Plans for seven-day GPs not thought out, says spending watchdog

Whitehall’s spending watchdog has criticised government plans to let patients see GPs every day of the week as poorly planned and likely to cost much more than weekday family doctor services.

In a new report, the National Audit Office said that Jeremy Hunt has set targets for rolling out the scheme – a key Conservative pledge – without evaluating the cost or working out where the money for it would come from.

Giving patients access to GPs from 8am to 8pm across the entire week by 2020 was championed by David Cameron while he was prime minister. Ministers also pledged to increase the number of GPs in England by 5,000 by 2020 – promises that have been backed by Hunt and Theresa May .

However, auditors who analysed the pledges found that the minimum additional capacity required by the new commitment equates to £230 per appointment hour at weekends and in the evening for every 1,000 registered patients. In GPs’ core contracted hours, from 8am to 6.30pm, the cost is just £154.

Hunt and the prime minister are under increasing pressure regarding serious problems within frontline services this winter. Ministers have been forced to deny claims by the Red Cross that the service is facing a “humanitarian disaster”.

Dr Chaand Nagpaul, BMA GP committee chair, said the government had been “irresponsible” in making uncosted pledges and must deliver extra investment to ensure patients could receive timely, safe care.

“Given that funding in general practice has failed to meet patient demand, NHS England and commissioners need to fully consider the consequences of their plans to extend access,” he said.

“To proceed without any sort of evaluation into the cost-effectiveness or the consequences of its objectives is irresponsible and could lead to much needed investment being spent on measures which don’t adequately meet patient needs,” he said.

The report, entitled Improving Patient Access, set out to evaluate how the Department of Health (DoH) and the NHS are tackling concerns around access to England’s 42,000 GPs in 7,600 GP practices.

The report found an apparent lack of knowledge within the DoH about the cost of extending GP surgery hours.

“We have not seen evidence that the department and NHS England fully understand the effect of this commitment to extend hours on continuity of care or other arrangements for providing general medical services outside of core hours,” it said.

Auditors, keen to establish the reality of extending opening hours, found that nearly half of all GP practices – 46% – close during core working hours, while 18% closed before 3pm one day a week.

Efforts to increase the workforce are at risk because GPs are leaving the service at a greater rate than they are entering it, thanks to shortfalls in recruitment, the report said.

Health Education England only filled 3,019 (93%) out of a target of 3,250 GP training places in 2016/17, according to auditors.

“The latest available data on part-time working in new GPs suggest there may be 1,900 fewer full-time equivalent GPs by 2020 than Health Education England had estimated there would be,” the report said.

The report sheds light on how patients registered with GP services open for fewer hours than average are more likely to attend accident and emergency departments. It found there were 22 more A&E attendances per 1,000 registered patients [8%] at practices open for 45 hours or less per week, after adjusting for differences in patients’ age and sex.

Meg Hillier MP, the chair of the public accounts committee, claimed that ministers were “trying to shoehorn in seven day access to general practice without a clear idea of the additional costs or benefits it will bring patients or taxpayers”.

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said the report “hits the nail on the head” by questioning the cost-effectiveness of forcing GP surgeries to deliver routine services seven days a week.

However, she went on to question why auditors failed to acknowledge the stresses that GPs are under or why surgeries may have to close temporarily during core hours for staff training, patient consultations or home visits.

“If general practice fails, the rest of the NHS collapses behind it. That’s why we urgently need NHS England to deliver in full on the pledges it has promised … swiftly and effectively, and for all governments in the UK to invest properly in the family doctor service, including more GPs,” she said.

The government claims that 17 million patients are already benefiting from evening and weekend appointments.

In response to the report, the health minister David Mowat said evidence shows that extended GP access is helping to relieve pressure on other parts of the health service such as A&E.

“We’re also relieving pressure on GPs by cutting red tape and investing an extra 2.4 bn to recruit 5,000 more doctors – in fact, fill rates for GP training this year were at a record level,” he said.

An NHS England spokesman criticised the NAO report for raising “the rather obvious fact” that it costs more to provide evening and weekend urgent primary care services than it does during Monday to Friday, nine to five.

“The alternative would be that patients simply head to A&E, with all the consequences that brings for more major cases.

“No one is suggesting each individual GP practice should offer this extended access, but there’s quite wide agreement that, as GP numbers expand, practices do need to club together to offer this service, a bit like the out-of-hours duty chemist rota.

“Across much of London, Manchester and a fifth of the country, GPs are already doing this, and more areas will follow next year,” he said.

Plans for seven-day GPs not thought out, says spending watchdog

Seven-day NHS plan puts weekday surgeries at risk, warns top GP

Britain’s top GP has said surgeries will have to stop seeing patients during the week unless ministers abandon their drive to guarantee access to family doctors at weekends.

Dr Helen Stokes-Lampard condemned the policy, a key Conservative pledge, as unrealistic and said it was ignoring the lack of demand among patients to see GPs at weekends and a serious shortage of family doctors.

The government has promised to ensure that people in every part of England will be able to see a GP from 8am to 8pm every day of the week by 2020 as a key element of its push to create a “truly seven-day NHS” by the end of the current parliament.

“It’s unrealistic in the current climate. We haven’t got the people, we haven’t got the resources. If you give people access on a Sunday afternoon they’re not going to have access on a Tuesday morning. They can’t have it all”, the chair of the Royal College of GPs said in an interview.

Calling for surgeries weekend opening to be restricted to Saturday mornings, Stokes-Lampard said: “We should be responding to what is needed in an area, and balance that realistically by what can be provided safely. Because quite frankly if you open on a Sunday afternoon but you’re closed on a Tuesday morning, who’s going to benefit?.

There is so little demand from patients to see a GP on Sundays that plans to compel at least one surgery in each area to open on that day by 2020 should be dropped, she said. Nor do many people want to attend a surgery on a Saturday afternoon, she added.

David Cameron pledged access to GPs from 8am to 8pm seven days a week at the Conservative party conference in 2014, and established a £50m “challenge fund” to deliver it. Some surgeries that have begun opening at weekends, however, have scrapped their experiment because of the small numbers of patients seeking appointments on Saturdays and Sundays.

The chair of the Royal College of GPs, Dr Helen Stokes-Lampard. Photograph: Andy Hall for the Observer

A relentless rise in the need for care is prompting more GPs to retire early or move abroad, leaving the profession facing a growing workforce crisis and patients facing long waits for appointments, Stokes-Lampard said. As a result “we’re layered too thin at the moment, we’re spread too thin. We can’t sustain a good five-day service at the moment, a seven-day service is unrealistic. If we can’t provide eight to six Monday to Friday because we’re stretched to breaking point, we’re certainly not going to be able to provide seven days a week.”

She said general practice was “closer to the edge than it has ever been in living memory”, and cast serious doubt on ministers being able to fulfil another key NHS pledge – to increase the number of GPs in England by 5,000 by 2020 compared with 2015. It will be very hard to deliver that number without many GPs coming from overseas or former doctors being persuaded back into work, she said.

The Liberal Democrat MP Norman Lamb, who was a coalition health minister until May 2015, denounced the pledge of access to GPs all day and every day as a “superficially attractive gimmick”.

“This target is driven by seductive headlines, not sound policy. It will distort priorities and resources away from action which could make a real difference to people’s lives, such as ensuring that people have both their physical and mental health needs effectively met in primary care,” he said.

“No one believes that there will be sufficient resources to deliver this plan. The risk is that it will leave dangerous gaps in provision during the week.

“Pursuing superficially attractive gimmicks like this amounts to a smokescreen for the dire threat the NHS and care system now faces as it is starved of the resources it needs to provide effective, prompt and safe care.”

The shadow health secretary, Jonathan Ashworth, said: “These serious doubts about a flagship government pledge will raise widespread concerns. It’s yet another warning about the scale of the underfunding and understaffing now impacting our NHS.

“In her six months as prime minister Theresa May has shown no regard for the state of the NHS, so it’s no surprise it now looks like her own manifesto commitments will be broken.

“But in 2017 the government simply must not carry on ignoring the warnings. Instead they need to come forward with a genuine plan to give the NHS and social care the resources they need to deliver the very best care every patient deserves.”

The Department of Health insisted the government would achieve its ambition of seven-day opening, and that the policy was popular. “This is a common sense reform with wide public support, and one we will deliver”, a spokeswoman said.

“People don’t just get ill Monday to Friday, nine to five, and 18 million patients now have weekend and extended access to a GP, which has already shown evidence of relieving pressure on other parts of the NHS.

“To deliver our pledge, we are putting an extra £2.4bn into GP services, which will help expand the workforce.”

Seven-day NHS plan puts weekday surgeries at risk, warns top GP

Seven-day working for GPs costs more and doesn’t get results | Zara Aziz

My practice started offering Saturday morning GP appointments as well as weekday slots from 8am. Previously, our surgery opened Monday to Friday from 8.30am to 6.30pm with some evening appointments until 7.30pm. The Saturday slots are now offered as part of a group of local practices (on a rota basis) to all patients across the practices for routine pre-bookable appointments. There are many such pilots across the country – which started in 2013 as part of the then prime minister’s £50m challenge fund. Some, such as those in Greater Manchester, offered Saturday and Sunday urgent and routine appointments in addition to extended weekday access. Others, like ours, offer additional weekday and Saturday morning access for routine appointments only. The government has committed to another year of extended access despite dubious benefits of the first wave.

The health secretary, Jeremy Hunt, has cited lack of GP services as one of the reasons for A&E and acute admission pressures in hospitals. Indeed, studies have shown that seven-day GP access reduces attendances at A&E for minor illnesses but has little impact on emergency hospital attendances for serious medical conditions.

A recent study from Greater Manchester showed that providing extended seven-day GP access to patients across 56 practices reduced A&E attendances for minor ailments by 26% (in comparison to 469 practices that provided routine access). This equated to savings of £767,867 through reduced A&E visits – however, this extended GP access scheme cost around £3.1m, which included evening appointments until 9pm on weekdays and both Saturdays and Sundays (across a range of times). But hospital visits for minor ailments form only a proportion of total A&E visits – this study showed that extending GP access led to only a small reduction of 3.1% in total A&E visits. So overall, the scheme cost three times more than it made in savings.

There has also been further evaluation of the impact of seven-day access on medical admissions of elderly patients at weekends. In central London seven-day GP cover cut weekend A&E visits by 18% and weekend hospital admissions fell by 9.9% (mainly in elderly patients). But there have been many more disappointing outcomes from the extended access schemes with many areas discontinuing the pilots early or cutting their hours.

In areas where extended opening hours are only offering routine appointments, like ours, cost-savings through reduced A&E attendances or emergency admissions is even more questionable since we are not seeing urgent or acute problems – it is the latter group of patients who are more likely to go to out-of-hours services or to A&E.  

Nevertheless, NHS England has used some of this early data to extend the seven-day GP access services. In 2015-16, it invested £100m. At a time when both primary and secondary care is seeing unprecedented budget cuts and rationing of “unnecessary” or even routine services, it makes little sense to waste money on weekend opening .

The cost per total extended hour is up to £280, with practices needing to cover premises’ costs and reception, nurse and GP hours. Staffing these hours has been especially problematic for some areas that do not have enough GPs. Within my own practice, there is little appetite to work more. Until a few years ago I used to work GP out-of-hours sessions until it became difficult to manage these with a young family. As a partner in the hub of practices, I am doing the Saturday morning sessions. The 12 slots are booked by a mix of people, some of whom could come during the week.

Expensive extended access is not likely to be sustainable, and my concern is where is this money likely to be diverted from? And should we not put it to the public to decide whether they would like seven-day provision or improved access within existing GP hours?

Evidence suggests that improved access within existing, standard hours leads to a more effective way of reducing patients’ use of out-of-hours services than extending opening times. But this requires more GPs and more rooms to put them in. and better signposting so patients can see nurses, pharmacies and health care assistants rather than only a GP. It makes no sense to run services on a shoestring during the week, offering limited appointments to patients – because you are spreading staff thinly across the week. We should be offering more daytime appointments. This requires a commitment from the government to help primary care tackle its workload and funding crises, rather than persisting with its obsession of seven-day working.

Seven-day working for GPs costs more and doesn’t get results | Zara Aziz

Jeremy Hunt cannot bully his seven-day NHS plans through

The Guardian’s revelation of the Department of Health’s analysis of the risks around seven-day working exposes how a highly political health secretary is meeting his nemesis in the hard graft of policy implementation.

There is nothing remarkable about the existence of a risk register; identifying a range of potentially serious problems is standard practice for any government policy. What is striking is that 13 major risks are rated red or red/amber – meaning they are very likely or likely to occur.

Translating Whitehall-speak into plain English, the document tells us that ministers are not sure what they are trying to achieve, that in all likelihood seven-day working will make little difference to hospital services, that there is little agreement on how it should be delivered, plans that do exist are of poor quality, and there are not enough NHS staff in place to make it all happen.

In short, this is a policy – and a health secretary – in crisis. Jeremy Hunt has been trying to batter seven-day working through by winning the propaganda war with the junior doctors over the introduction of new contracts, and doing so by misrepresenting the evidence. Listening to Hunt, the casual observer would assume that the only thing standing between today’s NHS and effective seven-day working is changing doctors’ shift patterns. This document reveals far more serious obstacles.

It is obvious that Hunt is ignoring advice from his civil servants on the most fundamental aspects of delivering a massive and complex policy. The document states baldly that “the objectives and scope are not fully agreed upon, but delivery has started”. In other words, Hunt has been willing to risk strikes by doctors without being clear what he is trying to achieve.

It appears he has not even established a clear position with Downing Street; the risk that the policy does not meet the expectations of No 10 is rated red – an extraordinary position for such a controversial course of action.

Perhaps the most damning revelation is that Department of Health civil servants endorse one of the major criticisms of Hunt’s seven-day working push – that there are simply not enough staff with the right skills to do it. Again, this risk is rated red. Even with generous funding, the timescales around NHS workforce recruitment, training and deployment are such that it would take years for full seven-day working to be implemented, yet Hunt persists in creating the impression that the only obstacle is the lack of will among NHS staff to do it.

Hunt has also ignored civil service advice on how he has pitched the case for seven-day working to the public. In another document obtained by the Guardian and Channel 4, officials have told him that his repeated allegation of patient safety failings at weekends “has not been helpful”. They have been pushing him to explain the benefits for patients, pointing out that attempting to play on fears of medical accidents is not winning public support.

In his early months as health secretary Hunt demonstrated the skills of a political Houdini. The coalition government had been under fire for months over Andrew Lansley’s botched health reforms, but his replacement was able to distract the public’s attention from the chaotic and expensive changes and take the fight over the NHS to Labour by using the Mid Staffordshire scandal to shift the spotlight to quality and safety.

But eventually, rhetorical flourishes have to give way to the long-haul of planning and implementing change, and this is where Hunt’s tenure as health secretary is starting to unravel. Having scored a success by picking a fight with Labour over Mid Staffs he believed he could chalk up another victory by winning a confrontation with the British Medical Association.

But his officials are trying to tell him that changing the junior doctors’ contract is just a small part of implementing seven-day working across the NHS. Hunt needs to listen to civil service advice by reframing the policy around the benefits for patients, being clear on the objectives, adopting a realistic timescale for implementation and above all securing adequate funding. It is simply not possible to bully this policy through.

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Jeremy Hunt cannot bully his seven-day NHS plans through

Seven-day NHS: Labour demands inquiry as leak reveals crisis warning

Labour is demanding an inquiry into revelations that senior civil servants fear the government’s push for a “truly seven-day NHS” may be derailed because it faces staffing and money problems.

Tom Watson, the party’s deputy leader, claimed that leaked Department of Health documents obtained by the Guardian and Channel Four News showed Jeremy Hunt had misled the public by pushing ahead with expanding the NHS in England despite his own mandarins’ concerns.

“Leaked secret papers show that junior doctors’ concerns were right. This warrants an inquiry. Hunt misled the public,” Watson tweeted in response to the disclosures, which have prompted renewed scrutiny of a policy that the Conservatives have pledged to deliver in full by 2020.

Senior Tories have responded to the publication of the department’s own risk assessment of the seven-day plan and other papers by making clear that they share the civil servants’ previously private worries.

Dr Dan Poulter MP – who until last year was a health minister alongside Hunt and is also an NHS doctor – tweeted his view that the documents constituted “a warning of the dangers of putting soundbites ahead of properly costed and resourced plans for our NHS”.

Dr Sarah Wollaston MP, the ex-GP who chairs the influential Commons health select committee, tweeted: “Cannot keep piling ever greater responsibilities on to an overstretched service without realistic resource and workforce to cope.”

In a swipe at Hunt she added: “Expect problems when thin evidence is used to bolster an under-resourced political objective instead of policy following the evidence.”

Diane Abbott, the shadow health secretary, said: “This is a scandal. The government is undermining the NHS with plans it knew to be unworkable. I will be writing to Jeremy Hunt to ask him to explain why [he] has contravened his civil servants’ advice and to ascertain whether he has misled parliament.”

Professor Jane Dacre, the president of the Royal College of Physicians, also warned that the drive to expand medical services at weekends was unrealistic because of the NHS’s worsening shortage of doctors, which is leading to more and more gaps in rotas and expensive use of locum medics.

“At the moment we are struggling to deliver care over five days, so to extend that to seven days and expect doctors to be able to provide high quality of care is not realistic. Doctors are working hard and they want to do the best they can for patients, but it is difficult to deliver the quality of care needed seven days a week without extra people to deliver it”, she told C4 News.

“There are just not enough doctors available to run a seven-day service at the moment. We all want to provide better patient care but to provide a seven-day service in our hospitals we need more doctors, and probably more nurses too. We also need pharmacists, occupational therapists and physiotherapists working at weekends as well.”

Hunt has made clear he expects the NHS to fund the expansion of services that he wants by 2020 from within the £10bn rise in its budget it will receive by then.

However, health experts such as Nigel Edwards, chief executive of the Nuffield Trust think-tank, have made clear that with the £10bn only bringing a 0.9% annual increase in NHS funding, the entire amount will be needed to help the service cope with growing pressures, and it will not cover the costs of having more doctors on duty in hospitals and GP surgeries by the end of this parliament.

Seven-day NHS: Labour demands inquiry as leak reveals crisis warning

Secret documents reveal official concerns over "seven-day NHS" plans

The health service has too few staff and too little money to deliver the government’s promised “truly seven-day NHS” on time and patients may not notice any difference even if it happens, leaked Department of Health documents reveal.

Confidential internal DH papers drawn up for Jeremy Hunt and other ministers in late July show that senior civil servants trying to deliver what was a totemic Conservative pledge in last year’s general election have uncovered 13 major “risks” to it.

While Hunt has been insisting that the NHS reorganise around seven-day working, the documents show civil servants listing a string of dangers in implementing the plan – as summarised by a secret “risk register” of the controversial proposal that has prompted a bitter industrial dispute with junior doctors.

The biggest danger, the officials said, is “workforce overload” – a lack of available GPs, hospital consultants and other health professionals “meaning the full service cannot be delivered”, they say in documents that have been obtained by the Guardian and Channel 4 News.

The risk register and other documents also show that the DH sees the NHS’s 1.5 million staff, especially doctors, as a “barrier” to the high-profile but controversial ambition of increasing patients’ access to hospitals and GP surgeries at weekends “because they do not believe in the case for change”.

Hunt has angered hospital consultants and junior doctors over the last year by ordering them to work more at weekends in order to help deliver the seven-day goal, even though both groups are often on duty on Saturday and Sunday.

Juniors have held eight days of strikes to protest against a new contract Hunt is imposing on them which they claim ignores the need for extra doctors to enable the expansion of care he wants – a claim that the BMA said was vindicated by the documents.

Dr Mark Porter, leader of the British Medical Association, said the papers proved that government had ignored warnings from healthcare organisations, especially that a lack of extra staff and more funding would hinder progress. That it has also “disregarded its own risk assessment’s warnings about the lack of staffing and funding needed to deliver further seven-day services, is both alarming and incredibly disappointing”, he added.

He also seized on the DH’s admission in the documents that it still has not worked out what No 10’s objectives were. In pushing ahead with implementing the plan, Porter said: “[It] only goes to show that this was nothing more than a headline-grabbing soundbite set to win votes rather than improve care for patients.”

Shortly after the May 2015 election, David Cameron, the then prime minister, made a speech in which he referred on 18 separate occasions to his “plan” for a seven-day NHS. Fourteen months later, the BMA added, that the documents show that there was still a painful lack of detail.

The papers also show that senior officials at the Department of Health:

• Fear the seven day plan might fail to deliver its stated aims, which include improving the quality of hospital care at weekends and reducing death rates among those admitted for treatment as an emergency on Saturday or Sunday. “It is possible that the programme delivers the planned outputs, but this does not result in the desired change (delivering against the plan but missing the point),” one states.

• Voice concern that there is also a risk that even if weekend services are successfully enhanced, that “patients do not report any difference/improvement in their experience [of] out of hours and at the weekend”.

• Worry that Britain’s decision on 23 June to leave the European Union “may adversing (sic) impact upon the delivery of the 7 Day Services programme, particularly with regards to workforce and finances” because the NHS employs 55,000 staff from around the EU.

A DH spokesman said: “Over the past six years eight independent studies have set out the evidence for a ‘weekend effect’ – unacceptable variation in care across the week. This government is the first to tackle this, with a commitment to a safer, seven day NHS for patients and£10bn to fund the NHS’s own plan for the future, alongside thousands of extra doctors and nurses on our wards.”

A department source added: “A risk register by definition details all potential issues under a worst-case scenario to help the government develop robust plans to ensure we meet our promises to the electorate, but we are confident our programme for a safer seven-day NHS is on track‎, and will deliver real benefits for patients.”

Hunt has persistently championed the idea of a seven-day NHS. On 25 April the health secretary told MPs of “the government’s determination to be the first country in the world to offer a proper patient-focused seven-day health service”. In that speech he specifically rejected “the concern that a seven-day NHS might spread resources too thinly”.

That was unfounded, Hunt said, because the government has increased doctor numbers by 10,100 since 2010 and would add a further 11,420 to the headcount by 2020.

The documents also show that privately some of Hunt’s most senior civil servants worry that the pledge to increase the NHS budget by £10bn by 2020-21 will not be enough to deliver the promised NHS expansion by 2020. The risk register notes that much of the £10bn will not reach the NHS until near the end of this parliament and thus not be immediately available to fund the changes. “This could result in ‘back loaded’ delivery increasing the risk that deadlines for completing roll-out [between now and 2020] are missed,” they say.

Several of the risks reveal damaging internal disagreements among those taking forward the seven-day drive, including over what the purpose of the plan is. That included tension between the DH and Downing Street in May when Cameron was still in power. In a section of the risk register headed “scope creep”, which was last reviewed on 10 May, it says: “The planned objectives and scope of the programme do not meet the expectations of No10/Cabinet Office, meaning that they may continue to change. This could lead to an inability to deliver the desired outcomes to the agreed timescales.”

Prof Chris Ham, the chief executive of the King’s Fund, rejected Hunt’s insistence that the £10bn was enough to deliver a seven-day NHS by 2020.

“It is not credible to argue that it can continue to meet rising demand for services, maintain standards of care and deliver new commitments such as seven-day services within its current budget,” he said. “Implementing seven-day services is a laudable ambition but is not realistic unless additional funding becomes available and workforce challenges can be overcome.”.

The shadow health secretary, Diane Abbott, said: “This is a shocking indictment of the Tory government’s plans. They pressed ahead with their proposals even when campaigners and NHS staff argued they were unworkable. It has now been confirmed by the advice the government received from its own civil servants.

“This is a scandal. The government is undermining the NHS with plans it knew to be unworkable.”

Abbott said she would be contacting Hunt to see if he had misled parliament.

Secret documents reveal official concerns over "seven-day NHS" plans

These leaks show Jeremy Hunt’s deception over the seven-day NHS | Rachel Clarke

It’s 4am. When your heart arrests and the emergency call goes out, what you really don’t want is a doctor whose first response to your crisis is a silent stream of expletives. You don’t want the person racing to your bedside to be so exhausted they can barely think straight. And you definitely don’t want them to be pumping your chest while wondering what to do with the patient pile-up threatening to overrun the unit from where they’ve just sprinted.

I don’t want those things either – but I’ve been that doctor and I’ve been that callous. I don’t know a single one of us who hasn’t. There’s an ugly truth about the NHS frontline right now that health secretary Jeremy Hunt would dearly love to airbrush away. We, the doctors and nurses at the sharp end, increasingly feel we are bearing witness to its slow, relentless disintegration. Daily, we are fighting against a breaking system and though for us that may be soul-destroying, for our patients – in so many different ways – it is potentially life-threatening.

The government would have you believe that not only is the NHS flourishing, but that it is being safely steered on its way to becoming the world’s first “truly seven-day” health service – an all-singing, all-dancing bonanza of unprecedented weekend care. Without any new doctors for these new weekend services. Or extra nurses. Or extra resources, in fact, of any kind.

But in private, as incendiary documents leaked to the Guardian and Channel 4 News now reveal, Hunt’s own department admits the lack of funds and staff for a seven-day NHS may derail the glib promises of last year’s general election manifesto. In its unpublished risk assessment of the seven-day policy, the Department of Health’s own working group admits that workforce overload means it may simply not be possible to find sufficient “skilled/trained staff” to safely deliver the new service. Worse, says the secret “7 Day Services Governance Group”, the objectives of this centrepiece of health policy, “are not fully agreed upon, but delivery has started”.

Imagine committing millions of pounds of precious NHS cash to a new service you know you lack the staff to run safely, and whose point – extraordinarily – you haven’t quite decided upon. Imagine the extra child mental health beds or groundbreaking new cancer drugs upon which you could be spending that money, had you not already committed to something so sketchy.

No one who actually works in the health service is remotely surprised the staff aren’t there: we can barely keep patients safe over five days, let alone seven. But for a doctor such as me, who could be hauled before the General Medical Council were I not to practise evidence-based medicine, this admission by the department that it doesn’t even know what it’s aiming for with the seven-day charade destroys Hunt’s efforts to portray himself as a patient safety champion.

My world is one of junior doctors squabbling to grab the last remaining space in which to see new patients, essentially a store cupboard with a couch squeezed inside; of trolleys deployed in corridors as de facto beds, flanked by foldaway screens that barely protect the patient’s dignity; of ambulances sitting idle outside the hospital, unable to deliver their blue-lighted occupants because A&E is crammed to bursting point.

On becoming a doctor, I was fully prepared for the blood, the gore, the death, the slog, but not – it turns out – for the shame of it. Increasingly, my eyes cannot meet those of the patients and relatives marooned under strip-lights, waiting and waiting to be seen. And it’s not just embarrassment. Head down, cheeks burning, I’m trying to avoid becoming the arbitrary target of an enraged family member who needs someone, anyone, upon whom to vent their spleen.

When Robert Francis published his report detailing the horrors patients endured in the now-defunct Mid-Staffordshire NHS Trust, the then prime minister, David Cameron, told a stunned parliament that the report was a “cry from the heart” for “quality, vocation, compassion” in our health service. Three years on, I can tell you that those values are being purged from the NHS by a government that has chosen, year on year, to shrink the share of GDP it spends on our health service. Overstretched doctors and nurses are as demoralised and exhausted as it is possible for a workforce to be. And what many of us now fear is Mid-Staffs writ large – this time on a national scale.

Only a politician who’s singularly out of touch – or driven by an ulterior motive – could possibly pretend the NHS is healthy. This year’s “winter” crisis has started in August. Doctor shortages are forcing A&Es to close. Whole populations in some parts of the country are being denied all but emergency care. My friends are quitting the profession they love in droves. Nurses on my ward are often in tears.

What many of us now fear is another mid-Staffs disaster writ large – this time on a national scale

As a junior doctor, the public exposure of the fatal vacuity of Hunt’s seven-day soundbite ought to make me feel vindicated. Instead, I feel sickened. For over a year, Hunt spun the line that our resistance to his new junior doctor contract was about nothing but grubby self-interest and our grasping obsession with Saturday “overtime”. The truth is, what prevents more doctors from working at weekends isn’t contractual limitations, it’s that there simply aren’t enough of us, and we’re already spread too thinly. We’d all love a seven-day NHS.

Hunt has refused to come clean on the multiple flaws and limitations of the policy he so fervently championed. Perhaps he thought Francis’s duty of candour didn’t apply to health secretaries.

To be perfectly candid, the NHS frontline these days is threadbare, scrappy, perilously understaffed and barely held together by legions of nurses, doctors and allied health professionals. I’m afraid there is no question of any of us being able to do more. I long for the government to choose honesty, not empty rhetoric – actions, not words – and inject the funding so desperately needed to give our health service a fighting chance of survival.

These leaks show Jeremy Hunt’s deception over the seven-day NHS | Rachel Clarke