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Junior doctors’ case a symptom of growing crisis in NHS

The British Medical Association (BMA) has withdrawn the first of its proposed five-day industrial actions. However the junior doctors’ case is one of the symptoms of a growing crisis in the NHS which the government must address.

The Faculty of Public Health (FPH) supports the junior doctors in their calls not to impose the new contract. We support the junior doctors in their fight for a safe and evidence-based service.

We believe both parties must make further efforts towards a mutually acceptable contract, turning a contract that is acceptable to a significant minority into a contract that is acceptable to all. We are continuing to argue for the specific aspects of concern to junior doctors in public health, through our work with the BMA in the Public Health Medicine Consultative Committee.

The government has failed to demonstrate the rationale and a costed strategy for its asserted policy of seven-day working. It has failed to demonstrate an adequate evidence base for this policy. Attempts to make five-day resources provide a seven-day service are unreasonable. Elevated weekend death rates are probably due to artefacts of weekend admission patterns leading to only more seriously ill patients being admitted. Major investment to secure seven-day working is unlikely to reduce weekend mortality if the major factors leading to admission at weekends are due to poor housing, social factors or lack of community nursing and care. 

The proposed action has thrown into sharp relief the widespread concerns, which we share, that there is a crisis in the NHS which must be addressed. NHS trust deficits are at their highest level ever, and there is a widespread concern at underfunding and overstretched staff, from the Academy of Medical Royal Colleges and individual medical royal colleges. There are major concerns about the shortages of young doctors in key specialties.

NHS management structures and agreements are dysfunctional, unfathomable and incompatible with an ostensible agenda of integration and cooperation. Deep cuts in social-care budgets have been catastrophic for maintaining independence and community support, creating pressures on hospitals, through additional demands for admission and delayed transfers of care out of hospital. Many of our members believe these cuts are also impacting on the reducing life expectancy of the over 85s. Major cuts in public health budgets of local authorities, highlighted as a "false economy" by the Health Select Committee on 1 September, also run counter the idea that we are supporting better health, preventing the need for healthcare and reducing demand on hospitals.

In our manifesto, Start Well, Live Better, FPH restated its belief there should be universal healthcare, free at the point of need and funded through general taxation. The NHS is consistently at the top of an international health care league table of developed nations.

FPH believes the drive for a planned population-based, integrated primary and secondary healthcare public health and social care, as demonstrated by the sustainability and transformation plans, requires a co-operative management ethos for the NHS. Some of the legal provisions requiring compulsory, competitive tendering of services run counter to the need for planning and cooperation.

FPH will continue to champion an evidence-based approach to health-policy making and for better funded public services.

We call for an independent review of the relevance of seven-day working for reducing weekend mortality, improving other outcomes, managerial efficiency and patient ‘customer’ care.

We call for a reinstatement of NHS, public health and social care budgets and progressive increases into the future.

We will express these and other concerns in our evidence to Lord Patel’s review of the long-term sustainability of the NHS and through our contributions to the work of the Academy of Medical Royal Colleges.

Written: 06/09/2016 , last modified: 27/10/2016