I’m working at the moment on the Unite (Amicus Section) response to the London Darzi proposals. One of the interesting little details is the huge attack on the working patterns of health workers – something that has gone almost unremarked.
Health workers have always accepted that they will work unsocial hours when there’s a clinical need to do so. Hospital in-patients very obviously need care 24 hours a day. Hospitals can’t be closed down so that all the staff can go home.
However, most healthcare isn’t hospital-based – it’s ‘primary care’. That means appointments in a community setting with GPs, practice nurses, health visitors, district nurses, physiotherapists, speech and language therapists and so on. Primary care appointments account for about 80% of healthcare contacts. GPs and practice nurses will offer early evening appointments, but most primary care staff work pretty much a standard day.
The plan is that all of this primary care (and a load of the outpatients appointments now offered in hospitals) will be shifted to big primary care ‘factories’ called polyclinics. There are a lot of problems with these, around access, privatisation, the closure and running down of hospitals and so on (which I’ll cover more fully another time).
The shift to unsocial working hours is a big deal, though. All polyclinics will open between 18 and 24 hours a day, 7 days a week – with all the implications for support staff and clinical staff that go with that. All community services will be offered for a minimum of 12 hours a day, 7 days a week. ‘Interactive health information services including healthy living classes’ are, rather oddly, required to be available 18 to 24 hours a day. Who actually wants to attend a healthy living class at midnight or 6am? Maybe all the other health workers who are being made ill by their appalling working hours!
Darzi even talks about 40 hours being the standard working week! So much for the idea of reducing from the AfC 37.5 to 35 hours in the next pay round.
There isn’t a clinical need for this. This is about meeting the demands of the CBI that virtually no one can take time off work to attend a medical appointment. This is not in the interests of health workers – or the people who access primary healthcare.
This represents a significant attack. Our unions have got to be proactive in opposing this.
The relevant page from Darzi’s report is available here: Darzi London Report – “Polyclinic” opening hours.