Saturday, 19 March 2016
A&E now 'overwhelmed' says top doc as he calls for army of medics to be sent in
Exclusive: Britain's most senior A&E doctor says a crisis in casualty departments is escalating rapidly, with risks to safety amid desperate shortages of medics.
Dr Cliff Mann, President of the College of Emergency Medicine, which represents A&E doctors Photo: Rex
Casualty departments are on the brink of collapse and hundreds of doctors should be drafted from other duties to avert an immediate crisis, Britain’s most senior Accident & Emergency doctor has said.
Dr Cliff Mann said hospitals across the country were being overwhelmed by "unprecedented" levels of pressure and overcrowding amid desperate shortages of medics.
At several NHS trusts, more than half of A&E shifts for doctors have gone unfilled since a cap on spending on locum medics was introduced, the President of the College of Emergency Medicine said.
In an extraordinary intervention, he urged health officials to now divert hundreds of doctors from other hospital duties to get “all hands on deck” and ensure casualty departments could operate safely.
In a letter to The Telegraph, Dr Mann said overcrowding in A&Es had reached “unacceptable” levels as he called for urgent “exceptional measures” in order to protect the public.
Dr Mann said hospitals been under extreme strain despite a mild winter, but that the situation was rapidly escalating.
He told this newspaper: “The pressures have become unrelenting. In recent days I’ve been contacted by a number of senior doctors, medical directors, high-level people, who are saying the situation now is like nothing they’ve seen before.
“One medical director was describing scenes at 4am, endlessly firefighting, trying to keep people alive in corridors.”
“My own hospital had the busiest day I had ever experienced two weeks ago – these are situations where every time you turn round, there are another four ambulances queueing.”
He said A&E doctors were doing their best, but could not guarantee safety in such circumstances.
“We are not delivering best care and on some occasions we are not delivering safe care,” he warned.
The senior doctor, who works as a consultant in Taunton, said medics should now be drafted from every department which could spare them, to prop up A&Es.
“At the moment we just have to deal with this sheer volume of patients, the pressures are overwhelming,” he said. “We just need more hands on deck to cope.”
Rising demand from a growing and ageing population amid shortages of A&E doctors meant hospitals had been under severe pressure for some time.
But new rules limiting pay for agency workers meant many hospitals were now unable to find locums, pushing units closer to the edge, he said.
Limits were first set in November, dropping again in February.
Dr Mann said the latest restrictions have left NHS trusts struggling to find temporary doctors who will accept the rates, leaving vacancies or forcing trusts to breach the rules.
They will drop again in a fortnight.
Dr Mann said: “Since locum caps came in we are seeing data from a number of trusts – in Barnsley, Leeds, Bolton, Plymouth and London which shows 50 and 60 per cent of shifts going unfilled.”
Just one quarter of new A&E consultants posts were filled this year, he said, and there is a shortage of 450 trainee doctors.
“People aren’t choosing it and those who did are increasingly walking away,” he said. “They can’t sustain 30 year careers with this level of intensity.”
NHS England has refused to publish weekly data on casualty waiting times this winter – in a move which was heavily criticised.
However, the College’s own audit of 40 casualty departments suggests performance against an NHS target to treat 95 per cent of patients in four hours has reached a record low.
Just 82 per cent of A&E patients were treated in four hours in the first week of March, the new figures show, a fall from 89 per cent in December.
“We have been stretching an elastic band – it has now snapped,” the college warned in a briefing paper today.
A Department of Health spokesman said: "The NHS is coping well in the face of exceptional demand and compared to January last year saw 111,000 more people in A&E within four hours. We are committed to delivering a safer seven day NHS which is why we have invested £10bn to fund the NHS's own plan to transform services in the future.”
A spokesperson for NHS England said: “A&E visits are up sharply since Christmas but fortunately the number of A&E trolley waits is down compared with last winter.
"In fact fewer hospitals have reported serious operational issues, but winter has bitten later this year and following renewed pressures in January and February, detailed plans are being put in place for Easter to ensure good service availability over the four day bank holiday. In the face of these challenges it is a credit to all those working in emergency care that we are still admitting, treating and discharging almost nine out of ten patients within four hours”.
10:00PM GMT 18 Mar 2016
The Tories stole the NHS Bill debate from the public but the Bill to save our NHS won't go away
The NHS Bill has too much support from patients and doctors to be defeated by a few Tory filibusters. It will be back.
Image: NHS Bill supporters outside parliament. Image: NHS Bill Now.
Last Friday saw a fantastic day of action in support of the NHS Bill. Campaigners should be proud. Tens of thousands of people contacted their MPs to make sure the NHS Bill was across their desks. We saw demonstrations up and down the country in support. At a rally outside the Commons, speaker after speaker got up to say what a public NHS means to them. Toots of support from taxis, lorries, cyclists and cars didn’t stop.
I only wish the activities inside Parliament could have matched that spirit. A tiny group of clown-like backbench Tory MPs deliberately prevented the NHS Bill from being debated. For four and a half hours, they bored on about a crass two clause Bill (brilliantly criticised here), that they’d picked off a shelf to stop any real debates going forward.
As a result, the NHS Bill received only 17 minutes of debate.
There was good support in the Chamber from both the SNP and some individual Labour backbenchers, including Rachael Maskell, Valerie Vaz, Liz McInnes, Andrew Smith, Jim Cunningham and others who made their support clear. However, we needed far more Labour backbenchers to join them if were we to have any chance of putting a ‘closure motion’ to stop the filibustering jokers on the opposite benches.
Getting 100 MPs to cancel long-standing constituency engagements on a Friday in the face of Tory fools isn’t easy, and whilst it was very frustrating that we didn’t get the numbers on Friday, I believe we can mobilise that support in the future. There is huge and growing support for the Bill to keep our NHS public. The Bill’s backers include the BMA, Unite, (with 100,000 members in the NHS), the President of the Royal College of Paediatrics and Child Health, as well as great activists like Harry Leslie Smith, a raft of famous faces and many, many local NHS campaigners. The response on social media on Friday was enormous.
And we have made some progress with the Shadow Health team. As a result of Friday’s day of action in support of the Bill, the Official Opposition has now said, they are “supportive of the overall objectives of the Bill” but have concerns about reorganisation and would amend the Bill. This represents progress, albeit with a worryingly vague caveat.
It is absolutely right to ask whether the Bill would represent yet another top down reorganisation that NHS staff simply cannot take. The answer is that this is an essential ‘bottom-up’ simplification exercise to restore the NHS as a publicly provided, funded and managed service. Health Boards would be designed by and made up of the very people working in the NHS bodies they would replace. In answering the reorganisation question, it cannot be overstated that the National Health Service in England is being broken up and disorganised on a daily basis. It is being tendered into a mess and the Bill brings back coherence in order to preserve the NHS for the future.
Secondly, Scotland has undergone a similar process with minimal disruption, so we can do the same.
The heart of the NHS Bill is to stop the competition and bring back collaboration; to move on from the internal market, to learn from it and treat it as a failed experiment, and bring back coherence to our NHS. What we can usefully ask now, is whether or not the amendments that the Shadow Health Team have in mind would remove the guts of the Bill. I’m hoping they will meet with me to discuss this.
As for what next, technically the Bill is still live and is scheduled to be debated again on 22 April. As it has 25 bills ahead of it, there is no chance of it being debated on that date, but I have no doubt the Bill will be back after the Queen’s Speech. In the meantime, I will be meeting cross party supporters to discuss next steps, which makes it more vital than ever for campaigners to keep talking to their MPs.
As for the Government, no doubt they were perfectly happy for a handful of their ranks to steal the debate from the public. One way we can prove that this is an issue that the public cares about is to sign this petition against the dullard filibusterers– it has taken off with tens of thousands signing after Friday’s Tory antics. Parliament should be a place for proper debate, not time-wasting tactics. This Bill isn't going away. We will not sit back and let the Tory privateers get away with this vandalism of our Health Service.
Five year wait - and still no answers on Charing Cross Hospital from local health bosses
Local health bosses were grilled at a tense meeting at Hammersmith Town Hall this week – and were unable to clearly state the crucial details behind their plans to downgrade Charing Cross Hospital.
In a performance that drew criticism from councillors and residents, the health chiefs were unable to say what services would remain at Charing Cross, what would happen to the A&E, or even if there would be any acute care beds. They were also unable present the business case on which their plans are based – despite them having passed it to Central Government nearly a year ago.
Cllr Stephen Cowan, H&F Council leader, said: “It has been five years since the ridiculous plan to downgrade Charing Cross Hospital was launched – yet health officials say they still can’t tell us exactly what will happen if the current A&E is allowed to go or exactly what they plan to replace the current hospital with.
“This is simply not good enough. I call on them to take on board the independent recommendations of the Mansfield Health Commission and immediately halt their plans. The people of this borough deserve better – and we won’t stop fighting until they get it.”
The proposals for ‘Shaping a Healthier Future’ – which involve slashing services at Charing Cross Hospital including its heavily used A&E – were deemed deeply flawed by the landmark Mansfield Report into local health service reorganisation, published in December.
The local health chiefs were summoned to attend H&F Council’s health scrutiny committee meeting to directly address the concerns set out in the report, but they failed to do so.
Committee member, Cllr Hannah Barlow, told the panel they had failed to respond to the Mansfield Report as the committee had requested. She said: “What we have been given today is a top-line vision slide deck, but what we had actually asked for is a considered response to the report’s findings.
“There has been no response or consideration for the vast amount of work that has gone into the Mansfield report. The number of residents and healthcare professionals that have offered their input into the report is significant. It is not to be discredited.”
The panel, comprising top members of H&F Clinical Commissioning Group and Imperial College Healthcare NHS Trust, were invited to H&F Council’s Health, Adult Social Care and Social Inclusion Policy and Accountability Committee. In their evidence, they reaffirmed their commitment to the Shaping a Healthier Future programme, which they say enjoys the support of clinicians and will improve outcomes for patients.
You can read Michael Mansfield QC’s landmark report on North West London NHS ‘Shaping a Healthier Future’ programme here.
Check the Hammersmith and Fulham website here:
The need to keep our A&Es gets more urgent
Last December every NHS Trust in London bar one missed their A&E waiting time targets. Our hospitals, run by Imperial College Healthcare Trust, had their worst performance for six months only seeing 88% of patients within four hours.
Still, that’s better than North Middlesex Hospital where an announcement was made over the tannoy telling people to go home unless they were in dire straits, as the A&E department could not cope with the numbers arriving for treatment.
At Charing Cross, there has been a 13% increase in the most serious cases attending A&E.
GPs are being asked to take the pressure off A&E, but are themselves under pressure from cuts in pharmacy budgets. Jeremy Hunt has announced plans to cut funding to community pharmacists by £170 million. I spoke on this issue during a Commons debate..
I also kept up to speed on the junior doctors’ dispute, meeting Johann Malawana, who chairs the BMA committee. Hunt is refusing to negotiate and intending to impose the new contract in August against the wishes of almost the whole medical profession. But public support for the doctors remain strong.
Andy Slaughter MP for Hammersmith
(Article from his newsletter)
Assembly Member speaks out at 'trend of decline' at west London A&Es
Dr Onkar Sahota AM says west London is suffering some of the worst A&E waiting times due to “under-resourcing, understaffing, and increased workloads”
West London patients face some of the longest A&E waiting times in the country, due to “under-resourcing, understaffing, and increased workloads”, says Hillingdon and Ealing 's London Assembly Member.
In January, more than 3,000 patients were left waiting to be seen for more than four hours at London North West Healthcare Trust A&E, whilst The Hillingdon Hospitals Trust A&E failed to see more than 1,500 patients within four hours.
NHS data shows a continuing trend of decline in waiting times for the most serious emergency cases at both trusts.
A&Es are expected to treat 95% of patients within four hours, in accordance with NHS standard waiting time targets.
At the Hillingdon Hospital Trust A&E department, a total of 1,574 patients had to wait longer than four hours – almost a threefold increase over the last eight months. London North West Hospitals trust saw 3,291 patients wait longer than four hours.
Dr Onkar Sahota, is the Assembly Member for Ealing and Hillingdon
Dr Onkar Sahota AM, Labour London Assembly Member for Ealing and Hillingdon, said: “These figures represent the utter failure of the government to recognise the desperate situation in west London hospitals.
“Under-resourcing, understaffing, and increased workloads are causing these failures.
“As our emergency services struggle, the Mayor of London and the government have ignored our cries for help.
“Let’s not forget, the Mayor has a responsibility to address health inequalities in our capital, and residents in west London are going to be left asking why they aren’t getting the same level of service as others.”
'Recent and dramatic decline'
Following the closure of Central Middlesex A&E department and Imperial A&E department in October 2014, London North West Trust has constantly performed significantly below the national average.
The Hillingdon Hospitals trust has seen a more recent and dramatic decline in performance, the Labour AM says.
Dr Sahota added: “Our Ambulances are missing their targets, our GP waiting times are getting longer, Trusts deficits are getting worse and the A&E system in west London is failing patients.
“What will it take for the Mayor and the government to stand up for Londoners?’
Accident and emergency at Hillingdon Hospital
NHS Trust 'exceptionally challenged'
Hillingdon Hospitals NHS Foundation Trust say that they were “exceptionally challenged” during January 2016, with 5,191 attendances in the month alone.
A spokesperson for the trust said: “This was an increase of 500 attendances (10%) when compared with the same period in 14/15.
“In addition, the number of patients we are receiving via ambulance as emergencies has increased year on year by 16%.
“The trust, in collaboration with Hillingdon CCG (HCCG), hosted a series of multidisciplinary workshops in January with the primary aim of improving patient flow in the Emergency Department (ED).
“A key aspect of the work focuses on increasing capacity within the A&E department to better meet surges in demand.
“In addition, it concentrates on refining current pathways and developing new pathways of care that either avoid the patient coming into the ED or allow for early transfer of care to specialty teams.”
New procedures introduced
London North West Healthcare NHS Trust says its Emergency Departments remain busy "in line with pressures felt every winter".
A spokesperson for the trust, which looks after Central Middlesex, Ealing, Northwick Park and St Mark's hospitals, said: "T here has been a steady increase in attendances year on year.
"We are working with local health partners to ensure patients are being treated and cared for in the most appropriate facility, be that in hospital or in the community.
"We recently opened a new ward block at Northwick Park hospital, providing 63 new beds.
"We have introduced new procedures and forged close links with the London Ambulance Service and Clinical Commissioning Groups to better manage the demand to ensure patient safety at all times - and we are pleased to say that we have seen an improvement in A&E waiting times.”
Check the Get West London link here:
Deepening concerns over financial future of national health service
The Public Accounts report says Government has not acted quickly enough to keep acute hospital trusts in financial balance—also finding "there is not yet a convincing plan in place for closing the £22 billion efficiency gap and avoiding a 'black hole' in the NHS finances".
- Report: Sustainability and financial performance of acute hospital trusts
- Report: Sustainability and financial performance of acute hospital trusts (PDF 288KB)
- Inquiry: Sustainability and financial performance of acute hospital trusts
- Public Accounts Committee
The Committee concludes the financial performance of NHS trusts and NHS foundation trusts has deteriorated sharply and this trend is not sustainable.
The Committee highlights the "long-term damage" to trusts' finances caused by unrealistic government efficiency targets, and describes the data used to estimate trusts' potential cost savings targets as "seriously flawed".
It concludes the current system for paying providers "is not fit-for-purpose as it does not incentivise the right behaviours needed for joined-up healthcare services".
Spending on agency staff "concerning"
The Committee is also concerned by the approach of government to trusts' spending on agency staff—finding that while this spending has contributed to trusts' deficits, the Department of Health, NHS England and NHS Improvement "are only recently making serious attempts to control agency spending".
Its recommendations to government include ensuring "all trusts in deficit have realistic recovery plans by the start of the 2016–17 financial year that will lead to timely and sustainable improvements" and that "informed and realistic" efficiency targets are set for providers.
As a matter of urgency, NHS England and NHS Improvement should also "set out how they will support providers to secure the collective action that is needed to get value for money from the use of agency staff".
Chair's comment
Meg Hillier MP, Chair of the PAC, said:
"Acute hospital trusts are at crisis point.Central government has done too little to support trusts facing financial problems with the result that overall deficits are growing at a truly alarming rate. Crude efficiency targets have made matters worse.Without urgent action to put struggling trusts on a firmer financial footing there is further serious risk to services and the public purse.In particular it is unacceptable for senior government officials simply to point to excessive agency costs as a source of trusts' difficulties.It is the job of those officials to take action to control spending on agency staff, and to address its underlying causes. The use of agencies is a sticking-plaster solution to deep-rooted problems with NHS workforce planning.The government's approach to planning is a serious and recurring concern for this Committee—one that we highlighted in our report last week on access to general practice, and in our hearing last month on managing NHS clinical numbers.There is a long way to go before the taxpayer will be convinced there is a workable and properly costed plan in place to secure the future of our health service.We expect the Department of Health, NHS England and NHS Improvement to report back to us in September on precisely what progress they have made in addressing our recommendations and those previously set out by the National Audit Office."
At 31 March 2015 there were 90 NHS trusts and 155 NHS foundation trusts, of which 55 NHS trusts and 100 NHS foundation trusts were acute hospital trusts providing healthcare services such as accident and emergency, inpatient and outpatient and in some cases specialist or community care.
Finances across the NHS have become increasingly tight with health funding rising at a historically low rate of 1.8% in real terms between 2010–11 and 2014–15.
Report summary
The financial health of NHS trusts and NHS foundation trusts has significantly worsened in the last three financial years. Trusts had a net deficit of £843 million in 2014–15, which is a severe decline from trusts' £91 million deficit in 2013–14, and £592 million surplus in 2012–13.
Trusts' finances look set to deteriorate further—halfway through 2015–16 three quarters of trusts had a deficit, and their total overspend could rise to around £2.5 billion.
The Department, NHS England and NHS Improvement have not taken action soon enough to keep trusts in financial balance. The target for trusts to make 4% efficiency savings across the board is unrealistic and better data is needed for more informed savings and efficiency targets.
Current system "not fit-for-purpose"
Failings in the system for paying providers need to be addressed as a matter of urgency, with NHS Improvement and NHS England acknowledging that the current system is not fit-for-purpose as it does not incentivise the right behaviours needed for joined-up healthcare services.
Spending on agency staff has contributed to trusts' financial distress, and action to tackle this problem is welcome, albeit late. The NHS will not solve the problem of reliance on agency staff until it solves its wider workforce planning issues.
We recognise the immense challenge of achieving financial and service sustainability when demand is rising and budgets are tight, and acknowledge the ongoing efforts of NHS England and NHS Improvement to find solutions. But there is much to do to produce the convincing plan necessary for the NHS to get itself back into financial balance.
Check the link here:
The photo that shames Jeremy Hunt: Patients queue for nearly three hours in overstretched A&E
A source said paramedics had to stand in the corridor with patients for nearly three hours. Handovers are meant to take 15 minutes.
Royal Liverpool Hospital's A&E department showing large queues
This shocking image of paramedics helping patients queue for nearly three hours in a hospital corridor reveals the scale of England's A&E crisis.
Taken at 1.30am on Saturday, it is revealed as a damning report says NHS finances are now at "crisis point" and endangering patient safety.
Jeremy Hunt has vowed to invest billions in the health service - but hospitals are also having to make £22billion of "efficiency savings".
Today MPs on the Public Accounts committee warn hospitals are struggling to reach the Health Secretary's "seriously flawed" target.
They add spending on temporary staff rose 24% between 2012–13 and 2014–15 in another hammer blow to the embattled Health Secretary.
150 NHS trusts had a deficit of £843million in 2014-15, up from £91million in 2013-14. It could hit £2.5billion this year.
Nowhere is the strain clearer than in our photo of the Royal Liverpool Hospital A&E.
There were 12 ambulance crews waiting to hand over their patients to staff when it was taken, a source told the Liverpool Echo.
Stretched: Hospital directors urged patients to consider other options if they can
Some paramedics had to stand in line for two hours and 45 minutes before busy hospital staff were ready to take charge of the patients they had brought in, the source added.
NHS targets say an ambulance handover should not normally take longer than 15 minutes.
Dr Peter Williams, medical director at the Royal, thanked the paramedics and said 'delayed discharges', commonly known as bed-blocking, were the cause of the delays.
He said: “We frequently have a significant number of patients in our hospital beds who are fit to be discharged.
“But their discharge is delayed as they have complex care requirements that must be arranged first.
“We need people to support us to deliver care to their loved ones when they need it most.
“Supporting us and social care teams in discharging your loved one from hospital is the best thing you can do for them.”
He added a consultant was on duty that night to make sure patients were seen in order of priority.
But the hospital - in common with most stretched NHS Trusts - also urged patients to consider their options before rushing to A&E, such as out-of-hours GP surgeries and pharmacies.
Check the link here:
http://www.mirror.co.uk/news/
March and rally against plans threatening closure of the children's ward at Ealing Hospital
Demonstration in response to growing concerns health bosses will shut down paediatrics under a smokescreen of making cuts to improve services.
Check the photos gallery here:
Hundreds of campaigners marched through the centre of Ealing to make some noise to save the children’s ward at Ealing Hospital.
Angry parents joined the march which set off from Haven Green, opposite Ealing Broadway station, on Saturday (March 12), with a show of support from local shoppers as the demonstration passed through the the town centre in protest against plans which could see the closure of the paediatrics department.
As part of cuts being made by the Ealing Clinical Commissioning Group (CCG), changes under Shaping a Healthier Future, the organisation that shut Ealing maternity unit, campaigners believe health bosses are hiding behind a smokescreen proposing cuts to the children’s ward when in fact it will be shut down.
Oliver New, from Ealing Save Our NHS , which organised the demonstration, said nobody supported the closure plans.
He said: “Health bosses want to close our children’s ward, and stop sick or injured children going to A&E. If parents take them to A&E anyway, they will just be sent elsewhere. The delay could be serious or fatal.
“Local parents are right to be really angry. Already they closed Maternity and it seems clear they are clearing the way to close the whole A&E at Ealing Hospital.”
'The delay could be serious or fatal'
With the sun shining, a band of Ukulele players entertained the crowds as they gathered at Haven Green before marching onto the Broadway and up to Perceval House, where they were greeted by a jazz band.
Protesters rallied outside Ealing council’s doorstep to create noise to save the children’s wards.
Ealing mum Mary Lynch, who spoke at the rally afterwards, said her children had need of Ealing Hospital several times and that it had saved her son’s life.
Other speakers included a junior doctor, and GLA member Onkar Sahota, Steve Pound MP , junior doctor and mother Helen Laycock and paediatric hospital consultant Tony O’Sullivan who dismissed suggestions that children would be better served by closure of the ward.
GET WEST LONDON
Junior doctors strike: Politicians join picket lines...
Shadow Chancellor John McDonnell declared his 100% support for the strike as he joined doctors outside Hillingdon Hospital.
Stephen Cowan joins the picket line outside Charing Cross Hospital, in Hammersmith
More than 1,000 operations and treatments are expected to be cancelled at hospitals across London after junior doctors again took to the picket line in protest at planned changes to working conditions.
The third walkout over pay and working hours began at 8am on Wednesday (March 9) and is due to last for 48 hours.
NHS England estimates 1,068 procedures scheduled at hospitals across London over the two days will have to be rearranged due to the industrial action.
Hammersmith & Fulham Council leader Stephen Cowan and shadow chancellor John McDonnell were among the politicians joining picket lines outside hospitals in west London as the latest strike got underway.
The picket line outside Ealing Hospital
Mr Cowan showed his support for junior doctors outside Charing Cross Hospital, while Mr McDonnell visited those outside Hillingdon Hospital in solidarity with their cause.
Sean Morris, a junior doctor at Ealing Hospital, said: "It was a very good turn out. Junior doctors are united. The mood was one of resilience
"(Health secretary Jeremy) Hunt claims his door is always open but that has shown to be false. He is not interested in junior doctors or the public who support junior doctors."
Two further walkouts planned for April
Further 48-hour strikes are planned for April 6-8 and April 26-28 if the dispute between the Government and medical union BMA cannot be resolved.
Health secretary Jeremy Hunt announced last month that controversial new working conditions would be imposed upon junior doctors after talks broke down.
The BMA has said it will apply for a judicial review of what it describes as the "unfair" contract, but Mr Hunt says the proposed legal challenge is "misconceived and is bound to fail".
The Department of Health says the new arrangements will improve patient care outside of normal working hours and a 13.5% rise in basic pay means no junior doctor will be worse off.
BMA plans to apply for judicial review over unfaircontract
But the BMA claims the new contract will hit those already working the most unsociable hours and will make it harder to attract and retain doctors.
BMA junior doctors committee chair Johann Malawana said: "We deeply regret disruption to patients, but the Government has left junior doctors with no choice.
"Ministers have made it clear they intend to impose a contract that is unfair on junior doctors and could undermine the delivery of patient care in the long term."
A Department of Health spokesperson said: "Further strike action is completely unnecessary and will mean tens of thousands more patients face cancelled operations – over a contract that was 90% agreed with the BMA and which senior NHS leaders including Simon Stevens have endorsed as fair and safe.
"The new contract will mean an average 13.5% basic pay rise, and will bring down the maximum number of hours doctors can work."
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