Hunting for a way out

Late last week Heidi Alexander made a last-ditch plea to the government in a bid to halt imposition and instead pursue a pilot of the new contract with independent evaluation and auditing of ‘the weekend effect’, an idea co-signed from across the House of Commons and seemingly giving Jeremy Hunt the ‘out’ he needs.

The proposal however seemed to anger swaths of my junior doctor colleagues, who understandably do not see how and why you would pilot a contract which is so clearly unsafe, unfair and unworkable. But maybe we missed the subtlety of what was being offered.

In producing this offer, Alexander constructed a political tool that Hunt could not simply ignore and left him in a difficult position whatever action he decided to take. Accepting the offer could have provided much needed breathing space for both sides – an opportunity for the medical profession to test the claims made by Hunt that the new contract will improve mortality rates and counteract the ‘weekend effect’ and a foothold for Labour to broker a constructive approach to resolving the dispute. Reject the offer and Hunt is publicly saying, ‘I am not willing to test the idea before implementing it’ or, ‘I don’t have enough confidence that the contract will deliver’, a move that paints him as reckless, illogical and uninterested in evidence-based medicine – the foundation of modern healthcare.

Of course, Hunt did quickly dismiss the offer, likely believing that, for him, this would be the lesser of two evils. To his mind, acceptance would demonstrate abject weakness in the face of a union, setting a precedent for others to follow, and destabilising the tenure of an already fractious governing party. His machismo and blind arrogance would never allow it. But I think Alexander knew this already – she had set a trap he could not avoid. Rejecting a more constructive, logical and sensible approach, now it is the government which is firmly in the seat of incompetence, unreasonableness and militancy – a position hard to escape from whatever the outcome of this industrial action.

This built the foundation for her rebuttal in the Commons yesterday, as Hunt delivered another prototypical and empty rendition of ‘spin’ bingo – 11,000 deaths, weekend effect, pay increase, less hours, seven-day services. In response Alexander delivered a virtuoso performance, anchored in Hunt’s tweeted dismissal of her well-developed and solid offer, and reminding him of his central role in the escalation and poisoning of the dispute.

Hunt seems set on a wholly destructive path – his eyes are closed, his foot is on the gas and the cliff is rapidly approaching. To back down would be to add to a catalogue of embarrassing Tory U-turns, and perhaps the end of his frontbench, if not long-term parliamentary, career. But to continue threatens the fundamental principles of the National Health Service. The factual arguments seem to be over; the public as well as medics and other healthcare workers across the country do not trust him. His repetitive spiel and increasingly personal attacks on doctors are not gaining traction. But for him this is not about the weekend effect, patient care, or the wider NHS; this is about showing that Tories do not lose to unions, staff or public pressure, and it will be the NHS and patients that suffer.

Whatever happens in this dispute, we can only hope that one day the country gets a health secretary who is less concerned with personal image, political point-scoring and beating the medical profession, and more focused on improving patient outcomes, building a motivated and fulfilled workforce, and tackling the long-term problems facing the nation’s health service.

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Photo: DCMS

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