Will the gamble pay off for Jeremy Hunt?

By Nicolle Laurie, Consultant, London

It all started to go a little pear shaped last Friday for Jeremy Hunt, the Health Secretary, when the Carter Review was released. The report looked at how the NHS can save money. The main findings indicated that a major concern was bed blocking in hospitals; people who are well enough to leave hospital but do not have the appropriate care in place at home therefore have to stay until this care is set up. The report revealed that between January and November 2015 1.59 million days were lost to bed-blocking, a figure that has been progressively getting worse since 2014. There were also serious concerns about the variations in the cost of care from one trust to another; with the cost of a new hip joint being £788 in one trust but £1,590 in another.

Then came Sunday when Jeremy Hunt appeared on the Andrew Marr show. Marr took the opportunity to confront Jeremy with a few home truths about the views of a number of junior doctors who made it clear that they were at the end of their tether and close to quitting, all because of Jeremy (this stems from the Government wanting doctors to introduce a seven day NHS). There was unfortunately nowhere for Jeremy to hide with the camera focusing in on him at every angle. The response from Jeremy was that the BMA was behaving ‘irresponsibly’. This of course did not go down well with the BMA, who immediately rebuffed this suggestion and made it clear that it was in fact Jeremy who walked away from the table when an agreement was close to being met, which wouldn’t have resulted in added cost for the Government. Maybe not the best interview, but then came an opportunity to change the news cycle - the announcement that the government would be investing £4.2billion into the NHS IT programme so that ‘doctors and nurses can spend less time filling out forms’, as Hunt puts it. Investment in the NHS, who isn’t happy to hear about that! But then came Monday…

It came and went in a flash for Hunt. An urgent question was called in the House of Commons on Monday regarding the upcoming junior doctors’ strike, scheduled for Wednesday. MPs on all sides of the House had expected Hunt to appear, however they were greeted by Ben Gummer MP, Parliamentary Under-Secretary at the Department of Health. Remarks in the Chamber could be heard far and wide echoing ‘where is Jeremy?’. The answer from Gummer was that he would appear in the Chamber on Tuesday, for Health Questions, and that he did. Only a few swipes were taken at Hunt regarding the junior doctor’s strike, presumably because Gummer had sheltered him from the storm the day before.

However, the week just kept on taking a downhill turn for the Health Secretary, with the King’s Fund releasing a report detailing how ‘in 2015, overall NHS satisfaction fell to 60 per cent, which is down from 65 per cent in 2014’. The findings of the report then got worse, ‘dissatisfaction with the NHS rose by 8 percentage points to 23 per cent (in 2015), the largest single-year increase since 1986’.

And then this brings us to the 24-hour strike planned by junior doctors that took place on Wednesday, due to the Government wanting to impose a seven day NHS that many feel will see longer hours and less pay for junior doctors.  It is thought that the action led to around 3,000 operations having to be cancelled. However, many junior doctors are thought to have defied the strike action and gone into work as usual, but the damage to junior doctor morale, patient safety and trust in Jeremy had been done.

Unfortunately, Thursday has probably been the hardest day so far with Hunt giving an urgent statement before Parliament informing the House that he would be imposing a contract on junior doctors, despite the clear opposition from the British Medical Association (BMA) and junior doctors themselves. Whilst making this announcement, Hunt was keen to stress that 90% of the issues had been agreed on during the negotiations – the issue of pay and working hours at weekend being the main unresolved point of contention. Sir David Dalton, who led the negotiations between the government and the BMA, wrote to Hunt yesterday informing him that negotiating would no longer be productive and that Hunt had a responsibility to the public and NHS to make a decision on this matter, hence his announcement today.

Real concerns were raised by Heidi Alexander, the Shadow Health Secretary, as to the ramifications of imposing a contact when there is such obvious objection. She quoted a report that had been released earlier this week indicating that 90% of junior doctor would be prepared to leave the profession if a contract was imposed. Damning in her summing up she said that this decision “could amount to the biggest gamble with patient safety this house has ever seen”.

Dr Johann Malawana, chair of the BMA’s junior doctor’s committee, said: “The decision to impose a contract is a sign of total failure on the Government’s part. Instead of working with the BMA to reach an agreement that is in the best interests of patients, junior doctors and the NHS as a whole the government has walked away, rejecting a fair and affordable offer put forward by the BMA. Instead it wants to impose a flawed contract on a generation of junior doctors who have lost all trust in the health secretary.”

The true ramifications of the announcement from Jeremy Hunt today has yet to be seen. As Heidi Alexander points out, Hunt has made a huge gamble that will either be noted in the history books as the moment the NHS began to deteriorate, or when it started to thrive and patient care improved.  Place your bets now…

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