Jeremy Hunt MP is the Secretary of State for Health, and is MP for South-West Surrey.
When I first became Health Secretary in 2012, dealing with the scandal at Mid Staffs was the first major challenge I faced. I resolved then that my mission was to transform NHS care into the safest and highest quality possible. I knew I was not alone in this – as every doctor and nurse wants nothing less for their patients.
However, one of the recurring themes has been inadequate weekend care. I will never forget my meeting with Frank and Janet Robinson in January last year. Their son, John, tragically died from a ruptured spleen after a mountain biking accident in 2006. When he arrived at hospital on a Saturday lunchtime, John was left to wait several hours unattended in an A&E unit desperately short of doctors. After a quick examination, he was sent home with a diagnosis of bruised ribs and a pack of painkillers – a decision that proved to be deadly. What makes it even worse is the fact that his parents are convinced things could have been different if their son’s accident had not happened at a weekend, when hospitals usually have around three times less medical cover.
This type of care is not typical of the NHS. But nor is it an isolated anecdote: nine academic studies in the last six years have corroborated the Robinsons’ concerns about higher weekend death rates, and six of those have made a link to reduced weekend services. That’s why we committed to a truly seven-day NHS in the first line on the first page of our 2015 manifesto.
Junior doctors are in no way to blame for this ‘weekend effect’: they already do the lion’s share of weekend work. But the contracts for both juniors and consultants were drawn up over a decade ago with Monday to Friday services in mind. To deliver our manifesto pledge, we need to reform both of these contracts to make it easier for hospitals to roster more doctors at weekends, alongside improving a whole host of other weekend services including diagnostic tests, pharmacy, physiotherapy, GP access and social care.
The reaction from the doctors’ union, the BMA, has been disappointing in the extreme, culminating in the first ever withdrawal of emergency care this week. We worked hard, and in good faith, to reach a negotiated agreement: we held 75 meetings; set up three separate independent processes to move the process on; and made 73 concessions in the last year alone. On the final sticking point of Saturday pay, we made three successive changes – ending with an offer that sees anyone working regular Saturdays get more generous overtime rates than nearly any other worker in 24/7 industries, from nurses, paramedics and midwives, to police officers, fire-fighters or airline pilots.
Unfortunately, this wasn’t enough for the BMA, who tore up a written agreement to negotiate on Saturday pay and refused to budge at all from their opening ask of time and a half for all of Saturday and Sunday. In the end, a respected hospital CEO I had asked to lead the discussions advised me that a negotiated solution just wouldn’t be possible, so I reluctantly decided to press ahead with the new contracts without agreement.
The last thing we want is a ‘miners moment’ in our NHS, but the BMA have made their unreasonable demands and extreme strike action a test of whether a powerful union can veto promises made by an elected Government. I know that increasing weekend medical cover as part of a wider programme to improve services seven days a week is the right thing to do for patients, so I am not going to abandon reform simply because it has become difficult or unpopular.
Labour Ministers made that mistake, giving in to BMA demands on the 2003 consultant contract and 2004 GP contract. The result was a ballooning pay bill and a dramatic reduction in weekend and evening cover. We must not make the same mistake. The NHS faces profound challenges: so, this year, we are putting in the sixth biggest funding increase in its history to support it. But with money must come reforms that benefit patients – so that we can deliver our Conservative dream to make NHS care the safest and highest quality in the world.