Spin, smears, staticide and grafting a scrotum onto Jeremy Hunt’s chin

Pondering the catalogue of cruel, ham-fisted assaults dealt my profession by the government is, I imagine, something close to what having a catheter inserted into your penis feels like, if the catheter tube in question has the proportions and ornament of a Roman column.

So the strikes are back on, and it’s impossible to imagine that the concerns of junior doctors like myself will drift away like the government hopes for, and not hang smotheringly over the NHS like a Victorian smog.

Let us relive the outrages.

First, of course, came the contract itself in which our ‘working week’ got some nightmarish surgery. The government generously grafted on Saturday and bolted on a stretching array of evening hours until they’d fashioned a mountainous, mutated, Frankenstein’s monster of a working week, one that didn’t remotely resemble the working week any normal person would recognise.

This was not, contrary to what readers of The Sun had been led to believe, about overtime. Overtime is what you do beyond contracted time, and we’ve always been contracted to work weekends and nights. My colleagues rarely go home at their official knocking off time. The memories of earnest, anxious juniors being eventually ordered by seniors off the wards, many hours after their shifts had officially ended, are proud ones. And we have to study too: postgraduate exams for junior doctors are abundant, time-filching, expensive (over 1000 pounds for my most recent compulsory clinical exam) and excruciatingly hard to pass. We revise for them in our free time, you know, that chink of daylight Hunt is keenly dispossessing us of.

The resounding anxiety for me about this playful and cynical redefining of the working week is that there appears little impetus to stop there. Why not dash out on whims and redefine all kinds of other things to the government’s advantage? Canteen staff could be redefined as nurses, then we’d have more of them. Bus shelters as hospitals, ditto. Being dead as ‘quite tired’ would deftly reduce mortality rates. A pigs head as a woman’s vagina: Cameron would favour that. The Health Secretary as ‘Overlord’, Hunt’s choice. And if we’re really pushing the boat out why not redefine the meaty stalk connecting Eric Pickle’s head to his body as a neck.

Could you imagine if Jeremy Hunt was himself admitted to hospital with a stroke? Ideally, on a Saturday. ‘Will I be alright?’ he pleads to learn from the exhausted array of underpaid attending medical staff. ‘Oh yes Mr Hunt’ reassures the junior doctor ‘You’ll be perfectly alright’. ‘Oh thank God!’ says Jeremy ‘But I should tell you Mr Hunt that in this very specific context, the term ‘alright’ has been (dramatic pause) Redefined.’

‘Oh?’ he whimpers.

‘Yes, ‘alright’ now encompasses being actually alright, severely disabled, comatose, near death and actually dead. And we think you’re going to be extremely alright Mr Hunt. Best of luck.’

The next affront came as the government tried to justify the contract by some cack-handed armchair juggling of facts around weekend death rates. The government misrepresented the data for their own ends, and those ends were torturously stretching already stretched staff and forcing them to work more antisocial hours, all without spending any more money.

This was perhaps the most foreseeable disgrace. Politicians have never been well regarded for careful handling of data and true to form statistics were routinely stripped down, aroused, gagged and spanked out of recognition. Passing statistics to a politician is like leaving your five year old alone at home next to a tub of kerosene and a lighter. You’ll come home to find little Jeremy has dowsed the cat, torched the living room and burnt half his own face off. And that’s what you get when the government tries to prove things, complicated, often unprovable things, just to suit themselves. You end up with pain, mistrust, large scale destruction and dead children. I think someone should deliver kerosene and a lighter to Mr Hunt, label it ‘Statistics’ and move away quickly. I for one would relish seeing Jeremy’s grossly disfigured face on the evening news explaining that some facts blew up in his face. Good luck finding a plastic surgeon with the self-control not to commit an act of creative sabotage. It would probably be a first for the Health Service Ombudsman — having to deal with a complaint concerning a surgeon grafting the scrotum of a withered cadaver onto a patient’s chin.

But having been introduced to the various flaws in his figures, the silly Hunt kept maliciously vomiting them at the public, an unstoppable fountain of enumerating spew watched by horrified doctors screaming ‘where’s the fucking off switch!’ and realizing there isn’t one. This is staticide on a quite wondrous scale. I’m a touch worried that any further ransacking of the facts could lead to the Department of Health announcing that all patients attending outpatient clinics are obliged to wear amulets and lucky charms.

It’s curious to me that he even attempted it — we study statistics in medical school Jeremy! We do! I did a whole module on them! It fell between ‘classification of the glomerulonephropathies’ and ‘modulation of neurochemical transmission at the neuromuscular junction’. It was called ‘Sums — doing them wivout using your fingers’.

Junior doctors already earn less than their European contemporaries, a profession that comes with great responsibility (not to mention a disproportionate wodge of student debt and studying expenses) and is requiring of innumerable skills: clinical, communicative and academic. Yet the basic pay is lower than the salary of an average public service graduate. Work it out her hour and a junior doctor’s starting wage is appalling given the above. But then I would say that, right?

Here’s some uncomplicated maths: More antisocial hours + Same workforce = staff more thinly stretched, and demoralized. Hospital rotas already look like the grins of rugby prop-forwards, but soon the timetable will be a sort of desolate wilderness where the gaps will outnumber the working staff.

Nobody is arguing against working Saturdays (we already do) or working more Saturdays if there’s enough cover, but if you’re not adding extra staff the entire workforce will be thinned out — this contract is an excuse to save money at our expense. Jeremy seems to believe in a sort of Loaves and Fishes school of economics.

‘But this is a pay rise!’ Announces Jeremy to funereal jubilation. ‘Not a pay cut! A rise!’ Even if the public are befuddled by spin and the maniacal waxing and waning of numbers in the media, it’s easy to assume that 98% of balloted professionals, with an academic background, are unlikely to vote against a pay rise. Which means Hunt’s trying to pull the wool over our eyes, and he’s shit at knitting.

But still we churn out ‘this is not just about the money!’ ever more forlornly, to a public turned increasingly distrustful thanks to government spin. More than money, this is about safety: Do you want the doctor assigned to take out your appendix to be ambling unsteadily towards you, at the wrong end of a 91 hour week, mumbling about getting some Nescafe ‘stat’? Nobody wants to set off airport metal detectors six months after their hernia repair. Knackered medics are not good for anybody.

Considering our resolute stance on prioritizing safety over money, the smear campaigns were particularly grotesque. Medics were splashed over newspapers holidaying in the Maldives, snorting lines of caviar, playing harps on horseback and making pink, origami swans out of the Financial Times. I’m exaggerating, but it went something like that. And all the while the politicians plumped up their own paypackets.

Curiously, and terrifyingly, this doesn’t appear to be all about the money for the government either.

Wait, wait, wait. Someone’s done the sums, right? They must of. There’s no way the government would roll out a ‘7 day NHS’ with a 5 day supply of staff without doing the sums. 7 doesn’t equal 5. Right? Right? RIGHT? Wrong! It turns out to be entirely uncosted, but by this stage my capacity for surprise is roughly my capacity for serenity when I see Jeremy Hunt’s lying, smeary, sinful, guff-spilling face on the TV turning the public against us.

And my own face, whilst watching the public accounts committee quiz Jeremy Hunt’s adviser about spending, took on the look of a patient being told they have a conjoined twin they were not previously aware of. ‘Wha!’ was my percussive groan as I watched the government respond — or fail to — to some pretty simple questions (‘how much will this 7 day NHS cost?’) — as stuttering as it was eye sopping. Here were members of the team behind the contract failing to explain any details worth knowing, because, we must assume, they don’t know them.

And bristling stealthily beneath all of this, in the murky depths, is the Elephant in the operating theatre: the merciless creep of privatisation. We’re willfully ignoring Case Study America, in which everyone pays more for less, vested interest smothers every notion of working in the patient’s clinical interest, insurance companies get mightier yet everyone gets over-diagnosed, over-treated, correspondingly sicker, and an entire swath of the populous get piteous provision. That, of course, is a worst case scenario. But the NHS also outperforms many of the European health services that have greater privatization than we do, the NHS is certainly more equitable, and at a pinch of the GDP.

There’s been a lot of blah about how hard our job is. Plenty of people work hard jobs, and for considerably less reward. I love my job. It’s wonderful payback for any hardships. But how do we define how much to pay public sector workers? We don’t take into account the fluffy rewards, nor should we. It’s about skills, education, complexity of decision-making, control invested within the position and so on. On those alone the case to pay doctors more is a strong one. Now. Before the monstrous new contract devours the rest of my life and shits it into oblivion.

And the latest insult? An investigation into morale which specifically excludes ‘talk of pay and the new contract’ aka The Source Of The Low Morale. It would be like being admitted into A&E, your own doctor flinging you down a flight of stairs, and then referring you to orthopaedics.

All this means that doctors will soon be gushing like a severed artery towards Australia, safeguards will continue to be slashed with psychotic enthusiasm, morale will sink until it’s no longer visible, systematic defunding of the NHS will continue unabated until nurses uniforms become pinned together pillowcases and your physician’s stethoscope is two plastic cups and a piece of string.

So this won’t go away. The actions of the government to date have proved disastrous. There are more strikes, more debates, but the winning and losing is of less importance now because the country has already lost. Is this about self-interest: marginally, yes. Is this about what’s best for our patients: overwhelming, yes.

Jeremy: we won’t lie down for you to scuff your blood-stained loafers on. We’re still united, we’re still impassioned. The stakes are too high, this is about doing right for my patients, and my scalpel is ready. Trust me Jez, I’m your doctor.

Doctor (emergency medicine), runner, wanderer and storyteller. Author of ‘Signs of Life’ (Profile), Aug 2020. www.stephenfabes.com

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