David Dalton disputes BMA claim on seven day services

The documents reveal that the DH offered to publish a statement in May making clear that its plan for a seven day service would include “the employment of additional clinical staff” and was focused only on improvements in emergency care.

Sir David, the chief executive of Salford Royal Foundation Trust who led negotiations for the government, said he was “puzzled” by the BMA’s stance and told HSJ that publishing the statement “would have been helpful to provide that clarity and to prevent what actually seems to be a misunderstanding”.

He said the BMA said it did not want the statement published as it was “unnecessary”.

When it announced plans for further strike action starting on 12 September, the BMA said detail around seven day services was one of its remaining concerns. It cited a leaked risk register from the DH that showed officials had identified a number of potential risks with the policy including a lack of available staff, negative publicity and the possibility that the policy may not improve care quality and safety.

In an article last week for The Huffington Post, junior doctors’ committee chair Ellen McCourt said the government had “failed to answer basic questions” on the seven day services policy, adding that the BMA had “repeatedly raised concerns over the past year about the lack of detail”.

However, the DH has released to HSJ a 10 point statement it prepared for the union in May to clarify its position on seven day services.

The statement says the delivery of seven day services would be limited to the clinical standards for emergency care published by NHS England in 2013, and that extra staff would need to be employed rather than stretching the existing workforce across seven days.

It also accepted that junior doctors already worked seven days a week and would be expected to contribute less than other staff such as consultants and diagnostic staff.

This was sent to the BMA, including Dr McCourt who helped to draft the compromise deal with the government in May. The union asked for the statement to be shortened to four points and then asked for it to be removed altogether from the deal agreed in May.

The issue of seven day services has been a touchstone issue in the dispute since Jeremy Hunt linked it to the contract in July 2015.

Sir David said: “I was very surprised to hear the BMA list ‘more detail on seven day services’ as one of their three key demands this week, alongside issues over pay for weekends and part-time workers. In fact, at my suggestion, the government provided the BMA with a detailed statement clarifying their plans for seven day services, in which they made clear that extra doctors and other staff would be employed and this policy would not be delivered simply by spreading the existing workforce more thinly.

“This statement was agreed with the BMA’s team on 16 May – a team that included Ellen McCourt, the current chair of junior doctors committee. Subsequently, they asked for it to be removed from the final [Advisory, Conciliation and Arbitration Service] agreement on the grounds it was unnecessary. So it is puzzling to hear them now cite lack of detail on this subject as a justification for further industrial action.”

NHS Employers chief executive Danny Mortimer, who was also part of the government’s negotiating team, added: “The BMA’s claim that further strike action is necessary because the government have refused to provide detail over seven day services simply doesn’t stack up.

“They were offered a detailed statement and this was rejected for inclusion in the final agreement, so I’m bemused to hear the BMA cite lack of detail on this subject as a justification for the most extreme strike action in NHS history.”

A spokeswoman for the DH said despite the BMA’s statements this week “these documents show that the department has provided clear detail on how seven day services will be delivered, which is not by spreading the existing workforce more thinly”.

A BMA spokeswoman said: “The BMA hasn’t said that a lack of detail about seven day services is the reason junior doctors are going on strike. What we have always said that Jeremy Hunt needs to stop conflating the junior doctor’s contract with delivering seven day services – junior doctors aren’t a roadblock to seven day services as they already work seven days a week. We simply asked for this section on seven day services to be removed from the final Acas statement because it was irrelevant to the contract, which he have consistently said. It was the government’s own risk assessment which said that there is no plan to deliver seven day services.”