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.

Click to expand...

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.

Click to expand...

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.

Click to expand...

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.”.

Click to expand...

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. 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.

Click to expand...