Leading statisticians have cast serious doubt on Jeremy Hunt’s claim that only 10% of patients are seen by a consultant within 14 hours of being admitted to hospital at a weekend, and described it as unfair, misleading and a gross underestimation.
NHS England has also distanced itself from the health secretary’s claim and said that the evidence it has collected on hospitals’ performance in this area does not bear out his interpretation of it.
The controversy over the accuracy of Hunt’s statement, which he made in parliament, is the second time in recent weeks that questions have been raised about a key plank of his justification for imposing a new contract on junior doctors and turning the NHS into a fully seven-day service. The row comes as the result of the ballot for strike action by junior doctors emerges on Thursday.
Doctors recently complained to the Cabinet Office that Hunt has also misrepresented key research on how many patients admitted to hospital at the weekend die because too few senior doctors are on duty, and the British Medical Journal, which published the findings, has accused him of misrepresenting them.
The new row is over Hunt’s assertion to MPs on 28 October that “currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend”.
Three experts in statistics, who at the Guardian’s request reviewed the NHS data on which Hunt based his claim, said that the average percentage of patients assessed by a senior doctor within 14 hours – across all hospitals, specialties and the whole week – is around 79%.
ProfDavid Spiegelhalter, one of Britain’s leading statisticians, said the evidence did not support Hunt’s claim. “The data from NHS England don’t seem to match up with the minister’s statement in the Commons. The average across all hospitals and specialties is 79% seeing a consultant within 14 hours. This gives a somewhat different picture, and more representative of the patient experience.”
Hunt told MPs that the 10% figure was a fact. But Spiegelhalter, Winton professor for the public understanding of risk in the statistical laboratory of Cambridge University, said Hunt’s statement was flawed for two key reasons. “First, the available data are only for emergency admissions. Second, they cover the whole week and not just the weekend.”
NHS England also made clear that “the data does not allow for separate analysis of weekday and weekend performance for this question. Hospitals answer on the basis of the full week. Therefore it is not possible to cut the data by weekday/weekend.”
Dr David Craven, a Royal Society research fellow in Birmingham University’s school of mathematics, said it was simply impossible to arrive at Hunt’s conclusion based on the data. NHS England’s statistics are not a reliable measure of how many patients were seen within 14 hours because the sample sizes are too small, he said. “The question itself seems to be chosen specifically to make the NHS look bad, and it is not a useful measurement if you want to know what the NHS is really like if you turn up as an emergency, whether on a Monday or a Sunday.”
Craven added: “With regards extracting weekend data from this, that is simply impossible, using this dataset at least. It only gives averages for the week. That’s like me telling you I had sandwiches three times this week and you working out if I had one on a Thursday; it simply can’t be done.” On Hunt’s figure, he added: “Prof Spiegelhalter is closer with the figure of four-fifths than one tenth is.”
It’s hard to miss the junior doctor contract crisis that’s going on in the NHS. The British Medical Association (BMA) has balloted its members, and if they vote to go on strike there will be three days of action at the beginning of December. But why are the junior doctors of our NHS considering striking?
I spoke to a number of them while researching this article, and all were really upset that it has come to this. The frustration is evident in their voices and their words.
It seems clear that Jeremy Hunt has publicly spread misinformation, which has confused and misled the public. The idea that there is a need to “extend” to a seven-day NHS belies the fact that this already exists. He claims that patients are more at risk at weekends – misunderstanding and misrepresenting a study that investigated associations between day of admission and mortality risk. Hunt’s language has been problematic and unhelpful – referring to those speaking out against the proposed changes as “militants”, for example, in an attempt to undermine them.
‘The truth is we have no choice’: junior doctors on striking
The junior doctors I spoke to believe a strike is unavoidable becauseJeremy Hunt has not allowed room for negotiation. This is not a rash decision: the BMA and the government have been discussing the junior doctor contract since 2012, but no satisfactory progress has been made and there has been a lack of meaningful negotiation. The Doctors’ and Dentists’ Review Body, who are advising the government, have recommended 23 changes to the contract. However, the government have informed the BMA that 22 of these are “non negotiable”. The BMA has repeatedly said to the government that they would return to the negotiation table if there was more than one recommendation to negotiate.
Hunt has also recently claimed in the press that he has offered junior doctors an 11% pay rise as part of this new contract. However, this ignores the fact that his plan to remove banding pay and change the classification of “sociable” hours will mean this is more likely to be a pay cut for most. Junior doctors were originally offered a 15% rise in basic pay to make up for the loss of the extra banding pay, the pay that Hunt dubbed “danger money”, so 11% is actually lower than they were initially offered and not a pay rise at all.
This isn’t about money – at the end of the day, a medical degree is very transferrable. Junior doctors are spending their free time campaigning so passionately about this for the love of the NHS, rather than for their livelihood. We’re fighting to protect the NHS, and the public. I never imagined that I would go on strike during my career, let alone be considering strike action just 16 months after qualifying as a doctor. It’s not a situation that anyone wants to be in, but we feel this is the only option left to protect patients, protect doctors and protect our nation’s NHS – Dr Emily Brown, junior doctor
There are also big changes for those working less than full time and those wanting to undertake academic work. These doctors will lose their pay progression, in effect being financially punished for gaining a more rounded skill set and keeping abreast of medical research. This change to pay progression is also more likely to negatively impact on women as they are more likely to be working less than full time.
Facing Jeremy Hunt’s fear: an interview with a militant NHS doctor
Pay is not the driving factor for those I spoke to – it is about ensuring the longevity of an NHS that provides safe care to patients. There are plans to change “sociable hours”. Previously, core sociable hours were 7am -7pm Monday to Friday. The new contract would change this to 7am – 10pm Monday to Friday and 7am – 7pm on Saturday. The methods by which doctors are safeguarded against working too many hours per week are being altered. The new methods appear less stringent and junior doctors are concerned they are more likely to be working excessive hours. This isn’t safe: tired doctors make mistakes.
Doctors already work long days, nights, evenings, weekends. Often at the expense of birthdays, Christmas days, weddings, funerals – I knew of one doctor who was rostered to work on her OWN wedding day, and had to plead with colleagues for someone to swap shifts with her (which, of course, someone did!) At the end of an already long shift, it is not uncommon for doctors to stay longer – because a patient became acutely unwell, because a relative wanted to talk to a doctor about their dying relative, or to lend a hand to a busy colleague if you want them to have a hope of getting home anywhere near on time. Doctors put up with a lot, and do it without complaint, for the good of the patients we care for and the job that we love. When Jeremy Hunt came out and said that doctors opt out of working weekends, and called into question our vocation and professionalism, it was like the dam broke – Dr Abbey Cargill, junior doctor
Junior doctors are very aware that strike is disruptive but feel forced in to it. This, they believe, will prevent a much more dangerous NHS in the long term.
Hunt claims that most doctors will find themselves working fewer hours under his proposed contract. If this is the case, the NHS is going to need to recruit a lot more junior doctors to cover these extra “sociable hours” he has proposed. Given that applications to medical school are falling, and more junior doctors are considering moving abroad where conditions will be better for them, it’s unclear how he intends to fill these positions.
Hunt also seems not to have considered that junior doctors do not work in a vacuum. As their sociable hours are extended, the same will need to happen for nurses, physiotherapists, porters, radiographers and all the numerous other staff. At the moment it’s unclear how this will be paid for, and where these new staff will be recruited from as well.
This new contract is only the latest of many insults. Pension contributions have increased, actual pension pay-outs have been reduced (from Final Salary to Career Average), free on-site accommodation has been removed, and pay has been stagnating for several years – Mr Alex Ashman, Clinical Fellow in ENT
Faye Kirkland and Denis Campbell and Suzi Gage
The Guardian November 18th 2915