Home » Friends. » Andrew Haldenby: Why now is the time to rally round Jeremy Hunt.

Andrew Haldenby: Why now is the time to rally round Jeremy Hunt.

Interesting comments on the article.

http://www.conservativehome.com/platform/2016/02/andrew-haldenby-why-this-is-the-time-to-rally-round-jeremy-hunt.html
Andrew Haldenby is Director of Reform.

Jeremy Hunt is under pressure.  On the second full day of the junior doctors’ strike, his judgement in picking a fight with the junior doctors is being questioned such figures as Alan Milburn.  His department may break its spending limit agreed with the Treasury for this financial year.  Public satisfaction with the NHS has fallen.  The odd rumour is passing around Westminster that he will be moved in the next reshuffle.

Who could blame him for wanting a move?  Almost any job in government would be a relief after facing up to the BMA’s gunboat diplomacy every day.  But the fact remains that he is a reforming Health Secretary, in a party far too nervous of health reform, and for that he should be prized.

On the doctors’ strike, Milburn said last week that the Government should settle it – get it out of the way because “arguments like this hold up bigger, necessary reforms”.  That may normally be the case (and I don’t make a habit of disagreeing with him on public service reform).  In this instance, however, the doctors’ representative body, the British Medical Association, clearly see the dispute as a test of the Government’s wider resolve.

Its aggressive rhetoric has raised the temperature and encouraged its membership towards strike action.  It would like nothing better than for the Government to back down on what has become a symbolic dispute.  Hunt is showing good judgement in holding the line.

He is also right that the NHS should make further steps to join the rest of our 24/7 society (while recognising of course that many staff already work at weekends).  When it reported last year, the independent doctors’ pay review body found the “case for expanded seven day services in the NHS … to be compelling”.  It noted that, across the economy, 24/7 services have become more prevalent since the 1990s.  It said that the NHS would be a beacon of international good practice if it were able to do better.

As Sarah Woolaston has said, the BMA will lose public support the longer it remains on strike.  It is interesting that it has decided not to go for a withdrawal of emergency cover, as it originally promised.  That is a hint that they fear that they are pushing the limits of people’s sympathy.

On the NHS more widely, he has given full support to a plan from Simon Stevens, the head of NHS England, which would see the NHS change root-and-branch around the needs of the patient.  That plan is making slow progress, and the slow pace of change over many years is the reason for the service’s current financial difficulties.  Nevertheless, the direction of travel is right and Hunt again has made the right call.

He will now be under immense pressure from within his department to dump the Government’s whole reform agenda in the face of the service’s money problems.  He will be urged to settle with the junior doctors, abandon patient choice as a distraction, and take personal command-and-control of the NHS on the model of the early years of the Blair Government.  In those days, quite literally, the Department of Health would telephone individual hospitals to see how they were managing their waiting lists.  I hope that Mr Hunt resists and that he gets support from the rest of Government.

(Tony Blair latterly sharply reduced the number of central targets and sought to promote competition and choice.   This was his view after a decade in office, as told to the Economist in 2007: “The purpose should be so that public services can adapt and adjust naturally – self-generating reform – rather than being continually prodded and pushed from the centre. Public sector unions can’t be allowed to determine the shape of public services.”)

The biggest hope for the future of the NHS is that it becomes more productive by changing the way it does its business.  The route to better value lies in preventing ill health, early diagnosis of illness and a unwavering focus on safe, high quality care, all of which is to the benefit of patients.  All of this, however, requires political leadership because the NHS workforce will need to change significantly.   The Department of Health needs the same strength of purpose that Theresa May has displayed over police reform.  Good reformers make waves.  Given the BMA, the Police Federation, the Prison Officers Association and so on, it comes with the territory.  The waves they make are a sign of their success.

This is not the moment to U-turn on health reform or on Jeremy Hunt.

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DMC197166p· 4 days ago

There’s supporting your friends, which is a good thing, and something we conservatives are very good at in my view

And there’s rewarding incompetence and being out of your depth

Milburn is right reform is needed but there is absolutely no evidence this reform will produce any meaningful benefit for the NHS apart from financial due to the pay cut aspect and is distracting from actually useful reform

Hunt when I’ve heard him speak always sounds so plausible yet the Doctors keep saying he’s a liar of the first order. It makes me very uneasy.

8 replies · active 4 days ago

As a bit of a stats geek (since my A level maths days) my interpretation of his use of the stats isn’t good, at best he’s been highly economical with the truth and at worst he has been lying

even Bruce Keogh, who has been a friend of both Hunt and the Conservative party during the current dispute, can’t and won’t public back him up about the stats

in terms of the hours things I don’t need the BMA or the DoH to tell me whats going on, GCSE level maths tells me what happens to average hours worked if you increase the amount of hours worked that you want to do with the same or less numbers of staff, and the answer isn’t an hours cut!

On your first point, a paper published in the BMJ in September last, showed an increase in average mortality of 10% for Saturday admissions, and 15% for Sunday admissions. There is dispute about the reasons for these differences – differences which had been noted before. There are clearly a number of factors at play, but it is not unreasonable to argue that one of those factors is NHS provision on Saturday and Sunday.
On your second point, the total amount of hours worked under the new contract would be the same. The number of junior doctors would be the same. What would differ is:
[a] the premium rates paid for Saturday working; the Government wishes to remove premium pay for Saturday, the BMA wishes to retain it in some form.
[b] the present system allows some junior doctors to work excessive weekend shifts whilst others do little or none. The reasons for this are partly historical, partly down to volunteering, and partly down to differences of clinical need. The Government wishes to allow management to roster junior doctors over the necessary hours as the service demands, paying premium rates on Sunday only. In return, junior doctors will receive 11% increase in basic pay.
There are a number of other adjustments, but I believe agreement has been reached on those.
I’m sorry that is completely wrong, Hunt has been completely clear all along, one of his key objectives has been to get more doctors rostered to work on weekends – that will produce an increase in hours worked – that is really simple and basic, the only way to avoid that is to take those doctors from the weekday, in other words decrease the level of cover elsewhere – I don’t think anyone is advising that

In terms of the stats it isn’t that simple, those figures show an increased death rate (a month later by the way not on the day of admission), for admissions on a weekend, now as we all know toenail repairs, varicose vein ops, routine procedures are all done on patients admitted in the week – procedures with extremely low mortality

as Keogh said you cannot therefore, without those confounders, claim that doctor staffing alone is the only factor here

as it happens I’m actually in favour of the principle of improving weekend staffing for doctors and all other NHS workers in hospitals but I don’t think aiming to do such a big thing at a time of limited finance is a good idea at all, politically and from the conservative point of view it is a complete self inflicted wound and one Hunt will likely pay with his job for later in the year

We differ on the rostering intention. I admit I cannot find clarity on this issue because the details of the negotiations are not available. However, I make two points [a] some doctors would work more weekends than previously, but some others would work less. [b] I understood that one argument put forward by junior doctors against the deal, was that rostering across the weekend would reduce the numbers available during the week – affecting patient safety – but leaving overall average hours unchanged. When the deal is settled – as it will be – you and I can decide who is correct.
I think Hunt has been very clear on the issue of increasing weekend working, indeed he says he is doing this for safety.
As I say I actually back the idea that we should have more people working weekends

I cant see how there’s any way that an increased amount of weekend working will produce anything other than an increase in hours on average, the maths just seems obvious irrespective of any spin from either side

Mr Hunt has history over being economical with the truth. I’m sure we all recall the way he laid down the life of his SpAd to save is own skin over the BSkyB affair. And today we hear that he is refusing all requests for interviews – he is often his own worst enemy.
Funny that he was on the 1 o’clock news so your second sentence at least is completely incorrect..
Apologies. I got my information from the radio, where correspondents were reporting that Hunt was not taking interviews. Maybe he changed his mind?
Hunt wants a 7 day NHS. It is a catchy slogan. But what does it mean? That all hospitals and GP surgeries are open seven days a week (24 hours a day?) fully staffed by secretaries, porters, laboratory technicians, nurses, doctors etc. Or does it mean something else? If so, what. Simply shouting a slogan with no apparent idea of what this means does not inspire the slightest confidence that Hunt, or Cameron, or anyone else in the cabinet, has the slightest idea what they are doing.

As for stats about increased death rates at the weekend. Firstly, the effect is also found on Fridays and Mondays. Unless I missed something, these are not weekend days. Secondly, as a GP who works one evening a week, untill 11pm and every second weekend, I can state with total confidence that the patients who call, and are admitted at weekends, are considerably more seriously ill than during the week. A factor recognised by various studies. You have to be extremely careful about looking at raw figures then claiming cause and effect. As all scientists know, association is not the same as causation – and anyone who tries to claim that it is, is a complete fool.

14 replies · active 1 hour ago

I have 8 doctors in my family – 4 GPs and 4 junior doctors. They all agree that care provided by hospitals at weekends is sub-standard and deficient compared to that provided on weekdays. As an NHS cancer patient myself, I concur with that from my own experience.

I think a 24 / 7 uniform standard of service at hospitals is a no brainer and I don’t think too many doctors dispute that. That however requires the problem of bed blocking to be resolved; the relevant support staff to be provided to doctors, and more permanent doctors rather than reliance on exorbitantly paid locums.

There is absolutely zero demand for weekend GP surgeries and if the Health Sec took action to reduce the amount of time wasters during the week by introducing a nominal charge for a GP visit, which GPs themselves resist in the main, then a lot of the problems facing GPs would disappear.

I think a 24 / 7 uniform standard of service at hospitals is a no brainer

You want to have fully staffed dermatology departments at 3am on a Sunday morning? Why?

That however requires the problem of bed blocking to be resolved; the relevant support staff to be provided to doctors, and more permanent doctors rather than reliance on exorbitantly paid locums.

Sure, but to do that we probably have to start by recognising that bed blocking is such a problem because we’ve dumped social care on councils and then stripped them of funding for it, haven’t thought about support staff at all, and are driving doctors to leave not just the NHS but the country.

I don’t recall saying 24/7 for each and every aspect of hospital life and dermatology is outpatients only so clearly doesn’t make sense.

That’s only part of the problem of bed blocking. Equally significant are the cumbersome procedures for discharging patients from hospitals.

You think ’24/7 uniform standard of service at hospital is a no brainer, and I don’t think too many doctors dispute that.’ I think you would find that all doctors dispute that. Operations for routine surgery at 3am, all laboratories open fully 24 hours a day, outpatients to be seen through the night at fully staffed out patient departments. Do you really mean this? If so, do you believe anyone has costed this fully?

I am also interested as to you exact relationship with these eight doctors in your family. Are they your children, your brother and sisters, your parents? You must have a truly amazing family. You should be very proud of them, especially the 4 junior doctors. I presume they all voted no to strike action, which would be equally amazing, as the vote for strike action was > 98%.

You’re right I am proud of them. My daughter was the youngest FRCP when she qualified. None of the 4 junior doctors are on strike today and none of them are opposed to weekend working; they are upset about the proposed reduction to special payments for doing so. Given the waiting lists for most operations, critical and non critical, and the amount of time iperating theatres stand idle, operations during the evening and even night, sounds eminently sensible to me, if there are beds available.
And how are you going to do this without considerably more staff resources? Every hour you add to the weekend is an hour taken away from the weekday.
The NHS clearly needs more permanent doctors and nurses to run an improved health service but if we retained those doctors who we train and who then choose to emigrate, we wouldn’t have the recruitment problems currently faces and we wouldn’t need to use locum doctors at exorbitant rates of pay to the level the NHS currently does.
couldn’t agree more with that, the problem is though that with the yearly pay cuts, the pension cuts, the press treatment of them and now this new contract and a further proposed pay cut the job is becoming less and less attractive and jobs in the rest of the english speaking world are becoming more attractive

the problem we have is those countries don’t seem to believe they have to do what we are doing and us doing all these things whilst they aren’t is increasingly making us look a less attractive option to work in

Absolutely – having trained doctors at public expense who then leave and have to incur the cost of recruiting doctors from overseas seems financial nonsense rather than proper use of resources. Personally, I don’t think the NHS is sustainable if it is going to continue to be funded out of direct taxation but that is a whole different issue.
I do wonder whether all the things we’ve done to save money (pay cuts, pension cuts etc) have actually saved anything net compared to the cost of having to pay locums and recruit from overseas etc to compensate for people leaving

I suspect we’ve bared saved a penny and caused a huge problem for years ahead in the process

In terms of long term funding its difficult, I know many in the DoH see the insurance model as a potential option but the problem in that is that every European country I see with those sorts of models actually ends up spending well more than we do as a proportion of GDP, and the last thing we need at the moment is a reform that’s going to significantly increase our need for spending

The problem Osborne has is that we actually haven’t had any austerity after the financial crash. Government spending has risen inexorably, driven largely by welfare,and all he has done is shuffled the deck on departmental budgets. There are huge savings he could make in Government spending, starting with the cost of running Government administration, to re-invest in defence and health.

I have mixed views abôut an insurance model. They do seem to work but most health users are those of the elderly who having paid NIC all their lives think they are entitled to free health care and who could not afford to start paying health insurance premiums. I do favour a user pays type model for certain aspects of health care – GP appointments, reducing the huge exemptions from prescription charges, charging for missed outpatients and non emergency visits to A&E; self inflicted health problems such as drunkenness etc

A nominal charge for one is a crippling expense for another. Which, when you think about it, is why the NHS is free at the point of delivery.
Well said. Hunt is pursuing a dubious objective (a full NHS service, 7 days a week) based on dodgy data, which is going to be funded by re-organising medical rosters (hence the doctor’s strike). Drop the daft objective and the dispute with the doctors disappears. Waffle from Andrew Haldenby (“the NHS should make further steps to join the rest of our 24/7 society (while recognising of course that many staff already work at weekends).”) is of no help.
Hunt is pursuing the right objective but is entirely the wrong way. Improving the quality of health care at weekends is entirely merited; trying to restructure the junior doctors contracts so they help fund it is not.
The country is behind the doctors. And the country is right. No way can a government – any government – win against our doctors. And rightly so. Best back down Jeremy. You are on a hiding to nothing..

5 replies · active 3 days ago

I’m not behind the doctors, so your assertion is incorrect. Why on earth would anybody be behind people who seem to have lost the notion of vocation, and who are happy to see their patients suffer through thousands of cancelled operations?
Not cancelled, postponed.
Cancelled or postponed, the patients are a secondary concern to the striking doctors.
But there is a big difference. Too many commentators misuse ‘cancelled’. Look it up if you are not sue.
I am not behind the junior doctors. Nearly 3000 people are suffering because their operations have been postponed. The doctors were all grinning and laughing on the picket line. I wish someone would say how many hours junior doctors work now and how much they are paid including unsocial hours and how many hours they will have to work under the new contract and how much they will earn after the 11% pay rise. Then we will be able to judge who is telling the truth or not.
Jeremy Hunt is well intentioned but too naive and accident prone. Having made a mess of the News Int bid for Sky whilst at Culture and now being the person responsible for this unnecessary strike, he needs to go – out of the Cabinet rather than to another portfolio.

He did a good job damping down the brouhaha caused Lansley’s reforms and it is clearly sensible to focus on improving the quality of care in NHS hospitals at weekends and moving towards a uniform IT platform so that any doctor treating a patient has access to that patients entire medical records. That requires more that a deal with the doctors however. It requires bed blocking to be solved and the provision of the necessary support staff. However, the initial proposals made to the doctors were ludicrously bad so rather than refer the pay review to an independent body such as MPs themselves have, he has got embroiled in an unnecessary testosterone fight with the BMA. Their behaviour of late has been shameful but the public will always side with the doctors against the politicians whomever is in power. If there is any truth in the story that Hunt himself vetoed a deal that all others parties had agreed to then he has a lot of explaining to do. The tragedy of all this is that it deflects attention away from Lord Carters quite sensible plans to save money in running the NHS that can be put back into front line health care.

1 reply · active 1 hour ago

I don’t think he’s at all naive. Incompetent, yes, but not naive. His avowed intent is to destroy the NHS, which is why he was made Health Secretary. The BMA, like the doctors, has been attempting to find a compromise solution. They found one, too, which was accepted by the doctors, but not by Hunt.
In this instance, however, the doctors’ representative body, the British Medical Association, clearly see the dispute as a test of the Government’s wider resolve.

Err no. The BMA sees this as a dispute about junior doctors contracts, working hours and patient safety. The only people talking of it as a test of the Government’s resolve are political apparatchiks around Westminster like Mr Haldenby. This sort of inane willy-waving as a substitute for real policy is both nauseating and making it more difficult to deliver a decent healthcare policy.

Mr Hunt, no doubt cheered on by the likes of Mr Haldenby, has decided that it suits him politically to be the Gove of Health. Alas, he is charged with being the Health Secretary, so making sure the NHS is working effectively and efficiently ought to come before what suits his political ambitions and career. We hit the nadir a couple of days ago when the NHS, Dept of Health and the BMA thought that they had resolved the dispute, only for Jeremy Hunt to personally intervene and veto that resolution. Mr Hunt prefers to have the strike so he can show what a tough guy he is. It’s pathetic and Mr Haldenby should be ashamed of backing him.

1 reply · active 4 days ago

The dispute is not about patient safety and working hours, no matter what the BMA says. it’s about the Government trying improve care in hospitals at weekend and the money doctors are paid for working unsocial hours. Junior doctors today do not work the hours they used to. The initial proposal made by the Government was just risible. Otherwise the dispute would be over by now.
Please do not refer to ‘bed blocking.’ Or perhaps you would like to come and speak to some of my patients in Intermediate Care and tell them they are bed blocking. The correct term for such people is ‘patients’ who would love to go somewhere else. However due to savage cuts in social care, residential and nursing care beds are being removed from the community at a rapid rate, so there is nowhere else for them to go. At the same, community care providers are going bust, so there is a massive loss of care in the community. We should perhaps change the term ‘bed blocking’ to ‘social care destroyers’ a.k.a. the current Conservative Government. All such problems could be resolved by the use of an amazing problem removing agent called…. money.

7 replies · active 4 days ago

Perhaps if GPs and consultants weren’t overpaid as they are at present, the money could be available to do more.
Ah yes, the Daily Mail argument. Try paying GPs and consultants less, and see how many you have left. Did you find, when you were at school, that the stupid and the lazy were the ones who went to medical school. Or, did you find that the pupils who went to medical school were the hardest working, most motivated, most engaged and brightest? Perhaps you think doctors should be paid the minimum wage? I would imagine most people reading this blog are pretty right wing and believe in the free market. Well, welcome to the free market. When your most valuable resource finds that the rewards available do not match their skill set, they walk. Then what?
The threat to walk is as empty as Hunts threat to impose the proposed new contract on doctors. Where are doctors going to go. They can’t work in the private sector until they are consultants; those inclined to emigrate have already done so. A few might change professions or go to Scotland and Wales but that’s unlikely to affect many. Foreign doctors wouldn’t be over here unless is was massively to their advantage. You are exhibiting all the characteristics of someone intent on losing public support rather than capitalising on it.
I don’t seriously think all doctors would emigrate, it’s niaive though to think contracts, hours and pay worsening won’t have an impact on the level and pace of that emigration though

Quitting to locum is also a significant issue as given how threadbare our hospitals are these days we have no choice but to pay it or leave them unsafe

The only foreign doctors that come here are from poorer and developing countries, there is no flow here from Australia or Canada or the US etc

Whether we like it or not people with brains and skills are in a global market

I don’t think the final contract will be anything onerous for, or not agreed with, doctors but I don’t think threatening to walk helps. Most overseas health employers like to take newly qualifieds rather than those who have had clinical employment in the NHS. Junior doctors usually have significant family and financial commitments too – wives who may or may not work, children who may be in private education, mortgages, car loans etc. To disentangle all that in the same timeframe as a job offer is very difficult. I want junior doctors to come out of this an agreed deal that works for them and works for patients as I suspect you do. Threatening to walk as Dr Kendrick does is an unhelpful and largely empty threat.
Remind me who spent all the money creating non jobs and thinking they could use tax payers money to do it? Oh yes I remember it was Labour. If they hadn’t been so profligate with our money we would not be in the mess we are in now and there would be money for social care. This country’ s financial situation will not be solved over night we are still battling the deficit they left, let alone paying off the debt and the interest that keeps being added to it.
Where are they going to walk to? Let’s face it, GPs and consultants do very nicely, don’t they? They earn considerably more than most of their patients, so they haven’t got much to complain about.
If they don’t have much to complain about, then why are they complaining. As for, where do they go to? RLE, that is the hot acronym on all doctors forums. Retire, locum emigrate. You can earn far more in Canada, Australia, the US, New Zealand, Dubai etc. Doctors know this, and they are going. As for me…locum, then retire. If you treat a valuable resource like rubbish, they go. As for earning more than most of their patients…one should hope so. Three A’s a A level. Ten to fifteen years of training. Do you really, really, think they should not earn more than average. If so, please provide your reasoning.
of course this willy-waving by JH has little to do with Junior doctors. The high part of the wage bill is nurses. He thought Junior doctors would be the easiest target and roll over. Once they were on normal rates for weekend the next group would be nurses and that would generate the big savings.
well, the junior docs have been more militant than their senior colleagues.
Enough of them will have few financial commitments and they will travel/take a career break/work as a locum, that the service in many areas will implode.
Junior docs are a reasonably intelligent, critical thinking , independent minded lot. JH thought that constantly shouting unproven half-truths ,that mortality if you are admitted at weekend is higher due to lack of doctors ( its probably due to patients at weekend being more ill and lack of diagnostic and support services ) would work.
Well it hasnt.

2 replies · active 3 days ago

I agree that I suspect the nurses are the real target here and the junior doctors were going to be the ‘easy’ start to be able to go the nurses and say ‘look they’ve accepted it’.
And for Hunt etc to claim that charging nurses for their training will lead to more nurses is just bonkers.
looks like a contract will be imposed and we could be heading into a deeper dispute and the prospect of a large swath of doctors jobs being unfilled in August, could be a very bad summer to fall ill in the UK unfortunately unless someone backs down down

how we got here in a fight against what is, to a large part, a conservative voting part of the electorate is beyond me

And there now a whole generation of people you might expect to grow into being conservative voters who now will stick redhot pokers in their eyes rather than vote Tory, ever. And the NHS will be JHs epiphet , just as Iraq is Blairs.
Shooting yourself in the head, or what .
Poor hopeless Hunt, the leading exemplar in the cabinet of someone promoted way beyond his competence level, flounders around inventing statistics and shamelessly lying to and about the very people whose support and commitment is vital for the NHS. Sweaty palmed apologists like Haldenby are beyond caricature – he hasn’t even realised that nobody values Hunt at the price of even ONE doctor, let alone the steadily increasing stream he is blandly driving away. He is hated with a passion. To cap it all, our puffed up buffoon Jeremy announces ( today of all days !) an enquiry, God bless him, into the cause of low morale among doctors, i.e. Jeremy Hunt. William Hill, as implacable as the grim reaper, has duly opened a book today on Hunt’s chances of surviving much longer in his second failed cabinet role. When I looked a few hours ago he was odds on to survive at 8/11….. not for long Mr Haldenby, not for long.
I have 2 of points of interest.

http://www.hsj.co.uk/sectors/acute-care/exclusive…

You imply Jeremy Hunt advocates patient choice. This article quoting the man seems to directly contradicts you.

http://www.bbc.co.uk/news/health-25476090

And this report states that Jeremy Hunt directly called chief executives about waiting times as you are claiming early Blair labour did.

I have voted conservative all my life, I am from a family that has also done so. I represented the conservative party in our school’s mock general elections. I went to public school. I am about as safe a tory vote as there probably is, but this government has changed my opinion.

The way hunt has conducted himself in these Junior doctor negotiations is appalling. These are the people who have worked hard and achieved highly since school. They are highly intelligent, highly educated, and highly skilled individuals. They deserve good working conditions and a good wage. If we can throw billions at the bankers, who continue to take the piss with their tax avoidance and huge bonuses we can afford to properly fund the NHS. If we insist on full services over 7 days we need to fund it rather than trying to force a generation of highly skilled professionals to work more antisocial hours for no extra pay.

The NHS is held together by the good will of the people working in it. Doctors, Nurses, Paramedics, radiographers, Physios and all other health professionals all work above and beyond and do not ask for more. These people should be treated with respect, not with hunt’s unique brand of arrogance and incompetence.

For all the health professionals considering emigrating, good for you. You deserve to be treated with respect and be able to deliver your skillset in a safe environment. I’m sure saving an australian’s life comes with about the same level of satisfaction as saving a British person’s life.

Hunt need to go and we need to start treating these people with the respect they deserve.

Let’s examine the governments legitimate aims regarding the NHS.
Clearly a pluralistic future funding stream is needed with working hours reform, of key staffing groups.
The state needs to shrink its commitment and act as a facilitator for the drive of entrepreneurial involvement.

However, Andrew has not read the developing tone music of Mr Hunts involvement.

A minister who becomes THE STORY of the dispute, inducing a visceral negative response from the junior doctors has to leave office.

It’s clear he has felt compelled to be “muscular” , and has perhaps failed to be persuasive for our natural supporters.

In other words, he has become a toxic brand, and needs to hand the reigns over.

The litmus test is whether he remains an electoral liability, and can get the job done.
The time for a fresh conciliatory but subtle approach is needed.

The man has forged important letters and presented them as evidence. In any walk of life that has any respect, this is gross misconduct and instant dismissal.
This whole dispute is extremely sad. The Conservative Party ought to be there for intelligent and hard working individuals that have dedicated themselves to public service. They should be our core constituency. Instead, this government has driven them to despair and fury.

Both sides have overplayed the “patient safety” card when this is clearly about cutting costs (for the government) and protecting T&Cs (for the BMA). However, both Jeremy Hunt and Ben Gummer have been extremely economical with the truth and relied on the complex nature of doctor remuneration to pull the wool over everyone’s eyes.

Regardless of whether or not he still thinks he was “right”, Jeremy should have stepped aside and let another figurehead try to broker a compromise in his place. David Cameron should have insisted as much. None of us have any idea where this is going to end up but its unlikely that either patients or tax payers are going to be better off.

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