the Community. Despite talking about parity for mental health, the budget has been cut more than acute hospitals. More money is needed now not over the next few years.
Talking about a seven day NHS is pie in the sky without providing more money (£1-1.4 billion estimated) and staff. To try and impose a contract rejected by 98 per cent of those doctors who supported strike action supposedly to provide a 7 day service is disingenuous at best and cynical in the extreme and confirms my view that the slip made by James Naughtie on the Today programme five years ago was prescient. Jeremy Hunt despite his warm words in the Guardian is pursuing the neoliberal agenda which wishes to see the NHS transformed into an insurance based system –actions speak louder than words and his behaviour in the dispute with the NCDs has been dishonest and manipulative. He must back down and listen to the evidence and the fantastic young doctors who have spoken up so well for patients in recent weeks. He has succeeded in waking them up to what is happening to the NHS as privatisation gathers force something Keep Our NHS Public failed to do over the last ten years!
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