{"id":34283,"date":"2015-05-22T14:17:01","date_gmt":"2015-05-22T13:17:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=34283"},"modified":"2015-05-22T14:17:34","modified_gmt":"2015-05-22T13:17:34","slug":"a-seven-day-nhs-my-seven-point-plan","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/22\/a-seven-day-nhs-my-seven-point-plan\/","title":{"rendered":"David Wrigley: A seven day NHS? My seven point plan for Mr Cameron &amp; Mr Hunt"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/01\/david_wrigley.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-30980\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/01\/david_wrigley.jpg\" alt=\"david_wrigley\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/01\/david_wrigley.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2014\/01\/david_wrigley-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a>The media have called this the &#8220;<a href=\"http:\/\/www.bbc.co.uk\/news\/uk-politics-32772548\">first major speech<\/a>&#8221; in this brand new Conservative majority government. Prime Minister David Cameron, with five years of power ahead of him, decided to focus on the NHS, and, in particular, he focused on one particular aspect\u2014seven day working. Trailed in the Tory manifesto and now offered to the nation it sounds appealing, but as is usually the case with many things Mr Cameron does, most of it doesn\u2019t stand up to proper scrutiny.<\/p>\n<p>Here is my seven point plan for Mr Cameron\u2019s seven\u00a0day NHS:<!--more--><\/p>\n<p>1. Get the five days right first\u2014If the government wants to make the NHS work safely and efficiently seven days a week, then it might be a good idea to get the five days of Monday to Friday working well beforehand. At the moment the NHS is in dire straits, struggling financially with medical, nursing, and allied staff leaving or retiring early in their droves. What was the adage Mr Cameron likes to use\u2014fix the roof while the sun is shining? Well, the sun isn\u2019t shining much in the NHS, but you certainly need to fix the roof Mr Cameron and pretty sharpish.<\/p>\n<p>2. Sort social care out\u2014The huge top down austerity driven cuts to local authorities has led <a href=\"http:\/\/www.theguardian.com\/society\/2015\/jan\/28\/social-care-funding-ridiculous-situation-local-government-association\">to massive cuts to social care<\/a>. This has led to social care being cut to the bone, and many older and vulnerable patients left alone or with haphazard 10 minute visits from zero hour contract care workers who have to dash from client to client in order to make any sort of living. If you want a seven day NHS,\u00a0Mr Cameron, then you need to properly fund social care as these patients are increasingly unwell and needing more NHS care. And with inadequate community services for them, they languish in hospital beds, unable to be discharged safely to the community<\/p>\n<p>3. Invest in your NHS staff\u2014Many nurses, for example, have been <a href=\"http:\/\/www.theguardian.com\/healthcare-network\/2014\/oct\/08\/everything-need-know-nhs-strike-pay\">left with 0% pay increases repeatedly during the coalition years<\/a>. MPs, meanwhile, received <a href=\"http:\/\/www.telegraph.co.uk\/news\/newstopics\/mps-expenses\/11079707\/MPs-will-get-10-per-cent-pay-rise-expenses-watchdog-says.html\">a 10% pay rise <\/a>during the coalition reign of power. Nurses\u2019 pay has fallen back hugely, and they feel undervalued and demoralised. They were pilloried for failures that were not of their doing. Many scandals in the NHS in recent times have been owing\u00a0to the fact that hospitals chased foundation trust status at all costs, forgot and disinvested in patient care, and forgot to support and care for the staff looking after those patients. Many health professionals are becoming unwell now because they cannot give any more to the job they love.<\/p>\n<p>4. Get your workforce planning sorted\u2014Mr Cameron said at his press conference: &#8220;We are training and hiring many more GPs right now.&#8221; Errrr, no you are not, Mr Cameron\u2014<a href=\"http:\/\/www.telegraph.co.uk\/news\/health\/news\/11517019\/One-in-3-trainee-GP-posts-are-empty-amid-warnings-of-crisis-shortage.html\">one third of GP training places are empty<\/a>. One in three GPs <a href=\"http:\/\/www.theguardian.com\/society\/2015\/apr\/15\/nhs-stress-third-gps-plan-retire-five-years\">plans to retire in the next five years.<\/a> This is all leading to a workforce time bomb and Mr Cameron has fuelled this with his past five years in charge of the NHS\u2014with unpopular polices and cuts to frontline services, such as general practice.<\/p>\n<p>5. End the dog eat dog competitive market in the NHS\u2014Currently we see billions wasted on an unwanted healthcare market, where providers fight each other for contracts and NHS managers spend weeks on end refereeing and sorting this all out. No one has asked for this and the money saved could fund decent social care for all the older\u00a0and vulnerable people in our society.<\/p>\n<p>6. Make all NHS services available seven days a week\u2014This will, however, cost billions. As a GP if I see a patient on a Saturday or a Sunday, I need the full range of services available to me in order to treat my patients effectively. I need a fully functioning hospital laboratory with blood collection services twice a day over the weekend. I need access to NHS physiotherapy for my patients with urgent musculoskeletal problems. I need access to health visitors to refer children needing their input. I need access to a fully functioning radiology department offering x-rays, CT scans, MRI scans, ultrasound, and other investigations. For those who say the patients can be seen Monday to Friday, I am afraid that won\u2019t work because more patients will be seen at weekends so capacity needs to increase to cater for them.<\/p>\n<p>7. Beware of the unintended consequences\u2014Increasing the NHS to a full seven day service will increase demand and this will increase cost. The NHS is already struggling financially, and Mr Cameron\u2019s extra <a href=\"http:\/\/www.bbc.co.uk\/news\/election-2015-32260220\">\u00a38bn was only plugging one small gap in the \u00a330bn<\/a> black hole opening up in the centre of the Department of Health. To stretch services further will lead to a poorer service in the coming years, and would lead the electorate to blame the government for a failing NHS\u2014not something Mr Cameron will want running up to 2020. Mind you, <a href=\"http:\/\/www.independent.co.uk\/news\/uk\/politics\/david-cameron-admits-he-wont-serve-beyond-2020-10128858.html\">he has already said<\/a> he will be leaving Downing Street by then anyway.<\/p>\n<p>A seven\u00a0day NHS service is attractive to patients and attractive to politicians seeking votes. No other western health economy has <a href=\"https:\/\/www.gov.uk\/government\/speeches\/pm-on-plans-for-a-seven-day-nhs\">managed to provide it<\/a>, and with the NHS already struggling, many really doubt this government can do it properly. I hope it won\u2019t be imposed on an already beleaguered NHS staff, who are forced to provide the seven day service against their professional advice. Doctors are here for our patients\u2014politicians are there for the votes.<\/p>\n<p>Be careful of what you wish for, Mr Cameron and Mr Hunt. This one could come back and bite you very hard indeed.<\/p>\n<p><em><strong>David Wrigley<\/strong> is a GP\u00a0in Carnforth, Lancashire. He is also a member of the BMA UK Council, and\u00a0the\u00a0co-author of the book <\/em>NHS for Sale<em> and <\/em>NHS SOS<em>. You can find him on Twitter\u00a0<\/em><a href=\"https:\/\/twitter.com\/DavidGWrigley\">@davidgwrigley<\/a>.<\/p>\n<p>Competing interests: I am a member of the BMA Council and the BMA General Practitioners Committee. I am co-author of the book <em>NHS for Sale<\/em> and\u00a0<em>NHS SOS<\/em>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The media have called this the &#8220;first major speech&#8221; in this brand new Conservative majority government. Prime Minister David Cameron, with five years of power ahead of him, decided to [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/22\/a-seven-day-nhs-my-seven-point-plan\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-34283","post","type-post","status-publish","format-standard","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>David Wrigley: A seven day NHS? 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