Friday, January 22, 2016

Muddled

Are we getting somewhere with the junior doctor contract? Well...who knows. In a fascinating game of cat and mouse, mostly played out in the public eye via selective leaks to selected people, chinese whispers, Facebook forums etc...a macabre tale of politics continues to rumble on- leaving many, many junior doctors wondering what exactly waits for them around the corner.

I have said all along...the junior doctor contract has nothing to do with 7 day service and patient safety..as confirmed now by Julie Moore and Jeremy Hunt himself now. Even the disputed studies haven't said it had anything to do with junior doctors...for sure, the usual suspects jumped in to say it was...but we conflated 2 issues..one, a genuine look at 7 day services and a contractual issue which simply meant to have more junior doctors on weekends, you either had to change the pay envelope or spread them out thinner on weekdays. Anyone who opined it was about working differently..well there's a difference between actually doing the job, running departments...and then being s keyboard warrior.

Muddled in all this has been a fundamental debate..the whole issue is 7 day services. Now that we have the issue cleared that this is NOT about elective services ( now there was a joke and a half) there is a need to have a serious discussion re 7 days. Let's park all the evidence for a minute and look at our own experiences. Is a Sunday as adequately staffed as a Tuesday? No, it isn't. Do we need it to be? Well, that's the debate when we have the financial issues we have at present. We are, officially, in the world of Monty Python where transformation funds also have a sustainability aspect, which you can only access on certain conditions, but need to be used to shore up failing trust bottom lines. We have a frothing debate about nurse staffing ratios when we don't have the finances or staff to get those ratios a tick box. We rail at the foreigners blighting our beloved NHS and then try our best to cripple other health economies by raiding those countries for their nurses.

We want better end of life care, we want better diabetes care, we want technology, we want better dementia care, we want improved community care, we want better access....we also want a 7 day service across hospitals. So which one is it that we want? All of those? Some of those? Is there any evidence that any of those are better than the others or is it driven by evangelism of a few, driven by who shouts loudest, driven by whose agenda is best suited to political needs? 

The message is muddled. The message is confusing...all the while we tear ourselves apart by opining, thinking, jousting...fantastic fodder for the press no doubt..while patients and health care professionals sit in between watching the saga unfold. We want a hospital to be safe staffed and resourced the same on a Sunday as on a Tuesday..well that's a fantastic and much laudable idea and as a health care professional, I will stand right by it. But only if you are willing to tell me what you want to stop doing. Did someone say change working habits? Don't make me giggle...I have tried/trying anything you hear about at conferences and meetings..emails/phones/Skype/hugging GPs/kissing babies....marginal benefits, amigos, marginal benefits at best till we,as a system can have a clear message about what's actually needed. And you think changing contracts will give you better staffing? Well, folks can't even implement what's in the PRESENT contract which has NO barrier to change weekend working for seniors. Did you say opt-out? Ah yes, but that's fir elective which has now been confirmed as not needed. Go figure.

So back to the junior doctor contract..a completely unnecessary protracted battle which has made even less sense as days have gone by- apart from the simple fact..to save money, we wanted the same doctors to stretch themselves for the same money, Heres a tip: you can't force vocation on anyone. Romanticising the notion of being a healthcare professional is beautiful and looks nice on a piece of paper...to get that bit extra, you need hands around the shoulders, a smile, some thank yous, a whole lot of genuine appreciation...not "do this for love..how dare you don't"

So to the many MANY leaders of this county, please...stop muddled messages. Stop coming to meetings and talking about challenging if you can't do so yourselves. Be brave, be bold and ask what exactly it is that the NHS needs as a priority...is it more nurses on wards and if so, is it at the expense of community nurses? Is it 7 day service it needs and if so, is it at the expense of end of life care..or is it by reducing dementia carers? Or is it stroke medicine.

Decisions...decisions..the problem? None of them are palatable. But then again, it may just be a whole lot better than a message which is muddled. Better get thinking quick...because that efficiency fund or transformation fund ain't coming time and time again. Either way, the muddle doesn't give the poor Trusts a chance to plan their strategies etc if no one quite knows what the message is.

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