Growing pains: Cameron must compromise with NHS workers to deliver seven-day healthcare

David Cameron spent some of his Sunday morning at a doctors’s surgery – symbolically rather than clinically. He feels that, following its election victory, his Government has a mandate to introduce seven-day healthcare. While that may be overstating the detailed attention voters devoted to his manifesto, it is certainly a popular idea.

Many surveys have indicated reduced levels of care for patients taken ill at weekends or in the evenings. Common sense, and painful experience, tells us that sickness can strike at any time, and that prompt diagnosis and treatment can almost pay for itself.

In virtually every other area of life – shopping, public transport, banking – old restrictions are falling away as consumers demand better services. Seven-day, 24-hour access to proper healthcare is clearly something the Government should pursue. Mr Cameron yesterday confirmed that he would press on with “voluntary” new GP contracts, as well as new arrangements for junior hospital doctors and consultants. What’s not to like?

Well, for those having to deliver those services, quite a lot. If we are not to merely spread resources more thinly across the NHS, it does require quite a radical alteration in working patterns and increased productivity. In his important interview with this newspaper on 3 October, the Health Secretary, Jeremy Hunt, pledged that no junior doctor would lose income as a result of these reforms. Fine; but what about their hours?

Whether Mr Hunt’s willingness to negotiate will prevent a national strike is not yet clear. Across the various royal colleges and the British Medical Association there exists an adamantine determination to protect their members’ interests, just as there is in Unison and the other unions.

Mr Cameron and Mr Hunt, then, face an uncomfortable set of options. They could, as Labour did before them, increase taxes or National Insurance to raise the funds to pay for these reforms, either by stealth or by earmarking higher NI payments. Plainly, that is something that runs against traditional Tory instincts and the party’s ambition for a “higher pay, lower tax, lower welfare” society. What is more, one of the great dirty secrets of British politics is that the public, for all of the professed devotion to the NHS, will simply not pay much more in taxes to improve it; this was one reason why Gordon Brown increasingly turned to borrowing and the private-finance initiative to support New Labour’s salvation of the NHS. Nor will winning the consent of all those doctors and nurses be easy. If the Government is to deliver on its promises it will have to conduct with health professionals much more realistically, and recognise the astonishing personal sacrifices so many make to keep the NHS running.

Despite all the scandals and propaganda in the press about a “failing” NHS, reports of the NHS from the public are overwhelmingly positive; on the whole, world-class care and expertise is available to all. By the same token, however, those working in the NHS have to pay heed to the limits to funding and the difficulty any government faces in keeping up with rising expectations from the service. Up to now, there hasn’t been much of a meeting of minds.

Mr Hunt has a formidable task in trying to reform working practices and modernise services. So far, he has managed to do so without either major industrial action or turning the issue “toxic” for the Tories. But the mood of militancy is growing, and a clash between government and medical professionals seems inevitable. Who will the public support then?