Paul Abbott

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Dear British Medial Association,

I have no wish to be quarrelsome. My daughter was born in an NHS hospital in Brixton, and despite the confetti of paperwork that weighed down the heroic midwives (not your fault) I came away with a dazed, lifelong admiration for the staff who had helped her into the world.

So I am a fan. But, there have been few howlers in your public statements and press releases recently, which are at best eyebrow-raising and at worst quite tactless. Nobody is perfect, but I would hope that the more scientific members among you would admit that this hasn’t exactly been your finest hour.

First of all, you speak for doctors: not voters. This is all fine and dandy (and rather tediously obvious) but your bosses do seem to have forgotten this basic point. The confusion within the BMA’s ranks was rammed home recently by one of your chief rabble-rousers, Dr Mark Porter. He attacked the Government a few weeks ago, on the basis that they had been going around doing what they had been elected to do.

Specifically: he thundered that the British people “don’t want a seven-day NHS” and that the Conservatives were wrong to propose it. This is awkward, because Tory MPs have just won their first general election in more than 20 years, with a specific commitment to bring forward a seven-day NHS. Dr Mark Porter may not like this. But, we are where we are.

As Jeremy Hunt explained last week on this site: “A truly seven-day NHS was the first pledge, on the first page, of our election manifesto.” Say what you like about it, but 30 million voters have just expressed their view at the ballot box. And the winning Government has a duty to get its manifesto through. Obviously the BMA is entitled to its own view, but voters are entitled to theirs too.

Second, while your public outbursts have majored on pay and conditions for junior doctors (fair enough, they do work extremely hard), almost none of the commentary that you have been pumping out seems concerned with the basic problem – which is, let us remember, the worrying spike in NHS death-rates for patients admitted on Saturdays and Sundays. Why not? Wasn’t that the debate that we were having?

I’m sure that you know what you are doing. But at times the BMA’s refusal to engage with the (well-established, proven) problem of weekend death-rates seems a touch self-serving. Your attitude has not always been in the finest spirit of your hardworking members.

For example: you recently denied point-blank that a problem even exists, claiming that Saturday and Sunday mortality spikes are a “myth”. Elsewhere, you floated the idea that the proposed reforms to tackle this blight on our NHS are dangerous and “unsafe”. Well, even if this were correct (I’m not sure of your motives) this is still not a hugely useful axe to grind, because the status quo is obviously dangerous and unsafe too, as the death-rate evidence shows. The question should be: how can we make things better?

In fact, for a medical trade union, you seem strangely reluctant to suggest new and concrete ways of helping your members do better at work on the weekend – i.e. helping them to save more lives of sick, elderly, and traumatized patients who have the misfortune to be admitted to an NHS hospital on the wrong day. This surely should be the crux of the public debate, whatever the issues about pay and rations.

On the substance, it is worth peering through the magnifying glass again at the shocking graph from the Royal Society of Medicine Journal (above). This plots the relative risk of death for NHS patients admitted on any given day of the week. I am not a scientist myself. But can you spot a pattern?

Strip back the veneer of medical science from the BMA, and you are obviously a trade union who use public pressure to bargain for higher wages. I don’t begrudge you that. Your members have a right to organise voluntarily to leverage more wedge out of their employers – who are, in this case, the taxpayer. Good luck to you!

But NHS reforms have to be fair to patients, too, as well as fair to doctors. And that is why I cannot understand why you are so single-mindedly supportive of the status quo; which effectively pushes down wages for junior doctors in large swathes of Britain and denies us the flexible labour market that we need, because of the false caps and market distortions of national pay-bargaining. Do you really consider the current system of securing junior doctors – whether in Brent, Birmingham or Billericay – to be a sufficiently good one to be worth defending so angrily?

Take just one issue – national pay-bargaining. Is it really still the BMA’s position that a politician should be given the power to annually set an arbitrary pay-rate across the whole of the NHS for every junior doctor? Is it still the BMA’s desire that wage-rates would be imposed from on high, by dictat, irrespective of local variations in housing costs, work ethic, prior experience, and patient need? Why has the BMA concluded that politicians should fix wage-rates, rather than doctors themselves? Why are you not demanding that junior doctors be given the basic economic freedom to negotiate their own pay-rises? Almost every other worker in Britain enjoys these rights.

At times, the BMA has taken in recent days to simply throwing mud, which is disappointing. Apparently the Health Secretary is now guilty of “megaphone diplomacy”. This is a slightly specious thing to say (isn’t it?) when it has in fact been the BMA thronging the streets with megaphone-wielding protesters – rather than anyone else. But your press office seems to have put so much vigour into drawing this cartoon that it has failed to engage with the basic argument that Hunt and everyone else has been making. Which is: what can we do about the tragically high level of deaths, for patients who happen to be admitted to NHS hospitals on the wrong day? You have worryingly little to say about this. NHS death-rates are substantially higher on weekends. This is an unpleasant fact of life, but it is a fact.

Again, to quote Jeremy Hunt’s ConservativeHome article last week:

“Six academic studies in the last five years have indicated a link between higher weekend death rates and reduced weekend services. The latest, published in the BMA’s own journal in September, said mortality rates were 15 per cent higher following admission on a Sunday compared to a Wednesday. To change this, we have to improve weekend services across a range of areas, from making diagnostic tests like MRI scans and ultrasound scans available, to integrating health and social care so that patients can be discharged at weekends, to improving clinical cover at weekends.”

Your campaign to secure higher pay for junior doctors is admirable. But your denial of weekend death-rates is unsettling. And your vociferous support for national pay-bargaining makes it look like you will only champion the interests of your members, when it also furthers the interests of the BMA itself.

However, I am sure your heart is in the right place.

With good wishes, etc,



29 comments for: Paul Abbott: The graph that shows why Hunt is right about a Seven Day NHS

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