The Health Secretary has decided to impose a new contract on junior doctors. Maybe introduce would have been a better word. To lay people the published terms look quite generous, but the working hours of junior doctors are to those outside the medical world, horrific. The whole argument is a product of the structural failure of the NHS, with its multiple quangos, fragmented management, efficiency drives which cost more to administer than they save, and a list of idiocies too long to record. And then there are the moonlighting consultants, trained at public expense (over £300,000) who only have to give 42 hours per week to the NHS before going on to make big money round the corner in private medicine.
Things will get worse. To make them better two fundamentals need to change. First the NHS has to be a 24/7 integrated system with hospitals operating three 8 hour shifts for everything and everyone, 365 days a year so that operations and treatments can be continuous and waiting lists eliminated, along with all the negative consequences of that ridiculous concept. All doctors, including consultants, must work full time for the NHS and be debarred from private practice. If they leave and go abroad or go private they must repay the cost of training a replacement at current prices.
The second fundamental is the issue which is too big for the spineless politicians we have in place to face. It is the funding profile. Mathematically you cannot have an infinite service funded by a finite budget. The more the NHS does and the more patients it sees the less money there is to go round because only for very short periods does the government of the day increase the cash flow. The system also creates a management structure which is dysfunctional. There has to be a system of taxation and or insurance which expands as demand expands to pay for itself by the volume of business it does. All the quangos, boards and whatever must be removed and responsibility taken directly by the Ministry of Health at national, regional and district levels. No CEOs, directors or whatever. Only ministers and managers.
The public loves the NHS but hates paying for it. That has to change too. It has to cough up the tax and insurance needed to fund the whole thing properly. The government has to take responsibility for how that money is spent and the outcome delivered. If it falls short it will find itself sacked by an angry people. That is how public services using public money are supposed to be run. All this ducking of ministers behind quango boards and independent advisers has to end. Either they deliver or they go.