Interview with Dr. Hamed Khan

This is a full transcript of an interview from October 9th 2015.

Dr Hamed Khan

Dr. Hamed Khan is a GP, A&E doctor, and has become one of many key NHS figures to talk openly about the problems this junior contract is causing, and representing a new initiative take the health service out of politicians hands.

Firstly thanks for agreeing to talk to me. You’ve been busy. Is it getting any easier getting your message across?

“I think it is. Slowly but surely we’re getting more and more support from the public, politicians and even the parts of the media. Incidentally I was speaking about the NHS deficit on BBC 3 Counties Radio this evening and Roberto Perrone (their lead presenter) told me how he had spoken to various people who thought that the only way to save the NHS by devolving it from political control, and creating some sort of independent commission to look at it, and oversee it in the longer term. What I’m also hearing frequently from both patients and front line professionals is that they feel that politicians are driven by elections and 4 year electoral terms, which hinders their ability- and perhaps motivation- to think about the longer term. And this is why our idea of bringing together the public, front line professionals and patients to think collectively about the NHS, without the limitations of a 4 year electoral term, is gaining so much traction. The idea of a Royal Commission to do this is novel, and new territory for many people- but again the independent nature of this is something that I feel many people find attractive.”

A lot has changed since we first made contact. Was Mr. Hunt’s recent letter a surprise for you?

“We are a large diverse group, and reactions within the group vary. Some of us feel that this is old wine in a new bottle, and that JH is merely putting spin on what is fundamentally no change in his original position. Others feel that it is a sign that he is has- very slowly- started to gain an insight into the level of opposition he faces, and is trying to change his stance and entice the BMA back to the table. We’re reluctant to give a knee jerk reaction, although I think it’s accurate to say that most of us are more skeptical than optimistic. It’s early days and the devil is in the detail. It doesn’t help that in the DoH appears to be very inaccessible, and reluctant to participate in any media discussions and debates. I’ve spoken to several journalists from numerous TV channels who have expressed deep frustration at the reluctance and refusal of DoH officials to appear and debate with front line professionals. It is understandably that many of us perceive this as a lack of openness that reflects the weakness of their arguments.”

And seems to be a reluctance to be transparent or accessible reflected in the delayed publications of the NHS deficit figures until after the Tory Party Conference.

“Well it certainly gives that perception. One thing that is clear from all this is that the way the DOH has managed its communications has been confrontational and deeply undiplomatic. The disconnect and disengagement has escalated to a highly charged emotive confrontation and what many people see almost as a state of war! Whatever the arguments, this breakdown of relations cannot be conducive to any constructive or purposeful discussions and progress.”

You mentioned that more are skeptical than optimistic and I can understand why. I’m going to play devils advocate for a minute. Do you think Hunt’s letter is a trap? My wife is a GP and we both went through it thoroughly. From where i sit he could easily back Jnr docs in to a corner with this. If he’s making concessions on the 48 hr working week, and therefore preserving patient care by making sure doctors are less tired, but Jnr docs still strike over the contract, he’ll be able to say that the strike is in fact all about pay.

“But he isn’t. The key safeguard was that trusts were fined if doctors breached the EWTD (Early Working Time Directive). He hasn’t addressed that in his letter. Rather he’s given a vague assurance that doctors won’t. But that’s meaningless without a disincentive for trusts. At the moment trusts are fined if doctors work more hours than allowed by the EWTD. My understanding is that trusts will not have to record doctors hours- and thus will not be fined if their doctors work beyond the EWTD.”

Explains part of the deficit at least. You’re fighting for an independent body for the NHS. What is needed to make this a reality and get politics out of the health service? What can the public do to help with this?

“Public support and awareness is the most important thing. We want members of the public to join us and participate in helping us run the organisation and direct it. The only funding we receive at the moment is, in essence, through crowd funding- that is the other important way in which the public can help us. Other than this, we’re trying to gain traction and support from politicians and major think tanks and academics. A number of MPs have responded very positively to our idea, and we are talking to them. As have several influential academics. For example I recently spoke to Nigel Edwards, the Chair of the Nuffield Trust, and he told me that he fully supported our vision and ethos.”

I see you have also gained the attention of Lib Dems Norman Lamb. He’s been quite vocal recently about the problems in the NHS.

“We’re delighted that he has been vocal in calling for essentially the same thing we have bwpid-screenshot_2015-10-22-21-53-36-1.pngeen calling for. And having someone speak openly with the level of insight and experience he has reflects the strength of our arguments and our ultimate aims and vision.”

You can follow Dr. Khan on Twitter by clicking on the picture.

The movement Dr. Khan talks about and represents is called NHS Survival. You can find out more and show your support for a National Health Service removed from political control at www.nhssurvival.org.

NHSSurvival

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Transcript of interview with Michael D. Cearns (medical student)

This is a full transcript of an interview from October 9th 2015.

Michael D. Cearns
Michael is a medical student in his sixth and final year of training at a London medical school. He will be one of thousands of junior doctors forced to work under the new imposed contract due to come in on 1st August 2016. I started by asking him what his main reason was for wanting to study medicine.

“I think it’s fundamentally a very worthwhile thing to do with your life. You spend your time doing your best for someone who needs your help, and that alone can give you all the satisfaction you could need from a career, I think.It’s also a great balance. It’s a career you can get your teeth into, because it requires plenty of scientific understanding but allows you to develop clinical reasoning skills, to perform procedures, to make decisions that directly affect people’s lives.”

And before you started did you have a specialty in mind?

“I was always rather interested by the brain, as an organ that contains within it everything you feel, do and think – everything that makes you who you are. Diseases that compromise that somehow take something very important away from you. During my time at medical school I’ve kept my mind open in terms of my career choices, though.”

Obviously a lot has happened to the NHS in the 5 + years you’ve been studying. Has what you’ve seen, especially the row over junior doctors contracts ever made you think about changing your mind about your future career?

“I think medicine is the right career choice for me. After spending this much time modelling myself on doctors and learning the art and science of practicing medicine, I find it difficult to picture myself in another career. That’s not to say that I am pleased with the way things have been going in the NHS recently – it’s obviously becoming clear that lots of doctors would consider leaving medicine or working abroad if conditions became too difficult in the UK. For me, the proposed contract would make life very difficult indeed, and it would compromise patient care, but it wouldn’t make me personally want to stop doing medicine.”

Has there been much discussion, either with your fellow students or your lectures, about what has been happening in the NHS?

“There has certainly been a lot of discussion amongst medical students, as it affects us so directly. My colleagues at my stage in training and I will start as junior doctors in August, when the proposed contract would take effect, so it’s generated as much commotion amongst medical students as it has amongst junior doctors, I’d say.”

It’s clear from all the doctors and nurses I know, and yourself that this fight over junior doctors contracts is about care, but there is still a few out there who believe that this is doctors fighting for more money. Have you found yourself trying to defend against this perception?

“At times, and I’ve certainly seen those opinions out there. In my experience, junior doctors rarely put themselves first. Their first priority is always their patients, and that’s why under the reality of the current contract, juniors clock off the rota at 48 hours a week and start their unpaid overtime, which will always be 10 – 20 hours per week at the least. This is out of compassion for their patients who are sick; to a doctor, an extra few hours is a small price to pay for the sake of a patient who is inevitably in a much worse situation and needs their help. The newly proposed contract discredits this ethic, demanding more of junior doctors who are already maximally stretched across a resource-poor service. The result would be lower standards of care across the board – that’s what happens if you make the same number of doctors work longer, tougher hours. The main reason we’re opposing this is that the very patients we are trying to help would suffer under those circumstances. That said, I’m not trying to claim that doctors don’t think about money at all – they’re human and recognise that this contract would have a very serious effect on them financially. I can’t think of a £22,000 a year job that demands such emotionally charged work, unsociable hours and high levels of responsibility as being a junior doctor. A friend of mine works in consultancy, and her manager said to her ‘when a doctor has a bad day, his or her patient dies; when I have a bad day, someone hasn’t given me a PowerPoint on time’. It speaks volumes to me that that came from someone in the financial sector, not from someone in medicine.”

Have you had a chance to see Jeremy Hunt’s recent counter offer to junior doctors sent to Johann Malawalana?

“Yes, I did. The fact that he has responded in this way means junior doctors have put the message across, which I think is a positive step. Ultimately, there has to be fair negotiation to reach a solution. The problem I had with Mr Hunt’s letter was that it didn’t provide concrete proposals – figures, forecasts, estimates. It tried to convey the government’s proposed ambition, but without altering the original proposal enough for it to marry up with that ambition. In other words, it was likely more show than substance. If you’re changing the working conditions of 53,000 people you have to be able to predict what effects that will really have.”

And what did you make of the publishing of deficit figures delayed until after the Tory Party Conference?

“I must admit it seems a bit politically convenient.”

What did you make of the figures? Were you surprised at such a high amount for just a few months?

“Nearly a £1billion is of course a huge deficit for three months – ultimately if services being provided at the moment are to stay as they are, that deficit actually represents under-funding to the tune of £4billion a year. And if you want to increase service provision – especially routine non-urgent services at weekends – you need more funding to do that.”

“An American style health service certainly would concern me a great deal, but I don’t particularly buy into the view that the Tories are trying to systematically dismantle the NHS with the aim of total privatisation. Were that to be the case, I also don’t think the public would stand for it in the long term. For the most part I try to avoid the party politics side to these arguments; accusing politicians of lies and deceit distracts from the main issues and doesn’t advance anyone’s cause a very long way. That of course doesn’t mean I don’t disagree with the Tories’ approach to managing the NHS, and I’m sure many of my friends and colleagues would interpret recent events in the manner you describe.”

A brilliant POV that unfortunately you dont see much now. Politics is distracting from care.

“Thank you – I couldn’t agree more.”

Just one final question: with everything you’ve been through in the last 5 years, and seeing what’s ahead of you, would you still recommend to people taking up medicine as a career?

“That’s a very good question. Some of my colleagues would probably advise against it. These are turbulent times for the NHS, but from where I sit, the thing that gets doctors up in the morning, makes them work the tough hours and the nights, is the patient and the fact that they can help them. That’s more important than the political rhetoric, the salary or any of the rest of it. In that sense, I would still recommend medicine as a career. The immediate future is going to be both challenging and pivotal in determining the future of the NHS as we know it. I hope that by engaging the public, doctors can secure working conditions that keep the public safe and provide them with healthcare free at the point of need. Aneurin Bevan famously said ‘The NHS will lastwpid-screenshot_2015-10-22-21-53-51-1.png as long as there are folk left with the faith to fight for it’. We’re still here.”

You can follow Michael through his Twitter account by clicking on the picture.

Don’t let The Good Ship NHS sink.

rewardingQuestion: if you were responsible for the biggest workforce in the country, one that potentially holds the lives of every man, woman and child in the country in their hands, would you treat them with respect? Would you meet and talk with them directly about your concerns over a stretched service and try to work together to find a solution? Would you think it absurd to create a new contract that removes a cap on lengthy, unfair and unsafe working hours while reducing their pay? If you’re answer is ‘yes’ to these three questions, congratulations – you are not Jeremy Hunt.

quoteI’ve found myself talking to lots of different people over the last couple of weeks about the state of the NHS, and the fight that the country’s junior doctors are putting up. It is of course these people that are making the biggest noise right now; fighting against an imposed contract that is, according to Jeremy Hunt and the Department of Health, non-negotiable (save for one clause) that will, according to the people who actually do the job, make their jobs unfair and unsafe for them and their patients.

jessenHaving seen the visible exhaustion on Jeremy Hunt’s face recently, and his clear contempt for transparency in his department by refusing to answer questions from the public, health care professionals, or even his fellow MP’s, it’s clear that he underestimated the reaction he would get to his new contract. Medics are seen to have effectively just rolled over in the past acombond taken whatever outlandish new proposals have been forced upon them. This is no longer the case. Marches in London and across the rest of the United Kingdom have made it clear that enough is enough. Support has been coming in from all sides, with patients, celebrities and even politicians showing their support. The Junior Doctors are shouting, and more and more people are listening, save the ones who caused this mess in the first place.

shipThis new contract isn’t just about junior doctors – it affects the whole of the NHS. The nurses who work with them, the varied care workers who rely on them, the consultants who train them (and may one day hand over their roles to them) and the students who will become them. When you see that 70% of junior doctors plan to leave the National Health Service if this current contract is enforced, and that the government plans to reduce funding the NHS to the lowest amount since the 1950’s, despite their pledge to create 7-day NHS, you are basically being told that the NHS is sinking fast. It’s a grand ship that’s had so many holes been rammed in to it but no one’s willing to plug the holes. It’s a ship captained by a man who is lying to you about the direction it’s headed, while he secretly signals for more expensive competitors to come along port and starboard side with their own ships that will cost the passengers all their pieces of eights, nines and indeed tens. This captain believes in efficiency and profit at the cost of patient health. The partnership between five UK NimageHS trusts and the Virginia Mason hospital in Seattle is one such example; an establishment that is “renowned for adapting the Toyota lean production system to patient care”. On the face of it, the hospital scores quite highly for standards in America, but as this comparison shows, it measures up poorly against a hard working NHS hospital. This is hardly surprising given that our NHS was rated the best in the world in 2014, with America coming in substantially lower.

protestThe facts and figures are there in black and white. Mr.Hunt’s ability to twist these figures is now being closely scrutinised after serious allegations (backed up with evidence) that he “misrepresented a key study” on weekend deaths. but still this is not enough. Action needs to be taken. Junior doctors have already marched in London, and there will be similar marches round the UK in the coming days. Add to that the British Medical Association will start balloting it’s members on strike action from 5th November, and you realise how terrible this situation has become. Jumior doctors do not want to strike, but they have been forced in to an untenable position, which thankfully, a growing number of the public understand.

I spoke to two individuals who are effectively on either side of the battle – Michael Cearns is a final year medical student in London, and will become a junior doctor in August 2016, when this new contract is set to be enforced. Dr. Hamed Khan is a GP, A&E doctor, and at the forefront of commentating on the junior contracts. I have transcribed their interviews in full, so you can have a glimpse at the different sides of this battle.

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Fear and Loathing in Great Britain: The Real Legacy of David Cameron

4It’s totally normal that when a person is nearing the end of a job, they would want to leave knowing that they had some kind of impact. Barack Obama is clearly thinking of his time in office. I’m sure Zayn Wotisname from that boyband my little girl likes did the same thing. Our illustrious leader, still with four and a half years of premiership left, is clearly doing the same. After all, he said even before the election he would be stepping down after this term in office. He clearly wants to leave the impression on the world stage that he created a “Greater Britain”, yet as I sit here now, I can see David Cameron’s legacy as British Prime Minister will be one of scaremongering, manipulation and segregation (and to a certain degree, swine based debauchery). He believes in a country that cares nothing for its own citizens. He believes in a country more concerned with money than with humanity – a country that he is turning in to a corporate playground with little hideaways for tax evaders. Now you could probably say that this is just the angry rant of some anti-Tory leftie who doesn’t respect the democratic process. You’d be wrong. I accept the result of the General Election. What I deplore is the lies Mr. Cameron told to win that election. I have no problem with the Conservatives. I know many Tories and they are genuinely nice people. What I question is whether the party in power is really a Tory party, or is it like it is in America, with the Republicans being infiltrated by the infamous Tea Party? Now I’m not quite sure what our version of the Tea Party would be called, but I’m pretty sure it would still begin with a ‘T’. Heck maybe it’s UKIP, I don’t know. Either way, if you look at the actions of our six month old government (not the lies we have been told), they do appear to be very similar to a small section of our American counterparts.

2David Cameron’s new Conservative party claims to be the party for working people; that they have the UK citizens best interests at heart. This years Conservative Party Conference seems to suggest otherwise, with every major speech or claim made by a senior Tory minister expertly dissected, derided and more often than not, dis-proven.

1Theresa May stated that we need tighter controls on immigration, repeating the claim she made back in November 2010. It was seen as nothing more than an attempt by the Home Secretary to lay blame on the (apparent) state of the country on people from other countries; people whom, as it has been proven time and again, make more of a contribution to our society than they do a drain. (A full dissection of the Home Secretaries claims, and evidence to the contrary, can be found here). Her speech, whilst trying to make clear that there needs to be a difference between refugees seeking asylum, and “economic migrants”, still left many, including myself, in doubt over David Cameron’s pledge to take 20,000 Syrian refugees over the next five years. This renewed demonisation of migrants, which is “almost devoid of a single factual accuracy”, coupled with the governments increased attacks on the low paid, hard working families, public sector workers and the disabled goes completely against the “cohesive society” soundbite that the Home Secretary coined, with great futility.
imageThis leads neatly in to George Osbourne, as he continued on his austerity journey by announcing he will cut tax credits, despite Mr. Cameron promising before the General Election, that no such cuts would be made. The Chancellor has also gone to great lengths to ignore serious human rights violations as he negotiated trade deals with China recently. A step that even former Tory party chairman Chris Pattem described as “lax” and describing Mr. Osbourne as “very far from traditional Tory instincts”. Showing support for China, as well as Saudi Arabia in a recent back-room deal that saw the worlds dominant oil producer gain a place on the UN Human Rights Council also calls in to question our governments feelings on human rights in this country. This remains a concern as Michael Gove continues to work on repealing the Human Rights Act – a fact that was carefully swept under the Party Conference carpet but is due to progress in the Autumn. It remains to be seen how much the public will find out about this step from the government directly, but I suspect little will be made by them of our links with countries that flaunt human rights to secure multi-million pound trade deals for oil and arms.

1jeremy-huntAnd then there was our trusted Health Secretary and rhyming slangs best friend, Jeremy Hunt. A man who has made no secret of his ambitions to be Tory party leader once Mr. Cameron steps down (Mr. Osbourne and Mrs. May are also considered contenders). A man who treats the country’s health service, its employees and its patients with such contempt you have to wonder if keeping Cameron around as leader a bit longer is the lesser of two evils. Mr. Hunt has had a busy month; from insulting Junior Doctors with an enforced (non-negotiated), unworkable, immoral contract, (a story I will be looking at in greater detail in my next piece) to insulting anyone in this country with a pulse by saying they need to work harder, like the Chinese. I’m all for hard work, but that alone isn’t enough. You need investment as well, plus recognition that there are those that are physically unable to work. What happens to them? This poisonous rhetoric of ‘survival of the fittest’ spouted by Mr. Hunt and Secretary of State for Work and Pensions Ian Duncan Smith (or IDS as he’s become known, which doesn’t at all sound like an expensive treatment for infected hemorrhoids) is just another spit in the face for those who struggle, who need help. People who genuinely need a welfare state that is being ripped out from under them. Never mind this being un-British; it’s inhumane.

Then there was the grand finale of the Conservative Party Conference, where David Cameron stood up on stage and performed the biggest work of modern day fiction over seen in a party conference. From describing Jeremy Corbyn as “a threat to national security” by cleverly quoting the new Labour leader but removing any context, (you can see Mr. Corbyn’s full thoughts, in context, here) to proudly declaring that his policies are helping the country’s poor when the opposite has been proven, he has shown nothing but barefaced contempt for the people of this country through twisting facts and figures, or just outright lying to support his own self/friends serving narrative.
imageMr. Cameron has this dream of turning the UK in to a country of “high wage, low tax and low welfare”. In theory this is something that I’m in favour of, well two-thirds anyway. I mean what family doesn’t want more money in their pocket and less to go to the tax man? The thing is that we have tax for a reason; to fund our schools, our hospitals, the upkeep of our roads and waste disposal services etc. This government, as with several before, have gone out of their way to demonise tax when they should be relying on it, championing it. People want more money, obviously, but they also want to live in a country that is kept functioning properly, You only need to look at a survey showing that a vast majority of people in this country would back a tax rise to support the NHS. I honestly do believe that if we could see our tax money in real action, making a difference to our country’s infrastructure instead of just lining politicians pockets, then we would have no real problem with it, but to live in one of the highest taxed countries in the world and to have the problems we have is just plain negligence, It is the reason why we are losing our welfare state and our other vital public services, and it’s clear evidence that the government is not listening to and does not represent the people of the UK.

3There is also the divisive subject of national defense, in particular Trident. Now I totally understand the need to defend your nation’s borders against external threats, but you have to ask if nuclear weapons are really the way to go. Mr. Cameron has gone on record as saying that he would have no problem pushing the button, and that Jeremy Corbyn’s refusal to commit to such a stance undermines national security. Be in no doubt, this is scaremongering at it’s best. Firstly, if David Cameron were to press that big red button first he would be nothing more than a highly paid murderer. Secondly if the Trident missiles were to be launched in retaliation it would not have been that much of a deterrent in the first place. We are constantly told that the biggest threat to our national security right now (current Labour leader excepted) is So Called Islamic State. They don’t have nuclear weapons, they have propaganda, ideology. There is more chance of an IS member already in this country getting in to the Trident system to launch the missiles on our own soil than there is of us needing to fire them off to Syria, Iraq or any other middle eastern country our government has a vested interest in. It makes no sense. Trident isn’t a nuclear deterrent, it’s a political one – something our government can shake to make themselves look big in front of other countries.

5It’s the same argument as in America – calls are growing louder for stricter gun controls because of multiple mass shootings this year alone, yet the trigger happy faithful believe such a move will strip them of any defense against ‘the enemy’, constantly invoking their second amendment right to carry fire arms – an amendment that was invoked in 1791 when muskets were the weapon of choice, not semi-automatic rifles. Times have changed, war has changed. I wish I could say war will stop one day, but I can’t honestly say that, simply because we’re so damn good at it. We always find an excuse to pick a fight, and as we all know, nothing drives the economy faster than war. So why would we stop? The way war is fought has changed – much more divisive, much more guerrilla-like than ‘the good old days’ of the Cold War. Trident is irrelevant. Even military spokesmen have said this, saying that funds would have greater effect being used on weapons and equipment for soldiers on the front line, the ones in all the conflicts we have our feet in around the world. We sit here and berate the Americans for their stupid, antiquated, 200-year old guns laws, and yet we have exactly the same problem here with Trident. The governments priorities are totally out of touch with those of the people.
wpid-img_20151007_175119.jpgDavid Cameron’s legacy will speak for itself when the political dust has settled around his tenure as Prime Minister. The facts above will break through the spin and innuendo that this Conservative government relies so heavily upon, but by that time it will be too late. Austerity will have pummeled those already in financial hardship. Our hospitals will be run by profit hungry conglomerates rather than care providing doctors and nurses. Our children will be packed in a hundred to a room because of the 50% reduction of teaching staff.

One of my favourite phrases is this: “The needs of the many outweigh the needs of the few”. So what if it’s from Star Trek that’s how it should be. For so many people that’s how it is. You only need to look at the public reaction to the plight of the Syrian refugees to know that in spite of our own problems, when there are others in trouble we step up to help. Even if it’s just to give a terrified kid a stuffed toy, we step up. Sadly, there is the minority who thrive on secrets, lies, under-hand trade deals and ill-gotten gains. Mr. Cameron and his government has taken that powerful line and changed it to something far more sinister, but appropriate for their view of this world – “The wants of the few outweigh the needs of the many”. Maybe that should be the real New Conservative logo. At least then we’d really know where we stand.