Junior doctors' contracts: BMA being misleading - Hunt

Five junior doctors have given their take on the contract issue

The health secretary has accused the doctors' union of misleading junior doctors over changes to their contracts in England, ahead of a rally later.

Doctors are expected to march in protest at the changes which they say will lead to a drop in their salaries.

Jeremy Hunt said the proposals would benefit doctors by reducing their maximum weekly working hours.

The BMA denied it had misled its members and said the rally in London would be a wake-up call for ministers.

The government has indicated it will impose the new contract next year in England. Scotland and Wales have both said they will maintain the old contract; Northern Ireland has yet to decide.

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Analysis

Image captionJunior doctors took part in a protest in central London earlier this year

By Hugh Pym, BBC health editor

There is a sense that Jeremy Hunt's patience is wearing a little thin. His latest interview is in effect an attempt to sidestep the BMA and appeal to the wider body of junior doctors in England.

But the BMA's response is that the thousands of doctors who will protest on Saturday in London and Nottingham will demonstrate the strength of feeling and unity behind the campaign against the controversial new contract.

The question is how ministers will respond to the weekend's protests and the BMA's continuing planning for a ballot of members on industrial action.

Read more from Hugh

What is the junior doctors row about?

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Mr Hunt told the BBC: "I think it is incredibly disappointing, the way that the BMA has misrepresented the government's position.

"It's caused a huge amount of anger unnecessarily; we don't want to cut the pay going to junior doctors, we do want to change the pay structures that force hospitals to roster three times less medical cover at weekends as they do in weeks and that means that there's a 15% greater chance of you dying if you are admitted on a Sunday, compared to being admitted on a Wednesday."

'Good deal'

He told BBC Radio 4's Today programme that a reduction in overtime rates at weekends would be compensated with extra basic pay.

Mr Hunt said he wanted to remove financial penalties "that force hospitals to roster less at weekends" and was willing to negotiate over safeguards that will stop doctors from working too many hours.

"This is a good deal for doctors. We are reducing the maximum hours a doctor can be asked to work from 91 to 72 hours [a week]. We're stopping doctors being asked to work for five nights in a row."

Mr Hunt also called on the BMA to return to the negotiating table.

Image copyrightPA

Image captionJeremy Hunt says changes to contracts will improve patient care

The BMA is demanding that the government withdraw its threat to impose the new contract in England from next year.

Dr Johann Malawana, chairman of the BMA junior doctors' committee, said Mr Hunt needed to listen not just to the BMA but to junior doctors themselves.

"The fact is we want a contract that is safe for doctors in terms of maintaining safe, clinical care and delivers a safe NHS for patients," he said.

'Financially unviable'

Commenting ahead of the rally in central London, Dr Malawana said the gathering would be "a wake-up call for ministers".

"The health secretary has accused junior doctors of misleading the public over the impact of his changes, yet at the same time he continues to conflate junior doctors' legitimate concerns and the government's rhetoric on seven-day services.

"The truth is that the junior doctor contract is in no way a barrier to seven-day services, with the vast majority of junior doctors routinely providing care to patients 24/7."

Dr Dagan Lonsdale, a specialist registrar working in intensive care medicine, said the thousands of doctors who will be demonstrating saw the proposed contract changes as "unsafe for patients and unfair to doctors".

"I already have a situation where I have to pay out fees for my training," the 32-year-old told BBC Radio 4's Today programme.

"If I am one of the doctors who loses out in this new contract, then again for my wife and I it becomes financially unviable for us to remain as doctors.

"Now that's not me being greedy, that's me just saying that the pennies coming in won't match the pennies coming out and I will have to leave medicine, that's a fact."

Gavin Brittain, a junior doctor in Greater Manchester, told the BBC: "We feel that the contract removes a couple of vital safeguards that are currently in place, that would lead to us working longer, unsafe hours.

"That might then lead to us becoming more tired, and as we all know, tired doctors are more prone to make mistakes and at the end of the day, mistakes can cost patients' lives."

More patients in Scotland given antidepressants

• 13 October 2015
 
• From the sectionScotland

Image copyrightThinkstock

Image captionOfficial figures indicate an association between deprivation and the use of antidepressants

The number of people in Scotland treated with antidepressants has risen by 5% in the past year, according to official figures.

The drugs were dispensed to 814,181 patients in 2014/15. Since 2009/10, use of antidepressants has increased by 28.5%.

Two-thirds of the patients given the drugs were women, with use peaking in the 50-54 age group.

The figures indicated antidepressant use was associated with deprivation.

They recorded 225,969 patients in the poorest parts of Scotland receiving the drugs, compared with 110,507 in the least deprived areas.

The total cost of antidepressants to the NHS in Scotland was £40.8m. The use of lower-cost drugs means this figure has fallen by one-third over the past 10 years.

'Extremely alarming'

The figures were described as "extremely alarming" by Conservative health spokesman Jackson Carlaw.

He said: "Years ago the SNP pledged to stop this rise, yet it hasn't even been able to make a dent in it.

"We are now looking at the flabbergasting statistic of more than one in seven people in Scotland being prescribed antidepressants this year.

"There's no doubt these drugs have a place in addressing mental health issues. But we urgently have to look at better alternatives than simply parking people on medication in the hope things don't get any worse, with no aspiration for complete recovery."

Liberal Democrat health spokesman Jim Hume also voiced his concern.

"The fact that we have seen such substantial increases in prescriptions raises real concerns over whether this reflects shortages in other services," he said.

"We need to ensure that doctors across Scotland are able to refer patients to the services that offer them the best chance of recovery. If doctors are prescribing anti-depressants because they feel they have no other option then this is a real problem.

"These figures should raise a red flag for SNP ministers. They underline the need for greater investment in mental health services across Scotland."

Stigma 'declining'

Jamie Hepburn, the Scottish government minister responsible for mental health, said: "The Scottish government has long worked hard to reduce the stigma faced by people with mental health problems.

"As this stigma declines we would expect more patients to seek help from their GPs for problems such as depression.

"This is reflected in recent statistics which show a 27% increase in the numbers of people starting treatment for psychological therapies in the quarter ending June 2015 - compared to the same period last year."

He added: "People with mental health conditions can be amongst the most vulnerable people in our county and it's vital that the health service is properly equipped to give them the support and treatment they need. That is why we are investing an extra £100m to further improve mental health services.

"This will include funding for child and adolescent mental health services, and will help bring down waiting times. It will also be targeted at improving access to services, and in particular psychological therapies."

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NHS agency staff cap 'to save £1bn'

• 13 October 2015
• From the section Health

Image copyright SPL

Ministers have set out details of how they aim to save the NHS £1bn on agency staff costs over the next three years.

In June, the government in England said agency spending was to be capped and it has now unveiled details of how that will work.
From April, NHS trusts will not be able to pay more than 55% more to agencies than it costs to pay a member of staff for a shift.
It comes amid mounting pressure on NHS finances.
Figures released last week showed trusts had overspent by £930m in the last three months - with agency spending highlighted as one of the biggest factors.

Ministers believe the move will save £1bn by April 2018 - the equivalent of shaving 10% from the £3.3bn annual agency bill.

'Tough new controls'

Reports have emerged of agencies being paid thousands of pounds to supply nurses and doctors for shifts.
The new limit will start to be phased in from November - with the "shift rate plus 55%" limit kicking in in full from April.
Agencies are being allowed to charge more to reflect the costs they face in terms of administration and National Insurance contributions.
Health Secretary Jeremy Hunt said: "For too long, staffing agencies have been able to rip off the NHS by charging extortionate hourly rates which cost billions of pounds a year and undermine staff working hard to deliver high-quality care.
"The tough new controls on spending that we're putting in place will help the NHS improve continuity of care for patients and invest in the front line - while putting an end to the days of unscrupulous companies charging up to £3,500 a shift for a doctor."

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mengele : Food and water fears for ponies

NHS deficits hit 'massive' £930m

By Nick TriggleHealth correspondent

• 9 October 2015
 
• From the sectionHealth

Image copyrightThinkstock

NHS trusts in England have racked up a £930m deficit in the first three months of the financial year - that is more than the entire overspend last year.

Regulators said the problems were the "worst for a generation" and demanded immediate action be taken.

The scale of the deficits - eight in 10 trusts are in the red - also prompted warnings that care would suffer.

The accounts cover hospital, mental health, ambulance and some community services.

Between them they account for about two-thirds of the NHS's £116bn budget - with the rest going on other areas including GPs, drug prescribing and training.

Last year, NHS trusts overspent by £822m - with the health service as a whole balancing the books only after a cash injection from the Treasury and by raiding the capital budget earmarked for buildings.

NHS deficit

£930m

NHS trusts deficit for April to June 2015

• £451m deficit for same period last year
• £822m total overspend for the whole of last year
• £2bn estimated deficit for the 2015/16 financial year

Source: Monitor and Trust Development Authority

But it is thought unlikely there will be the money in the system to plug the shortfall if the financial situation continues to deteriorate in this way.

It has been suggested the deficit among the 237 NHS trusts could top £2bn this year.

The figures released by the two regulators - Monitor and the Trust Development Authority - show the NHS is on track for that as spending pressures do tend to ease as the financial year goes on.

Nonetheless, trusts - and in particular hospitals - are now under pressure from regulators to make savings.

Spending on agency staff has been highlighted as one of the biggest potential savings, but the accounts also show that rising demands year-on-year have been gradually making it harder for trust to break even.

David Bennett, chief executive of Monitor, said: "Today figures reiterate the sector is under massive pressure and must change to counter it.

"The NHS simply can no longer afford operationally and financially to operate in the way it has been and must act now to deliver the substantial efficiency gains required."

However, most experts believe the NHS has little wriggle room to improve its performance.

Chancellor George Osborne said: "More than £2bn extra are going into our health service this year with more to come.

"Clearly the NHS has to spend that money well and deal with things like rip-off nursing agencies and management consultancies that charge too much.

"We want the money going to the frontline."

'Challenging'

Nigel Edwards, chief executive of the Nuffield Trust think-tank, said: "Financial problems on this scale cannot be explained by individual pockets of mismanagement - we are looking at a systematic problem across the health service.

"It is becoming increasingly impossible to provide quality standards, timely access to care and financial control at the same time."

Paul Healy, from the NHS Confederation, which represents trusts, said: "Hospitals and other front-line organisations have all-but exhausted their options for becoming more efficient."

He said it was important that the extra money being promised to the NHS this Parliament was front-loaded so that most of it came in the first few years.

But the Department of Health said there were still savings that could be made - and it expected performance would improve as the year goes on.

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Analysis: Do deficits matter?

It is easy to be blase about NHS deficits and think the money will always be found to bail out the health service. That is the case - but only to a certain extent.

While there are a number of trusts that have been overspending for years and have been kept afloat by the wider system, the support is not endless.

Three years ago, South London Healthcare, which ran three hospitals, was allowed to go under after racking up large deficits.

Howhe problem this year goes beyond individual NHS trusts and to the very heart of government.

A deficit on the scale of £2bn among trusts will make it incredibly difficult for the Department of Health to balance the books overall.

If that happens, it will have to go cap in hand to the Treasury. For a service that is being protected from cuts to have to do this raises some very difficult questions all round.

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Alongside the financial data, the regulators have also warned about worsening waiting times for hospital treatment.

Latest figures show:

• The number waiting for non-emergency operations, such as knee and hip replacements, is 3.3 million - the highest level since early 2008
• The 62-day cancer waiting time target has been missed for the past 16 months
• The four-hour A&E target has been missed for 11 of the past 12 months

Newcastle upon Tyne Hospitals NHS Foundation Trust chief executive Sir Len Fenwick, the longest-serving hospitals boss in the health service, told the BBC the pressures were likely to mean winter would be extremely difficult.

He predicted non-emergency operations would need to be delayed to help hospitals cope.

"In the coming winter, we do believe there will be greater pressures than ever before," he added.

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Bowel cancer is four distinct diseases

• 3 hours ago
 
• From the sectionHealth

Image copyrightSCIENCE PHOTO LIBRARY

Bowel cancer is four distinct diseases, each with a different prognosis, scientists have discovered.

Armed with this new knowledge, doctors might better determine which patients need the most aggressive treatment, the Institute of Cancer Research team say.

They looked at laboratory and clinical data from more than 3,000 patients with bowel cancer to see if they could better classify the disease.

Nearly all of the tumours could be sorted into the four groups.

The groups focus on the genes a tumour contains, rather than just the type of bowel tissue that it affects or how far it has spread - although those factors are important too.

Grouped by genes

Cancers that fit the four consensus molecular subtypes (CMS1, CMS2, CMS3 and CMS4) share genes that dictate their behaviour and might also make them more or less vulnerable to certain treatments, Nature Medicine reports.

Patients with CMS4 tend to have the worst prognosis and might need more extensive treatment, for example, while those with CMS2 have much better survival rates, even if the cancer returns.

Image copyrightThinkstock

Researcher Dr Ganiraju Manyam said the discovery was important for knowing how best to treat patients.

"The next step is to match existing therapies with these groups so that we can begin to personalise treatment.

"Some of these patients might be undergoing chemotherapy when they do not need it and could be spared it."

Lucy Holmes, Cancer Research UK's science information manager, said: "Each patient's cancer is unique and we need to tailor treatments and move away from a 'one size fits all' approach. Studies like this showing different types of a certain cancer are helping us get there."

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