Jeremy Hunt interview: Still a safe pair of hands?
BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1632 (Published 23 March 2016) Cite this as: BMJ 2016;352:i1632All rapid responses
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It is widely acknowledged that Jeremy Hunt’s media resources far outweigh what is available to junior doctors, yet this BMA-owned journal[1] has felt apt to provide him further coverage to his cause against junior doctors. Having previously fallen short of calling Hunt a liar in relation to his gross misinterpretation of weekend mortality rates [2], Dr Godlee (Editor) seems to have sat down with him for a rather cosy chat at a very sensitive time; her interview reveals nothing new or useful to junior doctors but simply confirms his intransigence and unrealism. The smug-looking photo also suggests his extreme defensiveness to say the least. Although the real motive behind this interview is not clear, it is unlikely that it has done any favours to junior doctors or improved their confidence in the BMA. At a time even when BMA’s legal advice appears to have been leaked to the press [3], this interview and ensuing publicity could be a further worry for some.
References
[1] BMJ 2016;352:i1632
[2] http://www.bmj.com/content/351/bmj.h5624
[3]http://www.telegraph.co.uk/news/nhs/12178595/BMA-ignored-lawyers-advice-...
Competing interests: No competing interests
Working in healthcare and the training of junior doctors both in clinical and university roles, I found Mr Hunt’s interview depressing on several levels. It is insulting to NHS staff and the public that he spoke of his recognition of the morale crisis in the NHS (but failed to recognise his role), the same unfounded “weekend effect” arguments for his imposed junior doctor contract, and the need for “honesty and transparency”, which he forgot during his closed meetings with media chiefs and mis-use of research data in recent months. Perhaps most upsetting to me, was Mr Hunt’s use of Don Berwick’s recommendations at one point to justify his view of improving the quality of patient care in the NHS.
Last week, at the Royal College of Physicians’ Annual conference in Harrogate, I found myself in tears along with many other members of the audience as Don Berwick, paediatrician and founder of the Institute of Health Improvement, narrated the story of Sean, a child grappling with severe depression among other illnesses. As an adult who had defeated his demons, Sean made Berwick’s day several years later with a surprise visit and a hug, but the story did not end well. A glittering career in the US military was tragically cut short by an aggressive brain tumour. Before Sean passed away, Berwick was able to track him down and attended Sean’s wedding. The uplifting part was the humanity and humility of this world-beating clinician scientist. Equally striking was the fact that public life, international celebrity and science had not reduced, but had rather heightened this clinician’s connection with his patients. Berwick provided a nine-step prescription to preserve patient-centred care and save the NHS, which he felt was threatened by several issues, including the current impasse between junior doctors and the government. He described four initial steps of de-escalation: The first 4 steps were “Stop excessive measurement”, Abandon complex incentives”, “Decrease focus on finance”, and “Avoid professional prerogative at the expense of the whole”. He followed with five steps to improvement, which reinforce the crucial role of research in healthcare.
Step 5: “Recommit to improvement science”. Don Berwick has advised successive UK governments of both major political parties about quality improvement in the NHS and it has been rooted in the science of a discipline over a century old. However, 7-day services and improvement of the junior doctor contract as the major thrusts of current health policy, lack a convincing scientific foundation or a strategy to conduct research which would improve healthcare quality.
Step 6: “Embrace transparency”. Data and evidence trump all, including medical and political careers. The Darzi review, Keogh report, the Francis report and other public enquiries have consistently recommended that research alongside clinical care improves outcomes and saves lives. As evidence-based medicine, data-driven healthcare, and evidence-based policymaking permeate our biomedical norms, it is unfortunate that mis-understanding, mis-quoting and mis-use of research have characterised the current approach to junior doctor contracts.
Step 7 “Protect civility”. Imposition of an unwritten clinical contract has jeopardised the social contract and the morale of a generation of trainee doctors and devalued their professional integrity. A rich evidence base from several countries highlights the deleterious effects of over-worked, under-valued junior doctors on patient safety yet this has been ignored by policymakers. A return to the negotiating table is necessary for both sides of this dispute and only civility can ensure this very distant scenario.
Step 8 “Listen, really listen”. A health system that does not listen and does not learn is against the tide of current expert opinion and research, and a danger to patients. The quality improvement movement supports “learning health systems” and other areas of health policy pursued by the government acknowledge the importance of listening to key constituents, including patients, public and healthcare professionals. Good working relationships between employer and employee, and government and doctor, protect patient outcomes.
Step 9:”Reject greed”. The greed which Berwick referred to was for money and status, which can affect clinicians and politicians alike. This step is perhaps most important in the current dispute. While Mr Hunt’s friends in the media portray junior doctors as greedy for money, this is a worrying distraction from the reality that patient safety plays second fiddle to individual political careers and the 5-year political cycle. The lack of joined-up thinking and long-term vision across politics, policy, science and healthcare and impact on other sectors(e.g. education, environment and social care) are manifestations of greed and need to be addressed far more urgently for patient safety than the junior doctor contract.
Mr Hunt should not selectively quote a great man like Don Berwick. He should instead hear all of what he has to say, which is, in my opinion, very apt to the unfortunate scenario he has created. It is absolutely crucial to start listening to healthcare staff if Mr Hunt wants to seriously pursue his laudable aims of improving patient care and staff morale. Without listening and learning, empty rhetoric and spin will reign.
Competing interests: I am an honorary consultant cardiologist in the NHS and a Senior Lecturer in the unversity sector and teach/train medical students and junior doctors. I am a member of the Executive of the BMA Medical Academic Staff Subcommittee.
It is depressing to read that Mr Hunt believes he has more to give when he has taken so much away. Funding in primary care has slipped drastically, recruitment and retention are both falling; post graduate training schemes for General Practice cannot be filled. This, in the face of a massively increased workload, increased patient expectations, decreased access to resources, downward pressure on referrals and prescribing, unless these activities are linked to Mr Hunt's policies of uncovering dementia and well person checks, both of which are of questionable value particularly within the context of increasingly scarce resources.
His desire to impose seven day working has given hope to patients but he fails to see that it cannot be provided by a demoralised, contracting workforce. He has set his sights on email and skype consultations, without any consideration as to what the patient's want, which is in the main, personal and continuing care. What he is achieving is an increased pace of fragmentation of the health care system.
He is now removing the hope of professional advance for junior doctors, an increasing proportion of who do not see a future for the NHS and who are emigrating or quitting the profession altogether. The ones who remain will be the specialists of tomorrow who as a result of their unnecessary and intransigent treatment by a careless minister will have any good will squeezed out of them.
The role of health minister is never an easy one and often seen as a poisoned chalice. A good health minister would endeavour to bring his work force along with him rather than alienate them in trying to achieve his objectives. I hope the minister will give some thought to what he has taken away and what he might be able to give back, both to patients and the profession, both of whom are being failed.
Competing interests: I was a general practitioner
Re: Jeremy Hunt interview: Still a safe pair of hands?
Whose jolly wheeze was it to pretend you could get 7 days working for the cost of 5? We should be told. I suspect an advisor to a failed PM now long gone. Sounds more like Blackadder than a health policy. Shocking that a Secretary of State should even pretend this was possible. This insanity cannot continue, an apology is required.
Competing interests: No competing interests