Doctors are striking: Are patients in danger?

Doctors are striking. The NHS is in trouble. Negotiations have failed. So are patients in danger now?


The problem

Doctors hours are divided into two categories; ‘sociable’ and ‘unsociable’ hours. In laymen terms, the nearest comparison would be ‘normal working hours’ and ‘overtime’. The government is proposing to redefine ‘unsociable’ hours, or ‘overtime’, from outside 7am – 7pm Monday to Friday to outside 7am – 10pm Monday to Saturday (adding three extra hours per day to the ‘sociable’ hours as well as a whole extra day). Thus they will get paid the same for working Saturday evening as they do on a Tuesday afternoon. There are a number of other changes including removing the safeguards preventing doctors working hours that closely resemble basketball scores and preventing the progression of those who decide to take time out for research (often considered mandatory in today’s demanding environment) and those who take maternity leave.


But doctors are paid so well, right? How dare they strike? Well…

Junior Doctors receive a basic pay that is dependent upon continual service to the NHS. They then receive a supplement depending on the amount of ‘unsociable’ hours they work. ‘Unsociable’ hours are currently defined as any time worked outside Monday to Friday between 7am to 7pm. Junior doctors are hence compensated for these hours with a supplement. The pay starts at £22k basic with a maximum of a 50% supplement. This is following a 5-year degree with and an accumulation of a minimum debt of £45k upon graduation (£54k now after the introduction of the new tuition fees under the previous coalition government), top qualifications pre university, and being considered in the top 2% in terms of academia in the UK.

These doctors, according to their contracts and on paper, typically work at least 48 hours a week (equivalent of six days from 9am – 5pm), including nights and weekends. The real number of hours worked however is often actually up to 70 hours a week which is more than any other set of doctors in medicine. Thus, in reality, junior doctors form a far greater percentage of your hospital workforce; over 30% even.


But how could the government have let the situation escalate like this? What happened?

Negotiations have been ongoing for at least two and a half years as the government has insisted that the NHS model is unsustainable. However, the government has also been rigid in its approach, even threatening to impose the contract regardless of objections from junior doctors. This threat was retracted on the night before doctors were due to strike in November. Since then, Jeremy Hunt, the Tory Health Secretary, has launched a campaign to demonise junior doctors.

This was no more evident than the incredible politicisation of the research paper authored by Sir Bruce Keogh which claimed that there were increased deaths in hospitals on weekends. Despite the paper clearly stating that it would be rash and misleading to assume that staffing levels were to blame for this, Jeremy Hunt seized on the research paper as a clear example of the need to implement his reforms.

What Hunt perhaps did not realise however is that his fierce media campaign had a killer effect; literally. Patients began delaying admitting themselves to hospital to ensure that they would be seen on a weekday on the assumption that they were less likely to die. Tragically however, some patients died as they waited for the weekday when they could have been saved had they simply turned up on the weekend. This phenomenon has been aptly named ‘the Hunt effect’.

The demonization did not stop there. Sir Bruce Keogh, who is also the medical director of NHS England and is now being asked to resign given the perception that he is in cahoots with Hunt (rumour has it he may even be in line for a lordship), even appeared to suggest in the aftermath of the Paris attacks that junior doctors were so immersed in their own interests that they would not tend to patients in the event of a terror attack. Keogh wrote:

“in light of the tragic events in Paris last Friday night, and the ongoing threat level in the UK, we need to ensure we have a clear understanding of arrangements should a major incident be declared.”

Keogh went on to ask whether junior doctors would be able to respond “within one hour of a major incident being declared”.

The government has sought to press home the point that the NHS model is currently unsustainable and in the age of austerity will have to see its fair share of cuts. However junior doctors have argued, quite bluntly, that money can be saved elsewhere, starting first with the large corporations who have expertly copped out of paying billions in tax to the government. One junior doctor was at pains to point out that the sugar tax that was discussed in parliament is one such example of an acceptable means to raise money. However, it was dropped, his words, “because it upset certain friends of the Tory party”. Other doctors referred to Mhairi Black’s argument in the Commons against cuts to pensions in which she stated:

“”We can afford to send air strikes to Syria and to pay for nuclear weapons, but we cannot afford to look after our pensioners? I just don’t buy it.”


So now that doctors are striking, are patients’ lives at risk?

The short answer is no. All non-emergency services will be suspended. Hospitals however will still be operating despite the strike though staff will be made up of A & E doctors, on-call doctors, and consultants.


And what happens if Hunt does not back down on his plans despite the strike and force through the changes?

Well in the words of one junior doctor, “Life as a doctor will be impossible. So I will probably be off to Australia where conditions are much better.”