The Prime Minister’s first speech of his second term set out to nip the electoral non-issue of a Conservative-led NHS in the bud by setting out a clear and comprehensive vision of its future. While a significant chunk of the speech was about mental health, the media focus was on the brief mention of seven day services, which were again mentioned in the Queen’s Speech.
With affected indignation, some media doctors correctly tweeted that hospitals are already staffed seven days a week, but I think they were choosing to miss the point because of their left-wing bias. What is meant by true seven day services is that the same complete range of diagnostic tests that are available on weekdays should also be provided at the weekends, which should be easily accomplished and will directly reduce mortality.
The Government is not suggesting that GP surgeries open all hours on weekends to sort out routine issues, but that the urgent workload is more evenly drawn away (in either direction – back out to the community or up into the wards) from the out-of-hours bottlenecks that form in our hospital emergency departments. It is easy to see why NHS staff feel hard done by when they haven’t had any salary increments in five years and they see other professions like the law sticking to their own archaic work practices, such as dividing the year into terms and dragging simple processes on and on. But, unlike the law, serious illness cannot wait until Monday.
Dr Mark Porter (the BMA chair, not the GP and BBC presenter of the same name) agrees in principle with seven day service provision, and recognises that the proposal is not all about doctors. But he has gone on to warn that it would require top-down re-organisation to introduce. This defeatist attitude to change in healthcare is not unusual; one only has to remember Andy Burnham’s response to the ‘Manchester devolution’, and ‘top-down reorganisation’ was one of the BMA’s main criticisms of Andrew Lansley’s Health and Social Care Act.
As an aside to this, on Radio 4’s ‘Any Questions’ following the Prime Minister’s speech, Jonathan Dimbleby seemed to be expressing surprise when he asked Chris Patten, one of the panellists, what he thought of the Department of Health “describing the BMA as the doctors’ trade union – as if to imply an underlying agenda”. If people are surprised to learn that the BMA is a trade union, it is because the BMA tries to be perceived as a public health body.
Social media criticism of seven day essential service provision was also evident from NHS colleagues’ Facebook postings in which they chose to take offence at the suggestion, falsely claiming that David Cameron was calling them lazy and reacting as if they were suddenly no longer protected by existing employment laws – the same laws that make public sector strikes unnecessary.
It is thought that about 70 per cent of NHS staff poll as Labour voters, and unions such as Unison have got site offices in many hospitals, which in part may explain its knee-jerk negativity. Further explanation of opposition to a change in NHS working practices is that because of the sheer size and heterogeneity of the organisation as an employer, change can only happen slowly – and this pace is in sharp contrast to the efficiency savings that are required by 2020-21 to close the £30bn NHS funding gap.
Perhaps because of this consideration, attention last week turned to the wage bill - rather than looking at productivity improvement as planned – and safe staffing levels are now being looked at. This is a shame, because if it were easier to get NHS staff to adopt better working practices, more of them could be employed.
Nobody is being asked to work longer hours – the huge amounts that the NHS was recently shown to spend on agency and locum staff spend demonstrate clearly that, in common with most jobs, healthcare workers are willing and able to work extra hours in their own roles as contractors if they so choose, to augment their basic salaries.
Seven day service provision will give support to the Cinderella specialities in healthcare, plus those whose services must be available around the clock, and so make the system more equitable. The self-selected media doctors can tweet all the opposition they like about the policy, but it will continue apace regardless – because as we have learned from the General Election result, there a vast difference between mounting a social media campaign and giving the public what they actually want and need.