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New Statesman, July 28th 2015

We need to talk about Jeremy: why doctors are so angry with Jeremy Hunt [1]

Jeremy Hunt is at the centre with another row with the medical profession. What’s going on?

Jeremy Hunt addresses a medical convention. Photo: Getty Images
First, do no harm. Photo: Getty Images

The long summer break can’t have come too soon for Jeremy Hunt. In the last 10 days alone, two separate waves of vitriol from the medical profession have come crashing down on him, and as he scarpers off to sun himself he must be wondering what type of mood he’ll be coming back to.

First there was the #Iminworkjeremy [3] campaign, a fierce rebuttal of Hunt’s attack on the BMA [4] over consultants’ supposed unwillingness to work seven days.

This must have seemed like a breeze though, compared with the last week’s bruising.  Cue #weneedtotalkaboutjeremy [5], an even angrier backlash sparked by the government’s response to a petition which has gathered more than 200,000 signatures (and rising), calling for a debate of no confidence in the Secretary of State. The reply was meant to silence the mob – it’s had the opposite effect, and been branded as “manipulative and misleading” by Dr Hamed Khan [6] who I know speaks for many doctors out there.

The whole saga has yet further uncovered a bitter divide, a growing rift between the Secretary of State for Health and the medical profession.

Yes, the government’s response to the no-confidence petition made the valid point that reports by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHSPRB) both cited consultants’ rights to opt-out of weekend and evening work as something needing to be examined.

But somehow that seems beside the point – the anger it sparked certainly suggests it is. It’s at best tactless, at worst downright insulting to effectively blame consultants – the vast majority of which do work weekends by the way – for 6,000 deaths a year without proper proof.

Especially when you’ve just handed them another four years of pay-freeze; when you’ve already incensed a straitened profession by shrugging off doctors who tell you that they see dangerous levels of understaffing before their [7] eyes; and when you’ve compounded their stresses and strains by cutting social care and public health funding.

And it’s certainly not very dignified when you’ve just gone back on a key manifesto pledge to cap social care costs. [8]

One of the organisers of the campaign, GP Dr Zoe Norris, a founder of General Practitioners pressure group GP Survival [9], told me that the handling of the seven-day policy was just the final straw.

She said: “This is one in a long litany of reasons we don’t have any confidence in Jeremy Hunt being in charge of the NHS. We were massively disappointed with the government’s response to the survey; it was standard churn, it didn’t say anything about Hunt himself or the no-confidence vote”.

The issue may resurface – Andy Burnham has pledged to press for a debate on the no-confidence vote in the new parliament – but for the time being the profession will have to grin and bear it.

What Hunt seems unwilling to even acknowledge is that the medical profession is unanimously behind the idea of working in a seven-day service – most of them already do – they just want to make sure it’s properly run and resourced.

So to claim that what’s really stifling a proper 24/7 service is the professionals who graft in the hospitals often well beyond their contracted hours, rather than five years of under-funding and disruption, is plain scapegoating.

As Dr Norris tells me: “Seven day working is something we aspire to, but what Hunt’s trying to do is push it through with inadequate staffing and resources as a political priority without demonstrating any commitment to patient care”.

If you’re going to slap down the profession you’re in charge of, expect to be slapped back. And when it’s a profession as dedicated and well-informed as medicine, expect it to be a pretty sturdy slap.

The uproar isn’t coming from a hysterical social media mob – it’s a forensic attack by people who know what they’re talking about, with an abundance of facts, figures, evidence and counter-evidence.

Within the conversation there’s GP Survival’s detailed challenge [10] of the government’s response and Hunt’s claims on the heightened death rates, and a point-by-point account of exactly why many have so little confidence in him.

There is this robust retort [11] by a trainee doctor, a damning open letter to David Cameron [12] from a dejected junior doctor, and an impassioned video blog by a nurse [13].

An investigation in the BMJ [14] behind the facts Hunt relied on; this no-holds-barred critique [15] of the whole policy by Mark Exworthy at the University of Birmingham; an international comparison [16] which shows the ‘day-of-the-week-effect’ is almost universally recorded.

There is this study by the Manchester Centre for Health Economics [17] which even questions the economic soundness of implementing a seven-day service, going as far as saying that there is “no clear evidence that seven-day services will reduce weekend deaths or can be achieved without increasing weekday deaths”.

Very revealing indeed is GP Survival’s own research into weekend work patterns [18] based on FOI requests to NHS trusts. The findings are still coming in, but of 13 acute trusts to have responded in full so far, only one consultant out of 3,755 is on record as having opted out of non-emergency weekend work – there is no opt-out for emergency work, a fact somewhat overlooked.

Saddest of all, there is tweet after tweet from disheartened junior doctor and medical student, questioning whether they should go any further in these early steps of their careers.

Even by Jeremy Hunt’s standards of flying in the face of doctors’ and nurses’ opinions, this, plus the 200,000 strong petition, is a lot to go against.

On July 16th Dennis Skinner said of Hunt that “doctors and nurses do not trust him – it is time he got out”. He’s not the only one calling time. We shall see whether he manages to keep flying through the summer and into the new Parliament – many, including me, were surprised he was reappointed at the DoH in May.

In the mean time GP Survival is building support, and Dr Norris says the aim now is to take its campaigning message beyond the Twittersphere and straight to patients.

Jeremy Hunt might be willing to make enemies of doctors and nurses, but voters are another thing when you’ve only got a majority of 12 MPs. And with even NHS England now saying that funding is falling short, and more cuts to local authorities on the way, pressure is mounting.

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