The fundamental problem with the junior doctors’ dispute is that the contract negotiations are being undertaken in isolation from:
i) sensible practical considerations
ii) financial reality
iii) international situation
1. All weekend staffing needs to be reviewed if a 7 day equitable service is the target*
Practically, all other health professional staffing at weekends needs review as doctors need physios, radiographers, psychiatry, technicians, porters and then there are the community services etc.
2. Junior doctor training in the UK goes on for longer than elsewhere in Europe, and some specialties require doctors moving to a new hospital a couple of times a year. There is a personal cost to working for the NHS (compared to other countries) and if the UK is to retain the highest quality staff then pay negotiations need to reflect the duration and pressures of training. Junior doctors stay as such until they become consultants, in their mid to late 30’s.
ii) Financial reality – The NHS is going to be at least £2Bn in debt by March 2016; salary costs are ~70% of the NHS budget and National Debt is still rising by over £5000 per second.
• if there is no increased investment in more health professionals, you are simply spreading the jam more thinly and there will be less health care during the week
• there is already demonstrable underinvestment: underinvestment is unfortunately best demonstrated by mental illness: it constitutes 22.8% of conditions in UK but only 11% of NHS budget; 92% of people with a physical illness receive care but only 26% of people with a mental illness; only 44% of GPs have a service they can refer patients to for severe mental illness¹.
iii) International situation
A key driver for the negotiations is the government’s desire to have a 24/7 NHS to improve weekend mortality statistics. This is not solely a UK phenomenon; the USA and Netherlands were found have worse 30 day survival rates than the UK, and although Australia faired better over 30days, the ‘weekend effect’ could be seen after 7 days. This systemic phenomenon needs further research.
Added to this, pay for specialist doctors might be similar internationally but reports from those who have moved to work abroad say that the conditions are better and the cost of living is lower. This contrasts with UK GPs who earn more than international contemporaries². (More research needs to be done that takes into account training costs, malpractice insurance and pensions).
Therefore what we should do is:
A. Agree an interim/temporary settlement (say over 4 or 5 years) to cover current costs before decisions are taken on a future settlement which will depend on the outcome of the following:
B. Have a cross-party review of health and social care funding with genuine solutions proposed that can be taken to the public for consideration. This would include…
C. Facilitating a national debate on the priorities for what the NHS budget should be spent on, and what the NHS can realistically do – because we can’t afford everything
D. Initiate a system review of what incentives, regulations, infrastructure, funding flows are required to allow initiatives and innovation to improve efficiency – there are too many blockages to improvement and innovation
E. Undertake a workforce and technology review to inform strategic planning for the delivery of services in the 21st C (guiding principle – skills maximisation)
Julia Manning, Chief Executive of 2020health said: “Politicians need to take the lead and explain to the British public what the choices are on having an NHS fit for the 21st century. We are still spending about 2% less of our GDP compaired to many EU countires and despite the Spending Review, we do not have funding settlement for the NHS and Social care that can meet current demand. Unless NHS staff feel they are being appropriately rewarded for their work, we will continue to see clinical staff move to work abroad where pay and conditions are better for a work/life balance.”
¹http://www.2020health.org/2020health/Publications/Publications-2015/Whole-in-One.html page 16
*1. Original BMJ report into weekend survival rates http://www.bmj.com/content/346/bmj.f2424
2. Imperial research into international picture http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_9-7-2015-17-30-44