Last weekend (19th & 20th July 2015) tweeter was alive with #ImInWorkJeremy as NHS staff tweeted that they were working that weekend. They told of busy shifts, early starts, and listed the other staff they were working with, even Consultants. This was a direct challenge to Jeremy Hunt and his latest plan for a seven-day NHS, because if you’d listened to him lately you’d have thought that the NHS was running only a skeleton staff at weekends and wilfully putting patients’ lives at risk. The #ImInWorkJeremy tweets painted a very different picture.
Jeremy Hunt’s argument has been that if you’re admitted to hospital at a weekend you’re 16% more likely to die then if you’re admitted during the week, and 6,000 people a year die needlessly because of the “poor” healthcare at weekends (1). And who fault is this? Hunt says it’s hospital consultants because they “refuse” to work weekends.
Margaret McCartney, in the BMJ, neatly took apart the 16% statistic (2). This figure comes from a 2009-10 study of English hospital admissions, during a thirty day period. There were 14 217 640 admissions and 187 337 deaths during this time, which is a death rate of 1.32%. Of that 1.32%, there was a 16% increase of deaths if the patient was admitted on a Sunday, but this means that there’s a 0.2112% increased risk of death for all patients admitted on a Sunday, and not a 16% (2). Also, there is no evidence for why there is this increase, it’s not just because the senior Consultant was at home that day.
The 6,000 deaths a year caused by “poor” care at the weekend, this figure comes from an unpublished study (1). Therefore no one can analyse the data, the study, its findings or even see what the study was about. We can’t check this figure because no one knows where it came from. This is one of the most dishonest uses of statistics, quoting ones that no one else can check.
But these criticisms don’t seem to have stopped Hunt, he is now threatening to push through this reform with or without the support of NHS staff, and as he does so he’s painting a prejudiced and out-of-date picture. According to Hunt, Consultants are fat-cats, more interested in playing golf than seeing their patients on a Sunday afternoon. This image isn’t true but it gleefully appeals to tabloid newspaper prejudices and makes good headlines. It also plays into the old image the bullying Consultant who nobody dares question.
The truth is that many Consultants are already working weekends. The 2003 Consultants contract, the one Hunt wants to rip up, says that senior doctors can opt out of weekend work only if their work is non-emergency/urgent, but they are still expected to be on call. So why does Hunt want to change this?
Am I being paranoid in fearing that there is an agenda behind Hunt’s plan? Consultants have been very vocal opponents of current changes being imposed on the NHS, especially the Health and Social Care Act 2012. Is this an attempt to silence them, to break their perceived power? If so what for, more contracts in the NHS? More privatisation of the NHS? Hunt’s actions are certainly confrontational, his talk of lazy doctors and consultants putting patients at risk. This is not the behaviour of someone wants to negotiate and improve patient care.
And what was Hunt’s reaction to #ImInWorkJeremy? On Friday (19th July) he posted a picture of himself, on a hospital ward, on twitter, and in the background could be clearly read patients’ names and details. He breached patient confidentiality (3).
I was working last weekend, I tweeted #ImInWorkJeremy both days, and both days I was late leaving because of the volume of work we had to do. Jeremy Hunt, he was on holiday, the start of his seven weeks summer holiday.
P.S. This blog was originally written for and published on the RCNi website