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| Jeremy Hunt has given my working week a facelift. The result is hideously ugly | Jeremy Hunt has given my working week a facelift. The result is hideously ugly |
| (6 months later) | |
| Pondering the recent catalogue of cruel, ham-fisted assaults dealt to my profession by the government is, I imagine, something close to what having a catheter inserted into your penis feels like, if the catheter tube in question is of outlandish proportions. | Pondering the recent catalogue of cruel, ham-fisted assaults dealt to my profession by the government is, I imagine, something close to what having a catheter inserted into your penis feels like, if the catheter tube in question is of outlandish proportions. |
| So the strikes are back on, and it’s impossible to imagine that the concerns of junior doctors like myself will drift away as the government clearly hopes, and not hang over the NHS like a Victorian smog. | So the strikes are back on, and it’s impossible to imagine that the concerns of junior doctors like myself will drift away as the government clearly hopes, and not hang over the NHS like a Victorian smog. |
| So let’s relive the outrages. | So let’s relive the outrages. |
| First, of course, came the contract itself, in which our working week got some nightmarish surgery. The government generously grafted on Saturday and bolted on a stretching array of evening hours until they’d fashioned a Frankenstein’s monster of a working week, one that didn’t remotely resemble the working week any normal person would recognise. If the working week were a close relative, you’d be seriously annoyed with his doctors at the results of the facelift. | First, of course, came the contract itself, in which our working week got some nightmarish surgery. The government generously grafted on Saturday and bolted on a stretching array of evening hours until they’d fashioned a Frankenstein’s monster of a working week, one that didn’t remotely resemble the working week any normal person would recognise. If the working week were a close relative, you’d be seriously annoyed with his doctors at the results of the facelift. |
| This was not, contrary to what some of the public might have fathomed, about overtime. Overtime is what you do beyond contracted time, and we’ve always been contracted to work weekends and nights. The junior doctors I know are so full of good intent that in the four years I’ve been in the profession, I don’t recall any colleague routinely going home at their official knocking-off time. In fact, earnest juniors are often ordered off the wards by seniors, many hours after their shifts have officially ended. And we have to study too: postgraduate exams for junior doctors are abundant, time-filching, expensive (over £1,000 for my most recent compulsory clinical exam, which I had to fork out for) and excruciatingly hard to pass. We revise for them in our free time – you know, that chink of daylight that the health secretary, Jeremy Hunt, has his eye on. | This was not, contrary to what some of the public might have fathomed, about overtime. Overtime is what you do beyond contracted time, and we’ve always been contracted to work weekends and nights. The junior doctors I know are so full of good intent that in the four years I’ve been in the profession, I don’t recall any colleague routinely going home at their official knocking-off time. In fact, earnest juniors are often ordered off the wards by seniors, many hours after their shifts have officially ended. And we have to study too: postgraduate exams for junior doctors are abundant, time-filching, expensive (over £1,000 for my most recent compulsory clinical exam, which I had to fork out for) and excruciatingly hard to pass. We revise for them in our free time – you know, that chink of daylight that the health secretary, Jeremy Hunt, has his eye on. |
| The resounding anxiety for me about this playful and cynical redefining of the working week is that there appears to be little impetus to stop there. Why not redefine all kinds of other things to the government’s advantage? Canteen staff could be redefined as nurses, then we’d have more of them. Bus shelters as hospitals, ditto. The health secretary as Overlord of Everything. | The resounding anxiety for me about this playful and cynical redefining of the working week is that there appears to be little impetus to stop there. Why not redefine all kinds of other things to the government’s advantage? Canteen staff could be redefined as nurses, then we’d have more of them. Bus shelters as hospitals, ditto. The health secretary as Overlord of Everything. |
| The next blundersome affront came as the government tried to justify the contract by some cack-handed armchair juggling of facts around weekend death rates. Let me simplify: the government misrepresented the data for its own ends, and those ends were torturously stretching already stretched staff and forcing them to work more antisocial hours, all without spending any more money. | The next blundersome affront came as the government tried to justify the contract by some cack-handed armchair juggling of facts around weekend death rates. Let me simplify: the government misrepresented the data for its own ends, and those ends were torturously stretching already stretched staff and forcing them to work more antisocial hours, all without spending any more money. |
| But having been introduced to the various flaws in his figures, Hunt kept maliciously vomiting them at the public, watched by horrified doctors screaming “where’s the off switch!” and realising there isn’t one. This is staticide on a wondrous scale. It’s curious to me that Hunt even attempted it. You know we study statistics in medical school, Jeremy? I did a whole module on them. | But having been introduced to the various flaws in his figures, Hunt kept maliciously vomiting them at the public, watched by horrified doctors screaming “where’s the off switch!” and realising there isn’t one. This is staticide on a wondrous scale. It’s curious to me that Hunt even attempted it. You know we study statistics in medical school, Jeremy? I did a whole module on them. |
| Let’s now discuss some irrefutable stats: junior doctors already earn less than their European contemporaries in a profession, it should be noted, that is highly competitive to access, comes with great responsibility (not to mention a disproportionate wodge of student debt and studying expenses) and requires innumerable skills: clinical, communicative and academic. Yet here we are, beginning on a wage lower than the average public service graduate. Work it out per hour and a junior doctor’s starting salary is appalling, given the above. But then I would say that, right? | Let’s now discuss some irrefutable stats: junior doctors already earn less than their European contemporaries in a profession, it should be noted, that is highly competitive to access, comes with great responsibility (not to mention a disproportionate wodge of student debt and studying expenses) and requires innumerable skills: clinical, communicative and academic. Yet here we are, beginning on a wage lower than the average public service graduate. Work it out per hour and a junior doctor’s starting salary is appalling, given the above. But then I would say that, right? |
| Here’s some complicated maths: More antisocial hours + same workforce = staff more thinly stretched, and demoralised. Hospital rotas already look like the gappy grins of rugby prop forwards, but soon the timetable will be a desolate wilderness where the gaps will outnumber the working staff. | Here’s some complicated maths: More antisocial hours + same workforce = staff more thinly stretched, and demoralised. Hospital rotas already look like the gappy grins of rugby prop forwards, but soon the timetable will be a desolate wilderness where the gaps will outnumber the working staff. |
| “But this is a pay rise!” announces Hunt. Even if the public are befuddled by spin and the maniacal waxing and waning of numbers in the media, it’s easy to assume that 98% of balloted professionals, with an academic background, are unlikely to vote against a pay rise. Which means Hunt’s trying to pull the wool over our eyes, and he’s terrible at knitting. | “But this is a pay rise!” announces Hunt. Even if the public are befuddled by spin and the maniacal waxing and waning of numbers in the media, it’s easy to assume that 98% of balloted professionals, with an academic background, are unlikely to vote against a pay rise. Which means Hunt’s trying to pull the wool over our eyes, and he’s terrible at knitting. |
| If money were our main concern, we could have it. We could, any of us, walk into jobs in finance with our CVs of straight As, crammed full of the evidence of focus and drive we needed to land a place in medical school in the first place, and survive the process. More than money, this is about safety: do you want the doctor assigned to take out your appendix to be ambling unsteadily towards you, at the wrong end of a 91-hour week? Do you want to wonder why you set off that airport metal detector six months after your hernia repair? Knackered medics are not good for anybody. | If money were our main concern, we could have it. We could, any of us, walk into jobs in finance with our CVs of straight As, crammed full of the evidence of focus and drive we needed to land a place in medical school in the first place, and survive the process. More than money, this is about safety: do you want the doctor assigned to take out your appendix to be ambling unsteadily towards you, at the wrong end of a 91-hour week? Do you want to wonder why you set off that airport metal detector six months after your hernia repair? Knackered medics are not good for anybody. |
| Curiously, and terrifyingly, this doesn’t appear to be all about the money for the government either. While watching the public accounts committee quiz Jeremy Hunt’s adviser about spending, I took on the look of a patient being told they have a conjoined twin they were not previously aware of. “What?!” was my percussive exclamation as I watched the government respond to some pretty basic questions, such as “how much will this seven-day NHS cost?” Here were members of the team behind the contract failing to explain any details worth knowing, because, we must assume, they didn’t know them. | Curiously, and terrifyingly, this doesn’t appear to be all about the money for the government either. While watching the public accounts committee quiz Jeremy Hunt’s adviser about spending, I took on the look of a patient being told they have a conjoined twin they were not previously aware of. “What?!” was my percussive exclamation as I watched the government respond to some pretty basic questions, such as “how much will this seven-day NHS cost?” Here were members of the team behind the contract failing to explain any details worth knowing, because, we must assume, they didn’t know them. |
| Let me give you the equivalent of these jabberings about finance in the form of a clinical consultation: | Let me give you the equivalent of these jabberings about finance in the form of a clinical consultation: |
| “Mrs Jones, you have cancer.” | “Mrs Jones, you have cancer.” |
| “Oh. Oh God. How do you know?” | “Oh. Oh God. How do you know?” |
| “Erm, dunno. Haven’t really decided. Not sure what you’re going to do. Now go away, I’m done with you. God, you can’t even walk!” | “Erm, dunno. Haven’t really decided. Not sure what you’re going to do. Now go away, I’m done with you. God, you can’t even walk!” |
| There’s been a lot of nonsense said about how hard our job is. Plenty of people work hard, and for considerably less reward. Let me say categorically that I love my job. But how do we define how much to pay public sector workers? We don’t take into account the fluffy rewards, nor should we. It’s about skills, education, complexity of decision-making, control invested within the position and so on. On those alone the case to pay doctors more is a strong one. But it’s also more demanding, emotionally, of time and relationships, than most professions. | There’s been a lot of nonsense said about how hard our job is. Plenty of people work hard, and for considerably less reward. Let me say categorically that I love my job. But how do we define how much to pay public sector workers? We don’t take into account the fluffy rewards, nor should we. It’s about skills, education, complexity of decision-making, control invested within the position and so on. On those alone the case to pay doctors more is a strong one. But it’s also more demanding, emotionally, of time and relationships, than most professions. |
| All this means that doctors will soon be off to Australia, safeguards will continue to be slashed with enthusiasm, morale will sink until it’s no longer visible, systematic defunding of the NHS will continue unabated until nurses’ uniforms become pinned together pillowcases and your physician’s stethoscope is two plastic cups and a piece of string. | All this means that doctors will soon be off to Australia, safeguards will continue to be slashed with enthusiasm, morale will sink until it’s no longer visible, systematic defunding of the NHS will continue unabated until nurses’ uniforms become pinned together pillowcases and your physician’s stethoscope is two plastic cups and a piece of string. |
| As we strike today, Jeremy Hunt should know this: we’re still united, we’re still impassioned, we’re still out for you. The stakes are too high and patients’ lives are at risk. Trust me Jez, I’m your doctor. | As we strike today, Jeremy Hunt should know this: we’re still united, we’re still impassioned, we’re still out for you. The stakes are too high and patients’ lives are at risk. Trust me Jez, I’m your doctor. |