Someone has to significantly rethink their position if we are to avoid undermining patient care by letting this saga rumble on.
Tuesday 5 July 2016 18.14 BST
For the second time in recent history voters in a referendum have been stirred to anger by politicians’ unhelpful, often inflammatory rhetoric and responded with a sharp kick in the shins for the establishment. Except this time the electorate was 54,000 NHS junior doctors in England and their fury was a rejection of Jeremy Hunt’s claims about their long-running dispute with him, not an endorsement of his highly questionable tactics.
That rage is a key factor in explaining the junior doctors rejection, by 58% to 42% on a 68% turnout, of the new contract that the health secretary – and their own union, the British Medical Association – had wanted them to accept. Dr Johann Malawana, leader of the BMA’s junior doctors committee (JDC), has quit, having failed to persuade his grassroots members to share his own pragmatic view that they should accept the deal as imperfect but the best they would get.
In the end there was no silent majority, weary after eight days of strikes, who voted yes just to put the dispute behind them. More than 130 BMA roadshows around England in recent weeks failed to win over the doubters. Large numbers of trainee medics remained unhappy with what was on offer and followed their instincts, ignoring the advice of their leader, their union and senior doctors, one of whom described acceptance as “the lesser of two evils”.
Blaming Hunt for their rejection is too simple. But his armoury of threats, macho language (“nuclear option” etc), depiction of junior doctor leaders as militant wreckers and portrayal of the BMA as liars – and especially his dangerously selective choice of evidence about death rates among patients admitted to hospital at the weekend – proved continuously and ultimately counterproductive. He alienated when he should have wooed, bludgeoned when he should have caressed. His disregard for his impact on young doctors’ morale and career intentions was reckless, to say the least. England’s loss will be Australia’s – and Scotland’s – gain.
But the crucial reason junior doctors voted no was the government’s pledge of a seven-day NHS, and Hunt’s insistence that they accept radically changed terms and conditions as the first major step towards delivering it. Junior doctors didn’t reject the concept or goal of a seven-day health service – hardly, given most of them already work across the whole week. But they did refuse to endorse a government plan that envisages an understaffed service already struggling to provide quality care across five weekdays being somehow stretched to do the same on Saturdays and Sundays, despite receiving no more money or extra staff to underpin such a big expansion.
The BMA’s tactics also merit scrutiny. It allowed the key sticking point in the first (failed) round of negotiations to be pay for Saturday shifts, said that routine Saturday working was a red line it would never accept, then agreed in the second, apparently successful, round of talks that all of the weekend could become normal workdays in return for an increase of up to 10% in basic pay. Many junior doctors looked at the final package on offer, thought “is that all we’ve achieved after striking eight times?” and decided it was simply not enough.
It is telling that Hunt, who had threatened to impose whatever version of the contract he wanted if doctors rejected the final offer, has not repeated that vow since the 58:42 split was announced. With politics in such flux, and NHS understaffing an increasingly visible problem, a cessation of hostilities would help everyone. [Update: Jeremy Hunt has now repeated that vow]Looking ahead, might Brexit’s likely reduction of the number of EU medics working in the NHS prompt ministers – maybe in the post-Cameron government; maybe the new health secretary – to review the wisdom of a contract that would lead even more expensively trained, hardworking juniors to practice elsewhere, admit that mistakes have been made and extend a belated olive branch? Someone has to significantly rethink their position if we are to avoid undermining patient care by enfeebling the NHS in letting this destructive saga rumble on any longer