President's view: The government risks a widening credibility gap

HCSA President John Schofield warns that safety cannot fall victim to the relentless push to force through major changes to services

The HCSA has always said that it supports safe seven-day services in the NHS. But as the weeks pass by, the ongoing acrimony surrounding contract changes for consultants, specialists and speciality doctors in training increasingly threatens the prospect of a safe, workable outcome.

With the government facing criticism from all sides over its proposals, including from key medical colleges and leading NHS figures, now would be the worst time to lose sight of the need for any settlement to enshrine safety for patients and staff.

We all know that this is clearly going to require significant investment, as well as service re-engineering.

It will also require serious and detailed discussion between all stakeholders. Negotiation not imposition is the only way that this can be achieved.

Yet instead of engaging with front-line staff to shape the health system of the future, it is saddening that the government has embarked on a public relations campaign that has at its heart a crude distortion.

At the Conservative Party conference in Manchester at the start of October, Jeremy Hunt talked of “the scandal of 11,000 excess deaths each year because of what is known as the ‘weekend effect’ in hospitals,” using this a justification for the government’s position on seven-day services.

As doctors, to us just one “excess” death, be it at the weekend or during the week, is one too many.

But the authors of the research to which Jeremy refers state clearly that it would be “rash and misleading” to conclude from their findings that any exact number of deaths among such patients could be avoided.

The use of such extrapolations is in effect scaremongering on a massive scale, and Jeremy Hunt should be ashamed of himself.

The dangers of this tactic were put into stark relief with growing reports of a so-called “Hunt effect,” where patients were refusing treatment at weekends due to the adverse publicity surrounding outcomes – risking their own health and leaving the health service facing higher costs treating more acute symptoms.

What’s more the high stakes of getting the push for seven-day services wrong were revealed by the heartfelt responses of hundreds of HCSA members as part of our research on workplace stress.

Seven in 10 reported levels higher than a year ago. One in three hospital doctors reported “unreasonable” levels of work stress most or all of the time in an average week. Around 83 per cent of respondents reported that work-related stress had taken a toll on their family life.

Even more ominously, 80 per cent of respondents were considering retiring early because of stress.

That threatened exodus among experienced hospital doctors is matched by evidence of a rising dropout rate among specialty doctors in training, as competition for posts collapses in historical terms.

The government’s hard-headed approach flies in the face of all these symptoms of an alienated and demoralised workforce.

Increasingly there appears to be a dangerous and damaging disconnect between those on the front line and 

policy-makers in distant Whitehall.

Yet we also know that, if they are empowered and given sufficient support along the lines of the recommendations within Lord Rose’s report on NHS leadership, that there are consultants keen to take on a role in leading the innovations that our health system requires.

We now stand at a crossroads. One signpost points to a seven-day future of unsafe, understaffed services and a burnt-out, demoralised workforce. The other leads to a round-the-clock NHS of technical and medical innovation and properly staffed, properly resourced acute services.

There is a growing sense that the credibility of the government and the Secretary of State himself is now at stake over its handling of these issues.

The HCSA intends publicly and in meetings with ministers to press our case harder than ever, and to drive home our own ideas on how the service can be reformed and improved.

We cannot and will not allow the previous failure of negotiations to temper our requirements for a safe service.

John Schofield is President of the Hospital Consultants & Specialists Association.