If we were ever to delve into the psychology of a tweet, we would see that Jeremy Hunt is a man who likes shortcuts very much.
“To drs on shift 2day: thx 4 ur hard work. Now we need 2 reflect that professionalism wth modern contract 2 make NHS safer!#ImInWorkJeremy”
That’s him, hijacking his own protest hashtag.
‘Professionalism’ is also a word that Jeremy Hunt likes very much when talking about the NHS. So is ‘human’. Nicer than ‘patient-centric’, he feels. More representative of an organisation that needs to ‘[re]humanise’ after years of government-imposed targets.
Ironic then that the contract reforms he is threatening to impose on junior doctors from August 2016 if they do not capitulate this month may well signal the most dehumanising and de-professionalising transition the NHS has seen since its conception.
Luckily for him, doctors don’t complain that much. It’s not really the done thing, since, let’s face it, medicine is more about selfless service than cosying up the corporate ladder. Also, the public don’t really want to hear it; partly, because of that vocation-of-selflessness thing - though these are medical professionals, not nuns - and partly because outdated notions of grotesquely overpaid GPs and arrogant surgeons continue to dominate general consciousness.
Because of this, it takes a lot for doctors to go public with their troubles; and in a role where one day’s absence could equal catastrophic loss of life, it takes desperation for them to strike.
But that is exactly what is happening.
And we should be paying attention.
Because there are many ‘inconvenient truths’ about the NHS - but lazy doctors isn’t one of them.
If you look closely between the lines of Jeremy Hunt’s bold new vision for the healthcare system, you’ll glimpse them: the undeniable crises lurking, berg-like, behind the glossy vision of ‘patient power 2.0’; wedged between his calls for the 'intelligent transparency' that begins with an ‘honest diagnosis’ of today’s state of play.
Well let’s talk about intelligent transparency.
Let’s talk about a system on the cusp of a perfect storm of long-coming, complex social realities caused by ageing, by obesity, by our smoking and our drinking, for which there are no quick fixes.
Let’s talk about a system already reliant on the relentless overwork and conscientiousness of its ‘junior doctors’ - a misnomer that covers anything between 8 and 15 years after qualifying - as well as countless other healthcare professionals to simply keep patients safe, pushing them well beyond their 60 hour week and into the brink of dangerous exhaustion, often without agreed remuneration.
Let’s talk about a system handing junior doctors 100 patients at any one time, preventing them from being able to address pain or comfort the dying or do their job to any satisfactory degree; leaving them demoralised and guilt-worn and disillusioned.
Let’s talk about a system without basic levels of care for its own staff; where junior doctors, working from 7am until 9 or 10pm as a standard most days, in gruelling physical and emotional conditions, will rarely take their 30 minute break for every 8 hours worked; where female doctors are forced to wear a tampon and a sanitary towel because it will be so long before they are able to visit a bathroom, despite asking every patient if they have passed water.
Let’s talk about a system which pays its junior doctors a fixed salary of between £23 - 28K, yet makes it harder and harder to secure placement or advancement without the additional financial, logistical and mental burden of advanced study; which forces them to pay hundreds of pounds for their own obligatory in-work training.
On his quest for the unicorn-like ‘7-day NHS’, Jeremy Hunt is now opting to ‘professionalise’ the system with a staggeringly short-sighted quick fix - outlined here - which, among other things, pushes the working week to 90 hours, while slashing pay by up to 30%; removes safeguards preventing (even more) dangerous levels of overwork; removes protection for maternity leave, or for those retraining in a new speciality, or studying part time; that will force one partner in two-junior-doctor families to quit due to childcare costs.
All this, under the banner of a promise to put ‘safety and quality’ at the heart of our healthcare system.
Common sense - let alone basic empathy - says these reforms must not be implemented. Because while the cure for the NHS is a myriad and complex thing, one thing is clear: the NHS cannot function without its doctors. Doctors, not just physically present - and with strong indications that thousands more are set to leave before August 2016, this is no longer a safe bet - but healthy and willing and able.
Listen to any doctors speak about these reforms, and it’s clear that for most this is not about pay. If that were the case, 53,000 junior doctors would already be long gone. This is about a basic standard of care we should have the sense to safeguard in a country that boasts the world’s most sophisticated and humane medical system.
Listen to Jeremy Hunt speak, and you hear a very different story. He might be Steve Jobs 2.0 when it comes to patient power, but his tone towards NHS professionals betrays a barely-concealed contempt for the legitimacy of their concerns. Instead, he is the harried parent or impatient visionary, lugging the deadweight of the NHS bureaucrats and the ‘predictable opposition’ of its greedy consultants behind him.
But this narrative does not tarry.
He tells the BMA to ‘get real’, declaring he ‘will not allow the [them] to be a roadblock to reforms that will save lives’. But the BMA represents the healthcare professionals who sustain the NHS. That he pitches himself against them like this - that he belittles them so publicly without even the grace to acknowledge the increasingly impossible situation they face - should tell us everything we need to know about the sort of NHS he is trying to impose: and it’s not one that will work for anyone.
Because this plan is no more than a tired book of tells: selling us a populist vision unhampered by trifling issues of reality; titillating our consumerism with the promise of self-diagnosing genomes and new technology; inflaming our customer expectations and fuelling our fears with provocative figures and disembodied statistics that shed no light on the real state of affairs.
How can this be seen as anything other than a calculated play on our entitlement culture, working against the doctors on whom the burden still rests to provide these promises?
Why should we trust a man who, in one breath, promises to enable the ‘world’s most powerful patients’, cherry picking their preferential care - and in the next reminds us (not stopping for long, though, on this sticky point) that far from discerning and empowered health connoisseurs, many of us do not yet have the means - for a plethora of equally sticky and uncomfortable reasons - to take even basic responsibility for our own health?
How can he swear to release hospitals from the tyranny of targets, while simultaneously shackling them to the whims of the patient-consumers who will soon have the right to pick and choose which hospitals and doctors are ‘best for them’ based on transparent data?
How can we trust a logic that declares that, since ‘many doctors are already working weekends without recognition’ the solution is not to respond to this overwork, but instead to contractually enforce it on a ‘formalised footing’, and call it the new dawn of NHS professionalism?
There are simply too many discrepancies here; too many lazy notions that do not tally with the reality - and are designed, at almost every turn, to side-step the issues metastasising in the bones of our society.
And this does matter for all of us: because we are all NHS stakeholders. Jeremy Hunt is trying to divert attention away from difficult truths by confusing what we can expect as consumers with what we can expect as contributors to a collective system, to which we need to give - not just in taxes but in the care we invest in our own health and those of our family - not just take from if it is to survive.
He’s counting on our 21st Century entitlement and our hurt and our fear to persuade us that we deserve these changes. He’s counting on the very worst parts of ourselves to drive these reforms through. And that should make us all angry.
Because I’ve spent a lot of time observing the NHS: the NHS of acute, synchronised brilliance and the NHS of avoidable mistakes and hawk-eyed bedside vigilance; in the company of good doctors, and in the company of bad ones.
And the truth is this: almost without exception, what made these doctors good or bad was not their medical skills, or their desire to heal. It was overwhelmingly the conditions in which they were being forced to perform. It was whether they were walking towards us, the fourth doctor in as many days, playing catch up with Dad’s notes between 30 other patients; it was whether they had the time to bear the brunt of our anger and distress that he had been allowed, again, to collapse during the night shift because there weren’t enough staff; it was whether they had the energy and the patience to explain the true implications of his condition - and whether they had the emotional reserves to help us process it.
So I know what it feels like, as a family member, to hold anger toward an imperfect system. I know how tempting it is to lay blame with doctors whose exhaustion and stress deny you the quality care, or time, or reassurance you need from them in desperate moments.
But we must resist those mean, tunnel-vision sentiments - and know, without doubt, that Jeremy Hunt’s contract reforms will entomb the NHS in everything that currently ails it.
And while there are huge, gaping holes in the NHS, and reform is needed, it is shame on our government, and shame on us, if we allow ourselves to be coaxed into believing that imposing these sanctions on our doctors will, in any world, by any means, improve this.
Shame on us, if we listen to Jeremy Hunt framing this in smooth, self-righteous tones as a simple matter of laziness, and choice, and extra elbow grease, and allow ourselves to be distracted from the real issue at hand.
There are things that need to be said about the NHS, difficult un-PC, things that no government wants to bear the brunt of. Things like, waste must be cut from fattened bureaucracy and incompetent multi billion-pound failed IT projects; like we won’t start curing the NHS until we start taking responsibility for curing ourselves; or, in an ageing society, we need to fundamentally reconsider our notions of intergenerational living and the role of social care.
But until our government has the courage to do the difficult things, instead of making easy targets of our medical professionals, we need to do our bit. We need to support our doctors, and call on our government to ‘get real’ about reform.
Because otherwise, I’m not sure what we’ll be left with.
(Image sourced from http://www.express.co.uk/news/uk/608568/Express-Crusade-Junior-Doctors-hundreds-protest-new-contract)