The key to a successful outcome to current discussions over seven day services will hinge on the needs of patients, the NHS and consultants. Safety, fairness and work-life balance are a must, writes Eddie Saville

Hospital doctors have lately been reduced to frustrated bystanders as the public debate on seven day working and fundamental changes to contracts has raged.

Eddie Saville

Eddie Saville

On 16 July, when the Review Body on Doctors’ and Dentists’ Remuneration released its observations on these issues, our profession felt the full force of the media juggernaut, with combative news anchors demanding to know why consultants appeared to be putting up resistance to such a well intentioned goal.

Yet ask doctors whether they are in favour of a seven days a week service and you will find the majority will answer positively.

A rebuttal

Equally, when it comes to another media insinuation sometimes directed at consultants – that they are only interested in themselves when it comes to the current proposals – Hospital Consultants and Specialists Association (HCSA) members can easily rebut the claim.

Within the last 12 months our members chose to take action short of a strike in support of our lower paid colleagues in other unions. Far from guided by self-interest, hospital doctors are part of the family of the NHS – as concerned about the health of the whole medical system as they are about the patients they treat on a daily basis.

It is for this reason that the HCSA, reflecting the view of the majority of our members, has long been willing to engage on the question of seven day services.

‘Even one death through lack of resources and skills is one too many’

It is not a new issue. There has for some time been an established consensus within a number of specialties that the presence in hospital of senior medical staff out of hours is essential to provide good quality medical care.

In some areas of medicine you will regularly see consultants undertaking weekend ward rounds and operating lists when they are on call.

While the figures used to highlight weekend deaths are disputable, even one death through lack of resources and skills is one too many.

So in the past the HCSA has been supportive so long as the changes:

  • have been consensual;
  • have not required lengthy continuous working;
  • ensured proper rest periods; and
  • provided for a reasonable family life.

Basic principles

On a large scale the key to a successful outcome to current discussions will be one that balances the needs of patients, the NHS and consultants. This means that it must adhere to three basic principles – safety, fairness and work-life balance.

Safety, so that hospital doctors are not run ragged by overwork or staff shortages, have enough training hours in the week to maintain cutting edge skills, and have the time to recover through proper rest periods.

Fairness, meaning proper recognition of the skill sets required within our NHS and the more than a decade of training it takes to become a fully qualified consultant – something it is also essential to recognise if we are to attract new blood and retain current staff.

‘Hospital doctors are not super-human’

And a work-life balance based on recognition that hospital doctors, like all NHS employees, are not super-human. Nor should they be forced to sacrifice the basics of family and recovery time because of well intentioned, but hastily conceived, plans that fail to acknowledge the additional resources seven day services will require.

Ultimately, neglect in any of these three areas will mean that patients, and the reputation of our world class NHS, will also suffer.

Solutions through negotiation

Yet we fear there is a very real prospect that this could be the outcome of the current debate, given the desperate scramble for a resolution that now seems set to take place.

We believe that the HCSA has the skills and ideas required to build and improve on the DDRB report. As an affiliate of the Trades Union Congress, our organisation has a wealth of experience when it comes to finding solutions through negotiation.

It was therefore to our dismay that the basic tenet of members’ representation – that getting down to the nitty gritty of talks is, ultimately, the only way to get results – was abandoned last October with apparently no plan B aside from “wait and see”, and hoping for a friendlier face in government. We believe that this was a strategic error.

‘A “wait and see” approach was a strategic error’

Such actions will certainly garner headlines, but are significantly less effective when it comes to achieving results.

So we are now in a position where months of possible engagement on the issue have been lost, leading to a real danger now that the outcome will be imposed.

The issues are far too important for that.

HCSA is proud to state that it is in favour of safe seven day services – safe for patients, safe for doctors and ensuring the NHS’s future is safe too.

Now is the time for cool heads.

We believe there can be no compromise when it comes to our world class health service, and it is in this spirit that HCSA offers our negotiating experience to assist in securing a deal that serves the NHS best.

Eddie Saville is general secretary of the Hospital Consultants and Specialists Association