Emails show Jeremy Hunt’s Department of Health 'colluded' with ‘independent’ body to impose junior doctor contracts

Jeremy Hunt and senior officials at the Department of Health “colluded” with a supposedly independent body responsible for billions of pounds in NHS funding to “bully” hospitals into imposing the controversial junior doctors’ contract, The Independent can reveal.

Internal emails seen by The Independent show Jeremy Hunt and his officials collaborated with Health Education England (HEE), which provides trusts with some £3.65bn every year.

HEE is supposed to be kept “at arm’s length” from the Department of Health but the emails, obtained under Freedom of Information law, reveal not only that Whitehall officials helped draft the body’s approach to contracts, but also that Mr Hunt himself was “personally managing the message”.

Campaigners argue that once trusts saw that the body providing so much of their income was behind Mr Hunt, they had little choice but to agree to implement his contracts.

It is the latest twist in Mr Hunt’s long-running drive to ensure new junior doctor contracts are implemented, which saw the minister fight off a High Court challenge brought by campaigners claiming he had compelled NHS employers to impose them.

Co-founder of Justice for Health Dr Ben White, who brought the case, said the emails shed new light on the matter and that the messages suggested HEE, with its hands on NHS pursestrings, had acted as an “enforcer” for Mr Hunt, leading to hospitals feeling bullied into accepting the proposals.

He told The Independent: “HEE is supposed to be an independent body responsible for the teaching and training of health care staff. Instead, this unaccountable body demonstrates collusion with the DoH to bully hospitals into imposing Hunt’s toxic contract.

“It has been shown Hunt has no power to impose this against the will of staff, therefore HEE is effectively the enforcer of Hunt’s botched settlement.”

He added: “HEE commands the future of doctors’ livelihoods, with the power to give and take away the right to become a consultant. They are therefore the NHS body with ultimate power over a junior doctor’s long term training.”

The organisation provides £3.65bn worth of funding to 429 trusts across the country and many NHS trusts are reliant on the cash.

In a letter sent from HEE chief executive, Professor Ian Cumming, to all NHS trusts, the organisation endorsed the junior doctors’ contract proposal and emphasised “the importance of the consistent implementation of the new junior doctor contract across the service”.

Several emails sent on 15 February showed drafts of the letter were sent to and from senior officials at HEE to Giles Denham, the then Director of Workforce at the Department of Health, for consideration.

One email, sent to Mr Denham from Lee Whitehead, Director of People and Communications at HEE, says: “Ian [Cumming] tells me that changes are being made to the draft, can you keep me in the loop on his behalf please?”

This is followed up with Mr Denham sending a “combined draft” of the letter to employees at HEE.

Meanwhile another email, sent on the same day, from Prof Cumming to Mr Whitehead, shows Mr Hunt’s direct involvement.

It says: “SoS (Secretary of State) wants this [the letter] in draft by 15:00”.

There is already anecdotal evidence from around the country that the relationship between HEE and trusts has proved critical to Mr Hunt’s efforts to push the contract through.

David Loughton, chief executive of Royal Wolverhampton NHS Trust, has claimed that although trusts around the UK wanted to walk away from the junior doctors’ contract it was not possible due to the need to manage relations with HEE.

He argued that “there is no question of us ignoring the Secretary of State as the contract will be imposed through HEE”.

Meanwhile Benjamin Tankel, the junior barrister representing Justice for Health, went further, telling the The Independent that the story exposed flaws in the transparency of NHS governance.

He said: “These documents show that DoH – including the Secretary of State personally – was very closely managing the message that HEE, a supposedly independent organisation, was sending out about the junior doctors’ contract.

“The NHS is a very complicated organisation. Its decisions are often taken in a fragmented way across different legal entities, which creates worrying gaps in accountability.

“This is a problem not only for junior doctors but for patients as well, because there will be many situations in which no one body is responsible when things go wrong.”

However, Prof Cumming played down the significance of the discussions between his organisation and the DoH, telling The Independent they were little more than a “common courtesy”.

He added: “The letter sent to trust chief executives from HEE set out our belief that a robust, high-quality education and training system which has 50,000 doctors working in 70 specialties for over 350 different employers rotating through different specialties and employers on a regular basis requires a single, basic set of terms and conditions that apply across all employers.

“The BMA and NHS Employers agree with this which is why they support national bargaining for doctors. Introducing competition based on salary, rest periods, working hours, rotas and any number of other criteria into an already complex system would be worse for the NHS, worse for patients and worse for doctors in training, making the whole education and training system for doctors, which the NHS leads the world in, almost impossible to deliver.

“We, as a national arm’s-length body of the DoH, of course ensured we discussed this issue with colleagues in the DoH and other arm’s-length bodies before writing to all NHS trusts. This is common courtesy.”

A Department of Health spokesperson said: “Patients would expect the Government to work closely with its agencies and arms’-length bodies and it is right that HEE expressed its independent view in order to ensure the smooth implementation of the junior doctors’ contract.”