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Patients are at risk from an overstretched workforce, not the junior doctors' strike

Dr Kailash Chand

NHS England’s medical director and professional lead for NHS doctors Sir Bruce Keogh questioned whether staff would be able to respond to a terror attack during the junior doctors strike. And now Dame Sally Davies, chief medical officer, is warning that the planned industrial action will endanger patient safety.

Sir Bruce’s letter connecting the junior doctors’ strike to terrorism was cynical nonsense. Let me remind Sir Bruce and his boss Jeremy Hunt, that many doctors and other hospital staff who weren’t working, instantly and selflessly offered to help at the time of the 7/7 bombings. I’m sure that junior doctors, along with the rest of us, know our moral and ethical obligations if disaster does strike.

The CMO should know that when doctors strike, the scientific research shows that patients stop dying. The most comprehensive review of the medical impact of doctors’ strikes is published in the prestigious academic journal Social Science and Medicine. Not a single study found death rates increased during the weeks of the strikes, compared to other times.

Why aren’t they telling their masters that one of the greatest dangers to patient safety is tired doctors and deplete workforces? 

In my view, both Sir Bruce and Dame Sally, who are part of the medical extended family, should have been supporting the junior doctors, who are working flat out well beyond their hours. They should be concerned about recruitment crisis: already there is exodus of doctors and gaps in rotas created by a lack of staff are crippling those who remain.

The fact that only now only 53% of doctors continue to train in the NHS after their first few years should be their anxiety. Why aren’t they telling their masters that one of the greatest dangers to patient safety is tired doctors and deplete workforces? Stretching an overstretched, overworked workforce even further is not the way to make the NHS safer.

The biggest threat to patient care is the Government’s insistence on removing safeguards which prevent junior doctors from being forced to work dangerously long hours without breaks, with patients facing the prospect of being treated by exhausted doctors.

As far as I’m concerned, it’s the job of the medical director to ensure that an organisation is clinically safe. In my opinion, he has failed that as he has allowed a major component of the delivery of a safe NHS to be so horribly vilified and attacked by his boss’s boss.

It’s not the first time Sir Bruce has been exploited for political ends. One of his recent report on hospitals with high mortality led to claims by the Jeremy Hunt of 13,000 avoidable deaths, a figure Sir Bruce himself said he did not recognise.

For the sake of transparency it’s high time the Cabinet Office set up an inquiry to establish the true independence of NHS England before damage to its reputation becomes irreversible.

Dr Kailash Chand OBE is the deputy chair of the BMA, and a retired GP. He writes in a personal capacity.

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Readers' comments (6)

  • Sir Bruce seem like a weak lackey to the class bully *unt. Shame on him.

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  • To anyone in England...
    If JH and the Government were TRULY "...going through 'the exhaustive process' of contacting every A&E department in the country to find out whether they will" then 'they' were either lying (!!) or being very inefficient and wasting time and effort (!!!).
    * Any A&E that was open on Christmas day should be open*
    *Any A&E that was open on a summer Bank Holiday should be open*
    *Any A&E that was open on the Extra Bank Holiday for the Queen's Golden Jubilee should be open*
    *Or that was open for the Extra Bank Holiday for when a Prince got married, should be open*
    Basically, if 'they' just asked a doctor (but, why talk to a doctor who know what is going on at the front line!??) they would have saved "an exhaustive process."
    IF you are UNWELL don't fall victim to the Hunt Effect and avoid hospital. If you are unwell - go and seek the treatment, free at the point of care, you need.
    The non-Junior doctors are there to support the patients and keep them safe, not just to support the junior doctors.
    Because ... the intended impact on the public and our patients is not to harm them; it is to bring the impact of concerns about the proposed imposed contract to the government from the people it is 'governing.'
    Junior Doctors are the public too, as are our patients and potential patients - ie ALL of us.
    We - the patients AND the doctors - are the public that can - and needs to - hold a bad policy to account, and prevent it if we can.
    We are not striking to apply pressure for MORE money than we already get (even if on principle some doctors and non-doctors alike DO feel that more pay is appropriate - that is another issue).
    The junior doctors welcome any unity and support from the rest of our community - we are also, in the end, patients, or relatives of patients, and taxpayers and voters too. Just like everyone else.
    However, the Junior Doctors in England also humbly acknowledge the inconvenience and impact to non-doctors who had waited for an outpatient clinic appointment, or an outpatient procedure. And now, you have to wait longer, or accept a re-scheduling.
    For that there are apologies. Many, many honest, humble apologies - the hope is they are worth something. This is a cost to our patients, our fellow normal person.
    The hope is that this particular cost to the fellow normal person - in the long run - IS paid off by preventing a deterioration in the existing care provision in the NHS.
    It is paid off in the long run by preventing a precedent where it is ok to impose a contract on public servants.
    It is paid off in the long run by preventing a precedent for the imposition of work-structures that are worse than the existing one, both in terms of fairness to staff, and safety for the patients.
    It is paid off in the long term by preventing a precedent that suggests any employee must accept an imposed paycut.
    It is paid off, in the long term, by preventing an intervention by government that has a very real potential to render the NHS entirely unable to function as it should.
    So... my plea to anyone willing to listen to our very real, very practical (and, in my opinion, very valid) concerns:
    Support the NHS
    Support and talk to the Junior Doctors
    Support and talk to the Student Nurses
    But don't be a 'victim' of the Hunt Effect on the days of the Junior Doctors' strikes.

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  • READ ON FACE BOOK !! Very Appt. and true

    Sorry long post but with the strike 2 days away I thought I would add some reflections I. The huge amount of increasingly vindictive rhetoric, media articles and frank misrepresentation of the facts needs clarifying. Eg excess deaths from lack of doctors at weekends? The studies state this simply cannot be inferred from the data. In some hospitals it MAY contribute, but it is not proven and the effect will likely be due to many factors, not a single one. That is almost always the way in medical disasters and problems.

    The pic was take 0730 Saturday morning as dawn is breaking over our hospital car park. I am arriving to be the Consultant Emergency Surgeon for the day. I also worked the New Year Weekend.

    But I sort of forgot it was a Bank Holiday then, as the emergency teams are exactly the same on public holidays and on weekends as they are on weekdays.

    Yes, my surgical team is exactly the same 365 days a year. As are the medics, anaesthetists, ED and everyone else in acute specialities. Has been the same in the 26 years I have been doing it.

    If u need your appendix out or an abscess drained or bowel obstruction relieved or a CT scan on a weekend or Xmas day for that matter you will get it.

    This is why I am confused by what the DoH means by 7 day working. Not yet seen a clear definition.

    Emergency services? We have them, as above. My hospital and many others already have consultants in the hospital all day and of course available, and in some cases resident, all night.

    Those that don't have consultants scheduled to be in the building have them on call to come when needed. And most will come daily anyway to see the new Pts and review the existing.

    If they are not scheduled to do shifts as we do, it is because those hospitals do not have enough of them to have them there all the time at weekends. This is for legal reasons with hours limitations and lack of resource in their numbers. The on call as opposed to resident shifts sort of gets round the hours limitation.

    In these days of closure of EDs and massive increase in work intensity in the remaining hospitals, it is probably an unsustainable fix. I doubt there is a consultant in an acute speciality who would disagree the best place for them is in the hospital. But the NHS can't afford it... Not enough consultants to do it...

    We already have a full complement of junior docs at the weekend. So the rhetoric about the new junior contract improving weekend care cannot apply to emergency work.

    Yes at weekends we lack many of the ancillary services that facilitate discharges. But the JDC can't affect that.

    Is it about elective work? No reason at all this shouldn't be 7 days a week. But you need the entire resources of a weekday NHS. The JDC changes of course won't provide that.

    What the junior docs do provide is the essential manpower to keep the NHS running. Both elective and emergency. No possibility of the consultants doing it alone. There are not enough of us.

    So they must have a sustainable safe contract that protects them and our patients.

    That is what they truly believe the strike is about. No need to go into details here, but 98% voting for strike action means there is no doubt the gov has got it terribly wrong. After all as a profession we may like a good whinge about the latest bright gov idea that isn't going to work but we suck it up and get on with it anyway as a rule.

    And yes it is also about the pay. Or more specifically avoiding what seems to be a major pay cut for potentially working more hours other professions call unsocial, with lack of a robust safeguarding mechanism to protect the hours worked.

    Please remember it is not "overtime" they get for nights and weekends. It is an enhancement for the recognised ill effects on health and well being of workers in any profession who do shifts like this. And they have no choice about opting out of emergency cover. Neither do we consultants.

    This government will go down in history as being the only one in over four decades to incite the medical profession to strike. It could have been easily avoided. But 50,000 united voices can't be wrong and this time they will not be silenced. What a shameful legacy for this government. Hopefully a legacy it will be as surely this debacle must mean they never have a hope of being re-elected.

    And Pts pls don't worry. Despite the gov rhetoric you will not be harmed by this strike if you are an emergency. The consultants will be covering our juniors. For the first three days ED depts will work as normal. There are likely to be more beds than usual as much elective work will be cancelled.

    It is true to say that in other medical strikes in history, mortality has gone DOWN not up.

    Yes elective activity will be cancelled and that is of course a travesty. But I don't blame the junior doctors. I was one, we went through bad times, but nothing like this.

    Their action has to have an impact if the gov are going to listen. All of them will regret and feel bad about the effect on elective work.

    But they are simply left with no real choice. I hope the public continue to support them, as to a significant degree they are ultimately doing it for you.

    And I hope it only takes one day of this limited action to produce the desired result. A complete reversal on the gov points the profession simply cannot accept.

    Sad times. Rather wish I had taken up the job offer in Aus a few years ago. Or the current one for Doha.

    But I won't. Because I believe passionately in the NHS. I think it is the best health service in the world and I will not abandon it.

    I hope our juniors get enough support in the coming difficult months to also not abandon it.

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  • Rajendra Roplekar This statement by a Practising Senior Medical professional should be on the Front Page of all News papers and All News channels . It should also be delivered to the Prime minister / Jeremy Hunt , Patients Advocate group and Parliamentary Ombudsman.

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  • Rajendra Roplekar Excellent . True to the facts unlike the shameful deceit and manipulation of media by Politician and Department of Health . Patients will come to more harm because the professionals ( Doctors and Nurses ) are leaving NHS at alarming rate. As usual Po...See More
    Like · Reply · 2 · 10 January at 13:56
    Rajendra Roplekar
    Rajendra Roplekar Hence NHS and Patients have Suffered, are suffering and will Continue to suffer unless these Decision makers are made to pay for their wrong actions ( See, for example the difference being melted out to the Soldiers who fought in IRAQ and Tony Blair ex prime minister for their actions !!)
    Like · Reply · 1 · 10 January at 14:02

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  • Kailash, whose job is in the first place to make sure that doctors work safe hours ?
    I, and thousands and thousands like myself and probably yourself, have done 80 hour weekends, 168 hour weeks with a few hours sleep, [to the point on one occasion I just could not get up [ after 94 hours without sleep and had to call in help]] and was a danger to patients and myself.
    It is the BMA surely and without doubt, who is responsible for this state of affairs.
    You are a leading light in the BMA. Why do you and others like you, first and foremost not define safety = how many hours, how many patients[ for each speciality] per day/ week etc.
    It is squarely your problem. Until you, the BMA, define safety, you cannot throw stones at others. If you defined safety and they breached it, you can complain.
    What guidelines have they ? what guidelines has the BMA provided?

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