Response to Government petition reply – Vote of no confidence in Jeremy Hunt

The Government response to petition 104334 of almost 200 000 signatures calling for a vote of no confidence in the Rt. Hon. Jeremy Hunt MP, Secretary of State for Health is disappointing.

The response plainly avoids the question at hand, making no mention of Jeremy Hunt or a vote of no confidence. Instead it focuses on seven day working, assuming incorrectly that this is the signatories’ only concern. 

The Government wants to talk about seven day working

It must first be made quite clear that NHS healthcare workers are absolutely committed to improving the quality and safety of NHS care on many fronts, not least better seven day working practices. On this we are in complete agreement with the Government. However, it is the detail of how reforms have been proposed and potentially unilaterally imposed that has caused serious concern. 

The Government response, as has been the case for much of their ‘evidence’ backing seven day working, is both flawed and misleading.

The Government are deliberately using poorly evidenced, inflated figures to win headlines and generate fear. To fully understand it, the reader requires in-depth statistical knowledge. A lack of references leaves the reader unable to verify the accuracy and robustness of the statistics used.

Weekend mortality statistics

The Government claim there is a 16% higher chance of dying if admitted to hospital at the weekend – this is misleading [1]. The actual data show there is a 16% increase in absolute risk of death if admitted on a Sunday instead of on a Wednesday. The figure for Saturday is 11% [2].

That is an absolute risk reduction on an absolute risk of death of 1.32%. Thus the risk of death is increased from 1.32% to 1.53%. The authors of the original study did not describe how the severity of patients’ illnesses were taken into account, potentially seriously confounding the results. 

The figures above demonstrate an association but do not explain the cause. 

There are likely to be many reasons for this difference in mortality, but these have not been fully explored. They may well include the fact that patients probably present with more advanced illness and so are more unwell at the weekend, though clearly more study is merited [3].

In fact the original study found that in patients who were already in hospital, the chances of dying on a Sunday were 8% less than a mid-week day. Ironically, they are more likely to be on longer stay wards and therefore much less likely to see weekend consultants than those newly admitted to acute care. Besides all that, using mortality is not an effective marker of care quality [4].

The consultant opt-out clause

The response is fixated on the consultant ‘opt-out clause’ of the 2003 NHS consultant contract. This clause covers non-emergency (elective) work only. The response’s argument focuses on making hospitals safer at the weekend – this relates to emergency work and highlights the critical lack of understanding of what actually happens in the NHS. It is again emergency work to which the above mortality figures relate. There is no opt-out from emergency work, but it is critically underfunded and poorly resourced.

A Freedom of Information request responded to by 13 acute NHS trusts so far has revealed just one consultant opting out of a total of 3755 consultants (0.027%) [5]. That’s equivalent to just 12 out of the roughly 40,000 consultants working in the whole of England. This destroys the Government argument that the opt-out clause is a “major barrier” to a 7-day service. The opposite is true, it is no barrier at all.

Furthermore, the response claims that the ‘opt-out clause’ allows doctors to charge for expensive out of hours payments. The FOI data shows that this is not the case. These extra charges are for additional work hours needed to fill existing gaps in staffing due to an overall lack of consultants, NOT because consultants are opting out.

Consultant pay

Naturally, the report moves to highlight consultant pay. It quotes an average consultant salary of £118,000. Where has this figure come, how was it calculated and what are we comparing it to? The NHS consultant pay scale for England is £75,249 rising to £101,451 after 19 years as a consultant.

Can consultants work more? Most full time consultants work 10, 11 or 12 programmed activities a week (40-, 44- or 48-hour week) as a routine. On-call work happens on top of this. Therefore most consultants already work in excess of a normal 40 hour week from the outset to cope with the demands of the NHS even before on call commitments.

For example, a consultant might work five days a week. Their on-call weekend occurs on top of this time. They still come back to work again the following week, often enduring a 12 day stretch. They don’t have Monday and Tuesday off to compensate, and if they did who would do their elective work on these days? 

It is difficult to see how current working patterns of 40-48 hour weeks (plus on calls) have any space for manoeuvre. Police officers, firefighters (note: not firemen as per the government response) and prison governors who demonstrate admirable seven day working, are not expected to work in excess of 40 hours a week to do so. 

The NHS is in a state of chronic staffing shortage and this affects patient safety. Acute care had its worst winter crisis for years with worse predicted this winter. There is a shortage of health professionals and a shortage of beds. Every day hundreds of unfilled shifts remain empty forcing already overworked professionals to do the work of far in excess of one person, compromising safety, quality and dignity. 

Discharging a patient requiring social care during the week is like wading through treacle, let alone at the weekend. The catastrophic cuts in health and social care mean that patients wait weeks for a care package or an urgent ‘fast-track’ palliative care placement as this cannot be done over a weekend. These, and emergency care are far more pressing issues for the Government to tackle, rather than picking a fight with doctors on an issue on which we all agree needs improvement.

The determined Government focus on forcing consultant seven day elective working is not based on any evidence that the opt-out clause is any major barrier to seven day working. It is unworkable in isolation and may have catastrophic consequences for the NHS. Jeremy Hunt is focusing on the wrong entity; far bigger issues affecting patient care are being ignored and swept under the carpet.

Why do NHS staff have no confidence in Hunt?

If seven day service proposals and some belligerent remarks about doctors were all that had angered NHS professionals, there would be no petition. 

Jeremy Hunt has a track record of bad decisions, poor policy and failure to engage with professionals. This was the last straw. The NHS sat up, took note and decided enough was enough.

Outlined below are just some of the many reasons NHS workers have signed to support a vote of no confidence in Jeremy Hunt:

  • Co-authorship of a book advocating the denationalisation of the NHS 
  • An enduring lack of engagement with NHS professionals and a refusal to involve them in shaping the future of the NHS 
  • A non-existent understanding of what happens ‘on the shop floor’ and how the NHS really functions as a health service
  • A promise of seven day GP working services with no credible plans for addressing the GP workforce crisis
  • Suspension of the NICE safe staffing programmes focused on minimum safe nursing levels for inpatient wards
  • An acute care crisis with deteriorating accident and emergency performances, closure of inpatient beds and personal haranguing of NHS trusts repeatedly missing targets
  • A calamitous lack of understanding of evidence based medicine leading to the promotion of homeopathy as an evidence based intervention (it’s not) and misleading information about drug advances such as dementia drug solanezumab
  • Lack of apology for patient breach of confidentiality despite his own introduction of Duty of Candour regulations – if this had been a health professional there would have been a disciplinary proceeding likely leading to a Fitness to Practice hearing
  • Persistent lies, propaganda and misinformation to the public about the NHS 
  • Complete lack of experience in the healthcare sector
  • Closure of emergency services such as West London Accident & Emergency departments and attempted closure of Lewisham Accident & Emergency despite the A&E crisis
  • Overseeing progressive privatisation of the service which clearly does not work
  • Six-fold exaggeration of costs incurred by foreign nationals using the NHS
  • Public health budget cuts of £200 million despite a ‘focus on public health and prevention’

Regarding Mr Hunt, the message is becoming even louder and clearer. NHS staff and the public have had enough.

Dr Daniel Furmedge, Dr Benjamin Dean, Dr Hugh Harvey, Dr Natalie Silvey, Dr Mohsin Khan, Dr Zoe Norris, Miss Stella Dilke, Miss Stella Vig, Dr Clive Peedell, Mr Vimal Gokani and Mr Mike Henley on behalf of 196 900 signatories. Supported by GP Survival.

20:00 Sunday 26th July 2015

#iminworkjeremy #weneedtotalkaboutjeremy

  1. McCartney M. The zombie statistic behind the push for seven day working. BMJ 2015;351:h3575
  2. Freemantle N, Richardson M, Wood J, Ray D, Khosla S, Shahian D, Roche WR, Stephens I, Keogh B, Pagano B. Weekend hospitalization and additional risk of death: An analysis of inpatient data. J R Soc Med. 2012;105:74-84
  3. Mikulich O, Callaly E, Bennet K, O’Riordan D, Silke B. The increased mortality associated with a weekend admission is due to increased illness severity and altered case-mix. Acute Med. 2011;10(4):182-187
  4. Hogah H, Zipfel R, Neuburger J, Hutchings A, Darzi A, Black N. Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis. BMJ 2015;351:h3239
  5. https://www.whatdotheyknow.com/user/kiara_vincent?utf8=%E2%9C%93&user_query=consultants+opt&request_latest_status=successful&commit=Search+contributions+by+this+person Accessed 26 July 2015

Sign the petition

46 thoughts on “Response to Government petition reply – Vote of no confidence in Jeremy Hunt

  1. Jeremy Hunt is just doing Oliver Letwin’s dirty work. It’s a Conservative project to run down the NHS and push us all, in desperation, to private medical insurance. If anyone commenting here voted Tory, they’re the real villains. If Jeremy is ousted, some other apparatchik will take his place and do the ideologues’ vision.

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  2. It is about time Mr Jeremy Hunt’s statement of high mortality over weekends in our NHS hospitals is debunked. Read this report and judge for yourselves. Last Saturday there were no less than 11 Consultants were working (including me) in theatres at QEH!!! Let alone those in A&E, Medicine, Pathology, Radiology and hundreds of nurses and junior doctors of differing grades. Instead of scare mongering, he better spend his time in trying to improve the resources in the NHS hospitals, not just over the weekends!

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  3. On the back of the fact that thousands of medical staff are all tweeting, facebook sharing and posting these articles very well written articles (like above) about Mr Hunt and the 7 day working plans, if one of the Authors started a crowdfunding site asking for donations to spread the truth in full page newspaper articles that the gen pop read, I feel medical staff around the country would all contribute so we can get our TRUE message out.

    Liked by 1 person

  4. Excellent, well thought out, professional response – this is not just about Doctors it’s about the whole NHS. It needs to be publicised wherever you can – the government could learn a lot here about morals and integrity

    Liked by 1 person

  5. Its time for a march!

    After a massive response from the public to this petition Jeremy Hunt is yet to comment personally. They are trying to take out momentum from the campaign.

    Use this platform to arrange a rally! Get as many people involved as possible!

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  6. Zero empathy, zero compassion, zero understanding, zero consideration.

    These are the words to describe Jeremy Hunt and those supporting his current plans for the NHS.

    The government’s lack of ability to directly address the demands of this petition specifically the resignation of Jeremy Hunt suggest a subtle and endemic level of higher level corruption at play.

    Are there private interests involved? You betcha.

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  7. This all takes me back to the 1990Thatcher/Clarke ‘reforms’. Things have gone downhill since.

    The bottom line is that as long as the profession consents to the big idea that party politicians run healthcare for votes. What if Jeremy Hunt resigns? Some other munchkin replaces him.

    The 1948 settlement requires to be revisited. As long as the profession continues to say that however they I’ll use us and waste public money we will always support the NHS, we will have to endure a succession of Hunts.

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  8. After providing 35 years of 24/7 in addition to my 9 to 6 pm in hospital diagnostics with no additional funding for staff this is not rocket science. If there were adequate staff then a proper shift system can be operated, I introduced it in my department 8 years ago. Jeremy if you try to blast, dismantle, insult the staff in the NHS, this countries proud and caring people will oust you.

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  9. Spot on. Govt response was entirely focused on the consultant contracts whereas theproblemwithJeremy goes much, much further. I particularly like the figure of 1/3755 consultants opting out.

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  10. Very thoughtful response.

    I am increasingly of the opinion however that this was a smokescreen however to mask the proposed changes to junior doctor hours/contracts. The redefinition of antisocial (9pm on a Saturday is social??) will mean most 50% banding uplifts will drop to 40% banding – for the same hours. Basically a pay cut.

    I am also very concerned at how we will attract and retain good doctors. A survey of ~7,000 doctors completing the foundation programme in 2014 found only 58.5% were continuing in specialty (inc GP) training in the UK – down every year since 2011, when it was 71.3%. There are going to be a lot of locum shifts to fill (and that’s before immigration rules making it harder for foreign doctors to come and bridge that gap…).

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  11. I read the response from the govt. they completely ignored the petitions and went off on a completely different tangent.
    What a bunch of douches!

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  12. I am absolutely in support of this document from the practising. Mr. Hunt is a past master of blinding diversion tactics and feeding incorrect and outrageous misinformation about serious issues like doctors pay,working practices etc.

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  13. The last 2 weeks has been incredibly demoralising. Personally being overworked and undervalued doesn’t annoy me, it’s my sacrifice owing to a belief in the NHS ethos. Jeremy Hunt’s work will see basic healthcare become a premium. I can’t be a part of that, I would be disgusted with myself.

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  14. Very good. We need to get this statement to as many people as possible, with modifications as desired, ( I think respondent Rachel’s info. about Northumbria is a particularly compelling illustration of the Governments deceit). If all doctors, and a large number of other healthcare workers, and ideally members of the general public read this it would have much greater political impact.

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  15. Excellent piece of work which should be published in Newspapers to enable common man know exactly where doctors are.
    Ask Mr Hunt when you are required to get a plumber, locksmith, gas engineer over a weekend what are their charges, an average charges for a plumber are £90 + Vat and Blacksmith £110+ VAT and gas engineer range from £110- £150 +VAT and can be more.
    This is a doctor who has spent 15 years of his life reading and then to become a consultant , who comes out of University with an average debt of £50,000 and more. No wonder doctors trained in UK have migrated abroad to avoid all this polities. The personnel gain and greed of some politicians who pretend to be oblivious to the acute shortage of health care professions and are trying to burn the candle from both ends, for their short term gains should be brought to the knowledge of the tax payers.

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  16. Excellent piece, we need more of this factual and critical dissection of what is happening, as I’m sure the public will eventually lose interest in the many emotional outpoorings. If we all stay strong together we CAN make a difference.

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  17. A well worded piece, thank you. But neglecting a major issue: That proposed changes would dramatically reduce the salary of Foundation Year doctors by altering what will comprise “unsocial hours”. Not only is this deeply unfair but could have an effect on the number and calibre of people applying to medicine in the first place.

    Can we please talk about this issue?!

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  18. I am very disappointed in the Governmant’s response to the petition but not at all surprised .
    Thank you for this excellently written and very informative piece .
    We must continue to spread the real truth . Hopefully someone in power will eventually listen .

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    1. They won’t listen unless you have proper leverage. See my response earlier.

      I’m not a union agitator by any means, but I really have been through this. Unless you can show the government that there will be immediate seriously negative consequences if they push ahead, you have no bargaining power. It really is that simple.

      Liked by 1 person

  19. There is every chance that Jeremy Hunt will oversee the demolition of the NHS. It is appalling that the Government are distorting the statistics for their own political ends.

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  20. I very much like this piece. Well-reasoned and comprehensive. One small suggestion though – in the section on mortality statistics, the section on absolute vs. relative risk reads a little confusingly. Perhaps consider something like this for the first two paras of that section:

    The Government claim there is a 16% higher chance of dying if admitted to hospital at the weekend – this is misleading [1]. The actual data show there is a 16% increase in the background risk of death if admitted on a Sunday instead of on a Wednesday. The figure for Saturday is 11% [2].

    That is a 16% relative risk reduction on an absolute risk of death of 1.32%. Thus the risk of death is increased from 1.32% to 1.53% – just 0.21% (or 1 in 500). The authors of the original study did not describe how the severity of patients’ illnesses were taken into account, potentially seriously confounding the results, as sicker patients may be admitted at the weekend than during the week.

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  21. If you want a recent example of a government trying to ride roughshod over doctors working in public hospitals, look no further than the Queensland Health Senior Medical Officers’ Contract dispute of 2014. (Senior Medical Officer is the equivalent of Consultant in Australia). The State government of the day was drunk on power, with around 80% of the seats in parliament, and they thought they could do what they liked. They picked a fight not only with doctors, but lawyers and teachers too.

    The Health Minister of the time was trying to force senior doctors onto contracts that were unfair on a personal level and also compromised patient safety. Doctors were portrayed to the media as being lazy, fraudulent and unethical. The two main unions representing doctors joined forces and organised a mass resignation campaign which forced the Minister back to the negotiating table.

    We got the changes to the contract we wanted. More satisfyingly, at the State election in January, the government suffered a record swing against it, and is now in opposition.

    The point is- you need leverage against Jeremy Hunt. To do this you need a union with teeth. The DOH thinks that doctors will simply roll over and accept this, because that’s what has traditionally happened in the past. You need a well managed PR campaign to counter government spin, and a genuine, credible threat of withdrawal of labour.

    I am a British expatriate doctor now working in Queensland as an SMO. I was part of this, and I submitted my resignation letter to the union along with thousands of other doctors. These were held by the union to be handed to the government on the same day if demands were not met.

    Can’t stress this enough- without leverage you have nothing.

    Liked by 1 person

  22. Very well written and something with which I would certainly agree, apart from bullet points 9 – 12 which weaken the article’s impact. 9) This is just politics (naive not to recognise this). 10) politicians often have no prior experience in the departments they run – this is not an argument to disbar them from running the department, especially if they seek good advice (which clearly is debatable). 11) One closure and one attempted closure does not demonstrate a general policy to dismantle A&E services (although more would clearly strengthen this). 12) this statement requires evidence (especially as your argument stems from an evidence based approach.

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    1. 9) “persistent lies” is “just politics” – really? How is this acceptable?
      10) lack of experience is acceptable?
      11) it is considerably more than “one” closure or attempted closure. Departments & complete hospitals across the country have been closed or severely reduced by successive governments. More closures are planned. The occasional new hospital does not compensate.
      12) although intuitively obvious, yes, evidence would be good

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  23. This fails to mention the pay review of junior doctors which means we’re facing a pay cut of 16% that’s what worries me. There’s no mention of that in any of the media or any of the #weneedtotalkaboutjeremy rhetoric.

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  24. I would like to highlight that the response states “Hospitals like Salford Royal and Northumbria that have instituted seven day services have already seen improvements in patient care and staff morale.” I work at Northumbria Hospital, which is actually called Northumbria Specialist Emergency Care Hospital, and as the name suggests is for emergencies only. There is no elective or outpatient work at the hospital. There is a seven day consultant service but it is ALL emergency work and therefore completely irrelevant to the point the authors of the response are trying to make! In addition, Northumbria Hospital was opened on the 16th June 2015. I would be interested to know how in less than 6 weeks since the opening the government had compiled evidence to show that we have “already seen improvements in patient care and staff morale”? This links to your point on the lack of references. As far as I am aware there is no such evidence to support this claim.

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  25. Thank you for writing this. Our collective voice must be heard. Changes must be made if this country’s greatest modern achievement is to survive, and for there to be another generation of doctors.

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  26. This is excellent, thank you. We need to get this to celebrities who have lots of followers and a love of the NHS, who can get it out there to the masses. Any suggestions?

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  27. Intelligent people have a choice, they do not have to be doctors if they are going to be treated as badly as this. The hard work and altruism has ultimately become the norm and is taken for granted to such an extent that people feel they have no choice but to work out of hours for free. Many will stay because they want the NHS to work and believe passionately in it, this is an admirable thing but good will and altruism does not lead to a sustainable future for the NHS, and does not lead to a positive morale in its staff.

    Liked by 2 people

  28. What about the junior doctor contracts too? No one seems to be mentioning that this is going to represent a 15% paycut for many. And even bigger for doctors that have their oncalls off site.

    Liked by 1 person

  29. This whole affair makes me question deeply weather it is worth the effort, money and considerable time I am investing in becoming a doctor when the profession is consistently undervalued and under appreciated by those who have no other motive than their gain of power and influence to the detriment of society. Why should I continue to make sacrifices for my intended future profession when society doesn’t value me? When politicians don’t value me? When my considerable abilities are devalued to such an extent I am paid below minimum wage to save peoples lives? What value do we place on a life anyway? Less than minimum wage it seems. Pay decent wages, and good people will enter the profession. Pay peanuts, and the best will go elsewhere (law, engineering, dentistry, finance…) – and who can blame them? Certainly we value lives less than we value a shiny set of teeth in this broken society. We pay for much of our university training, we pay for membership exams, we pay for postgraduate training, college membership, indemnity. We are expected to act with the highest standards. Why then do those who run society not have to live by the same standards? Why do they not feel morally compelled to do so? If doctors behaved like politicians they would lose their licences to practise. MPs feel no moral or other obligation to behave with any integrity. Doctors have put up with too much for too long and nobody who runs this country (and many in it) truly, truly, understands what an incredible thing the NHS is, and can be, and should be.

    Liked by 2 people

    1. I would love to see Jeremy Hunt doing a volunteer weeekend as an orderly on an orthopaediic ward. Then he would be able to say that he had actual experience of the NHS. I might actually believe him that there were no stafff more experenced than him on the ward, Sadly, I can’t see anyone allowing the sad little git a place in any hospital. Come on Jeremy, show us what we get for the £70K that you think you are worth!

      Like

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