Junior Doctors strike - Hunt must take the blame

Update Sept 2016
After many false hopes of potential settlement (including Hunt's potential departure following the Brexit vote)the junior doctors voted not to accept the new deal and eventually decided that escalating the dispute would be the only way forward. Reluctantly they posted notice of a rolling programme of 5 day strikes (daytime only) starting in September, but feedback from members and senior doctors soon revealed that the NHS would be too fragile to cope and patient safety might well be compromised. The first strike was called off and on 24th Sept a newly elected junior doctors leadership (including several radical names) decided to suspend the proposed actions entirely while not accepting imposition of the document. This will cause difficulties for junior doctors as new rotas are introduced next month and the JD leadership is likely to propose a different series of actions. A High Court judgement on the junior doctor's challenge to the new contract as the result of Hunt acting beyond his remit and irrationally is expected on the 28th Sept. The Junior Doctors' statement is on the BMA website.

Update 18/02/16 Following the strike on 10th February Hunt announced that he would be imposing the contract. In a typical NHS management muddle a number of leading NHS Trust executives including Sir Andrew Cash from Sheffield Teaching Hospitals were cited as supporting Hunt. However many of them, including Sir Andrew, notified that while they regarded the revised contract as fair and reasonable they did not support its imposition. Following reports that the imposition was not binding on Trusts, Health Education England which is now in charge of national training schemes announced that Trusts which did not impose the contract could be fined. Junior doctors are considering their positions while senior doctors have rallied to their support. This is a huge crisis for the NHS.

10/02/16 Both the Independent and the Guardian have reported that a provisional agreement between NHS Employers and the BMA has been personally vetoed by Jeremy Hunt. The crux seems to be around the description of Saturdays. Jeremy Hunt did not turn up to Parliament on Monday to answer an urgent health question, leaving it to his sidekick Ben Gummer. The interesting parliamentary exchanges can be read here.

The new chief negotiator's letters to junior doctors and to Jeremy Hunt can be accessed here. Note David Dalton's references to the crisis in morale among junior doctors (not to mention other NHS staff groups) and figures published today suggesting that fewer and fewer doctors finishing training will stay in the NHS.

This is clearly a strike which did not need to happen and the fault appears to lie firmly with the Government. As well as failing with this particular contract negotiation, they continue to undermine the NHS as a whole.

Finally a report just out from the National Audit Office, the independent spending watchdog, firmly criticises NHS workforce planning and says it is often driven by the need to make cash savings rather than clinical need. It says:
there is a 5.9% reported staffing shortfall in 2014, equating to some 50,000 clinical staff.
Across the health system as a whole, there are shortcomings in how the supply of clinical staff is managed, in terms of both planning the future workforce and meeting the current demand for staff.

"Trusts’ workforce plans appear to be influenced as much by meeting efficiency targets as by staffing need. Our evidence indicates that trusts’ workforce plans are often driven by the financial plans that they prepare for the NHS Trust Development Authority or Monitor. These plans envisage significant recurrent pay savings. Between 2012-13 and 2015-16, trusts planned to make recurrent pay savings of around £1 billion each year, although actual savings consistently fell well short of this amount. By focusing on efficiency targets when balancing financial sustainability and service requirements, trusts risk understating their true staff needs. This in turn could result in Health Education England commissioning too few places to train new staff. At trust level, it may also lead to gaps in staffing or additional costs from using more expensive temporary staff to address shortfalls.

All key health policies and guidance should explicitly consider the workforce implications. Past developments have not fully assessed how the necessary staff will be made available and funded. When major changes to services are proposed, such as the ‘7-day NHS’, the various national oversight bodies – including the Department, NHS England, NHS Improvement, the Care Quality Commission and the National Institute for Health and Care Excellence – need to work together to understand the staffing implications and financial impact.

The Department and Health Education England should review the funding arrangements for training clinical staff. The review should involve evaluating the effect of current and planned funding arrangements for higher education institutions, clinical placements and students. Specifically, they should ensure that the right incentives, including financial reimbursements, are in place to supply sufficient staff with the right skills in the right locations."

In these circumstances - more and more responsibility, stretched out over more and more time, and with less and less help - is it any wonder that Junior Doctors feel that they are being "hung out to dry"?