Category Archives: In Depth

5 Reasons We Need A General Election

NHSpace looks at the arguments for calling a snap general election this autumn.

1 – The Country Dislikes ‘Unelected’ Leaders

When Gordon Brown took over the premiership in 2007, there were moans from the press that he was ‘unelected’. This wasn’t strictly true. Brown had been elected by his constituency, inherited the role of Labour leader from Tony Blair, and had been invited by the Queen to form a government. However, he lacked the mandate that many leaders gain by leading their party through a general election. George Osborne later stated that such leaders lack democratic legitimacy, and William Hague claimed that such leaders are “unacceptable” to the majority of the public. Of course they were talking about Brown; they may not feel the same way when the boot is on the other foot.

2 – Cameron and Johnson Have Abdicated Control

Having lost the EU referendum, David Cameron found himself lacking the legitimacy to continue leading the country. But his Brexit counterpart Boris Johnson has pulled out of the Tory leadership race, apparently knifed in the back by the charmless Michael Gove. The favourite for the leadership is now Theresa May, who backed the Remain campaign. With the options for Tory leader now consisting of Remainers and second-tier Leave figures, the public is unlikely to be happy whatever the result.

3 – There Was No Brexit Manifesto

Despite making a range of promises regarding NHS funding, immigration and the single market, the Leave campaign did not have a formal manifesto. (Since the referendum, they have in fact gone back on several promises and deleted almost all the content from their campaign website.) The manifesto on which the Tories were elected last year also did not detail how they would manage a Brexit vote. Nobody in Westminster has a specific mandate from the public on how to deal with Brexit. The public should now be given a chance to elect MPs based upon their plans to deal with the referendum outcome.

4 – The Country Needs Certainty

The Brexit vote has plunged the country into uncertainty. The country is currently leaderless, nobody is certain if or when Article 50 will be triggered, and the markets have responded by plummeting to historic lows. Without a general election, there will continue to be a lack of strong government, and discontent will continue as the country remains divided by the referendum result.

5 – The Public Want An Election

While most are against the idea of a second EU referendum being called, polls indicate that the majority of the British public want a general election this year. This includes 4 out of 10 Leave voters, some of whom feel they were misled by the Brexit campaign claims.

An All-Out Strike?

On Thursday 11th February, Jeremy Hunt announced that he would be unilaterally imposing a new contract on front-line doctors. In his infamous imposition letter, Hunt claimed he had the support of a whole raft of NHS CEOs. In fact, most of them had never seen the letter and did not agree with the imposition.

The BMA had proposed an alternative contract that was ‘cost-neutral’ (no more expensive than the existing deal) but kept Saturday as a weekend day with appropriate pay. Hunt couldn’t accept this because of his obsession with a ‘7-day NHS’, which we all know already exists. He therefore vetoed all such deals offered by the BMA, preventing any settlement that might scupper his plans to force doctors to work extra weekends for no extra pay. To add insult to injury, Hunt claimed that no doctor would work consecutive weekends, and then published ‘example rotas’ that had doctors working three weekends straight.

The BMA has now asserted that, by failing to provide “appropriate funding for the required level of workforce needed to deliver safe services and adequate training”, the government has broken the original ‘heads of terms‘ agreed during the initial negotiations in 2013. There will be no more talks based on ‘cost neutrality’ – that horse has now bolted, and the BMA will settle for nothing less than a fully-funded workforce. As Dr Johann Malawana of the BMA puts it, “We also know – and the public understand this – that if the Government wants junior doctors to take the brunt of delivering more services across seven days, they need to put their money where their mouth is.”

So will we be seeing an all-out strike in the coming weeks and months? The BMA have made it clear that they do not take such action lightly, and have done all they can to avoid harming patient care. But with the Conservative government working to impose an unacceptable contract that is based upon flawed ideology rather than evidence-based medicine, full strike action may be the only option left.

Analysis: BMA Suspends Strike Action

Junior doctor Alex Ashman updates us on junior doctors’ contracts.

This afternoon, the British Medical Association (BMA) announced that they were suspending the 48 hour strike, which was due next week. Hospital management across the country are sure to have cheered at that news. But why would the BMA want to avoid industrial action? What are they asking for? And what are the government doing?

Why Did The BMA Suspend The Strike?

The threat of industrial action before Christmas was enough to force Health Secretary Jeremy Hunt into talks at the eleventh hour. Hunt had previously refused to negotiate, so this ceasefire was a small victory for the BMA.

Last week’s strike action was triggered by a lack of progress, and the need for the BMA to retain the mandate provided by the 97% of members who voted for action. The strike revealed a great deal of public support for junior doctors, and was said to have ‘landed a hit’ on Hunt.

Conciliatory talks at ACAS have now resumed, with Hunt sidelined. The BMA are obviously keen to aid the talks by suspending strike action, whilst keeping the ace in their hand – the 10th February walkout – as an incentive for the government to make a deal. Avoiding excessive strike action keeps the public on the doctors’ side, and thus keeps pressure up on the government.

Why Are The BMA Still Threatening Action?

There are several aspects of the new contract that the BMA find unfair, including:

  • Removal of safeguards that prevent unpaid overtime.
  • Classification of late evenings and Saturdays as ‘normal hours’.
  • Removal of pay for unsocial hours.
  • Removal of annual pay rises.
  • Removal of pay protection for academics and pregnant women.

Last week, the BMA stated that they still disagreed with the government on around 20 out of the 44  points being discussed.

What Are The Government Doing?

Outside of the talks, the government continue to bully junior doctors. Jeremy Hunt and David Cameron openly blame junior doctors for an imagined lack of 7-day NHS cover. Despite Hunt being criticised for misrepresenting stroke mortality figures, Cameron still repeated his misleading figures on national radio. Both the Health Secretary and the PM have gone on the record threatening the ‘nuclear option’ of forcing the contract upon junior doctors. Whispers in Whitehall are that the government are certain they will win the dispute through sheer brute force. Perhaps they have forgotten that, as with any nuclear option, they are courting mutually assured destruction.


Junior Doctors’ Pay – The Facts

Junior doctor Alex Ashman has the inside story on what junior doctors are actually paid.

A new ‘investigation’ by the Daily Mail has apparently revealed that fifty thousand NHS staff earn more than £100k. The timing of this announcement is somewhat suspicious, coming as it does during a dispute over junior doctors’ pay. But how much do junior doctors actually earn?

Basic Pay

A first year doctor (F1), having completed five/six years in medical school, receives a basic salary of £22,636. Thanks to below-inflation pay rises under the coalition government, today’s F1s are as much as £6,300 worse off compared to F1s in 2010.1

F1s are paid poorly because they traditionally received free onsite hospital accommodation. This was taken away in 2010, but there was no compensatory pay increase.

After one year, F1s become F2s, and their basic pay rises to £28,076. Further progression is rewarded with smaller increases thus:

Year of Service Typical Title Basic Pay Minimum Age
 First House Officer / F1  £22,636  23
 Second Senior House Officer / F2  £28,076  24
 Third Senior House Officer / CT1  £30,002  25
 Fourth Senior House Officer / CT2  £31,838  26
 Fifth Registrar / ST3  £34,402  27
 Sixth  Registrar / ST4  £35,952  28
 Seventh  Registrar / ST5  £37,822  29
 Eighth  Registrar / ST6  £39,693  30
 Ninth  Registrar / ST7  £41,564  31
 Tenth  Registrar / ST8  £43,434  32
 Eleventh  Registrar / ST9  £45,304  33

Banding Supplements

For many junior doctors, basic pay is funded by their regional deanery. The hospital they work for then pays a banding supplement based on the unsocial nature of the hours they work (nights/weekends/long shifts).

Banding supplements were introduced to punish hospitals for overworking their junior doctors. Doctors working traditional 80-hour weeks were given up to 100% extra pay, ending the 80-hour week pretty damned quickly!

Today’s junior doctors seldom receive the higher banding rates. A few receive a 0% rate and are ‘unbanded’, meaning they work 36 hour weeks. Most junior doctors work up to 48 or 56 hours a week, meaning they work 30-55% additional hours. For this they receive 20, 40 or 50% more pay, depending on just how many long shifts, nights, weekends and bank holidays they work.

How Many Junior Doctors Earn 100k?

None of them. Not unless they have a side job that pays more than their work as a doctor! As demonstrated above, doctors can easily reach their mid-thirties without ever getting anywhere near such a salary. Even a junior doctor in their tenth year earns less than an newly-elected MP.2


1 – In 2010 an F1 earned £22,412 basic pay, which would be £26,840 in today’s money. Assuming they work in a post with 50% banding pay, today’s F1s are £6,300 worse off compared with their 2010 colleagues.

2 – MPs currently receive an annual salary of £74,000 plus expenses. Compare this with an ST8 on 50% banding, who will earn £65,151 but have to pay their own professional expenses.

7 Reasons Why The Junior Doctor Contract Is Unfair

Junior doctor Alex Ashman explains why you shouldn’t listen to the Daily Mail.

Doctors aren’t in it for the money. Remember that they chose this career over many other options. If money was a big deal, they’d have skipped medical school and gone to work for Deloitte. Instead, they chose to work weekends and nights, getting shouted at and getting covered in other peoples’ bodily fluids. So please let’s do away with the Daily Mail conspiracy theory that doctors are scheming to bring down the NHS, like a bunch of crackpot Bond villains. They are in fact real people with children to feed and mortgages to pay.

Here are the real reasons why junior doctors are fighting against the new contract:

It Removes All The Safeguards

The new contract does away with ‘banding’, whereby hospitals have to pay junior doctors a higher rate if they are forced to work unsafe 80-hour weeks. Banding was a great innovation and successfully brought in a 48 hour week as required by the European Working Time Directive. Under the new contract, doctors will be left with no protection from dangerous long hours, thus putting patients at risk.

It Extends Normal Working Hours

The new contract extends so-called ‘normal’ hours to include late evenings and Saturdays, treating 9pm on a Saturday evening as being the same as 9am on a Tuesday morning. This can only be an attempt to have doctors work more hours, which is bad for patient safety.

It Punishes The Busiest Specialties

Junior doctors already working long hours in A&E, in GP surgeries, and in paediatrics will all suffer as a result of the new contract. These busy specialties are already struggling to recruit new doctors and will likely see an exodus of staff under the new contract. If this happens, the NHS will genuinely tip over the edge and experience a real ‘crisis’.

It Punishes Women and Academics

The new contract removes annual pay progression, which is awarded based on level of experience. This is the only annual pay increase doctors get, as their baseline salaries usually get 0% increases each year. Thanks to the removal of annual pay progression pregnant women, academics, and doctors who work less-than-full-time (e.g. parents who also work) will receive less pay.

It’s Being Forced Through By The Government

The contract negotiations between the government and the BMA doctors’ union were essentially a sham. The government came to the table with a list of demands, unwilling to haggle. Naturally, the BMA walked out.

Hunt Lied About Weekend Deaths

Jeremy Hunt’s line, about increased weekend deaths being due to doctors not working weekends, is a lie in more than one way. Firstly, junior doctors already provide a 24/7 service for the NHS. Secondly, the authors of the scientific paper used by Hunt have stated that any attempt to link weekend deaths with junior doctors’ working patterns would be ‘rash and misleading’.

Hunt Lied About The 11% Pay Rise

With the removal of ‘banding’ payments, junior doctors stand to lose around 30% of their pay package. Jeremy Hunt has offered an 11% increase in basic pay to compensate for this. Not only is this not a ‘pay rise’, but the 11% figure doesn’t relate to anything in the actual contract details, and thus seems to be a ‘sound bite’ used by Hunt in an attempt to discredit doctors.

6 Reasons You Can’t Take Jeremy Hunt Seriously

1. He confused a train’s emergency cord with the toilet flush – anyone familiar with NHS toilets would have seen this trick before and know to avoid the emergency pull and use the handle instead.

2. He’s trying to re-brand the Tories as the NHS party and has been name-dropping Nye Bevan in his speeches – the same Nye Bevan who famously described the Tories as ‘worse than vermin’.

3. He doesn’t understand the new junior doctor contract is unsafe and unfair – Hunt clearly has very little insight into how the NHS works, especially given that one of his fellow Conservatives has raised concerns about the new contract.

4. He says GPs are being punished with underfunding as a ‘penance’ for the 2004 GP contract – Hunt is happy to punish different parts of the NHS workforce for their apparent sins, and doesn’t seem to understand that this will hurt patients, too.

5. He thinks tax credit cuts will make people work harder and be like the Americans or Chinese – Hunt’s failure to understand the need for a financial safety net doesn’t bode well for our medical safety net.

6. He thinks doctors’ judgement should be replaced with more computers in the NHS – Hunt obviously hasn’t used the 111 service, which uses computer-based flowcharts and usually ends with ‘call an ambulance’ or ‘go see a doctor’.

Is Jeremy Hunt Breaking The Rules With His Latest Panic Pledge?

Thanks to Dr Louise Irvine, Jeremy Hunt has already been feeling the pressure in his seat of South West Surrey. But now it would seem that a second candidate is getting to him. Today, Hunt made an unscheduled visit to Stafford, another Conservative seat, to ‘set the record straight’ by pledging not to completely close the county town’s local A&E.

Stafford candidate Karen Howell has long been campaigning against the Tory plans to close her local A&E. Here’s what she thinks of Jeremy Hunt’s visit:

This is an outrageous attempt by Jeremy Hunt to try and ​bribe the people of Stafford into voting Tory. His government moved the ​A&E ​services away from Stafford. Now he is claiming they ​will be restored​ 24/7​. The people of Stafford have been through enough. It’s disgusting that the Health Secretary is playing politics with them like this.

That much is clear. But is this just a case of dirty Tory politics, or has Hunt actually broken the rules? Purdah, which began on 30th March 2015, is a pre-election period in which government officials are not allowed to announce new initiatives, at a national or local level, that could be advantageous to a given party or candidate in the election. While it is unlikely that any punishment would be applied to Hunt for today’s actions, it is rather suspicious that the last government’s Health Secretary made a 30 minute visit to a town 3 hours away from his South West Surrey seat in order to make a health-related announcement.